J Relig Health

DOI 10.1007/s10943-016-0281-0

ORIGINAL PAPER

The Effect of Holy Qur’an Recitation on Depressive

Symptoms in Hemodialysis Patients: A Randomized
Clinical Trial

Hassan Babamohamadi1 • Nemat Sotodehasl2 •

Harold G. Koenig3,4 • Faten Al Zaben5 • Changiz Jahani6 •

Raheb Ghorbani7

Ó Springer Science+Business Media New York 2016

Abstract Patients with advanced renal failure often face considerable sociopsychological
stress as a result of lifestyle changes due to the disease and its treatment. The aim of the
present study is to examine the effect of the Holy Qur’an recitation on depressive symp-
toms in hemodialysis patients. In this clinical trial, 54 hemodialysis patients were ran-
domized to either an experimental (n = 27) or a control (n = 27) group. Patients
completed the Beck Depression Inventory-II (BDI-II) at baseline and at 1 month after the
intervention. Participants in the experimental group listened to recitation of the Holy
Qur’an, while those in the control group received no intervention. The mean BDI-II score
at baseline was 33.6 (±6.7) for the experimental group and 29.3 (±9.0) for the control
group; at the end of treatment, BDI-II scores in the experimental and control groups were
14.5 (±4.8) and 31.6 (±9.2), respectively. Results from the repeated-measures general
linear model controlling for baseline differences indicated a significant treatment effect
(F = 9.30, p = 0.004, Cohen’s d = 0.85). Holy Qur’an recitation has a significant effect

& Nemat Sotodehasl

Sotodeh1@yahoo.com
1
Nursing Care Research Center, Nursing Department, Faculty of Nursing and Allied Health, Semnan
University of Medical Sciences, 5 Kilometer of Damghan Road, Semnan 3513138111, Iran
2
Nursing Care Research Center, Faculty of Nursing and Allied Health, Semnan University of
Medical Sciences, 5 Kilometer of Damghan Road, Semnan 3513138111, Iran
3
Center for Spirituality, Theology, and Health, Duke University Medical Center, Box 3400, Busse
Building, Suite 0505, Durham, NC 27710, USA
4
King Abdulaziz University (KAU), Jeddah, Saudi Arabia
5
Psychiatry Department, King Abdulaziz University, PO Box 80200, Abdullah Sulayman Road,
Jeddah 21589, Saudi Arabia
6
Nursing Department, Nursing and Allied Health Faculty, Semnan University of Medical Sciences,
5 Kilometer of Damghan Road, Semnan 3513138111, Iran
7
Social Determinants of Health Research Center, Community Medicine Department, Faculty of
Medicine, Semnan University of Medical Sciences, 5 Kilometer of Damghan Road,
Semnan 3513138111, Iran

123
 J Relig Health

on lowering depressive symptoms in hemodialysis patients. Holy Qur’an recitation is an

easy-to-implement and cost-effective strategy that may be used to supplement the treat-
ment of depression in this setting in Iran.

Keywords Holy Qur’an recitation
Music
Depression
Hemodialysis
Iran

Background

End-stage renal disease (ESRD) involves an irreversible and progressive deterioration of

the kidneys causing physical and psychological consequences. The disease impairs the
body’s ability to maintain fluid and electrolyte balance leading to uremia or azotemia
(Gerogianni and Babatsikou 2014).
Although hemodialysis as the main treatment of ESRD increases longevity, it can also
lead to various psychological disorders such as depression, anxiety, and severe stress
(Feroze et al. 2010). Psychological disorders and depression in dialysis patients are often a
reaction to losing the ability to work and generate an income, reduced energy, decreased
sexual functioning, other limitations caused by physical disability, and a reduced life
expectancy. Psychological disorders like depression, if not detected and treated, can
adversely affect nutritional state, compliance with the treatment regimen, immune func-
tioning, progression of the disease, and may ultimately lead to treatment discontinuation
(Finkelstein and Finkelstein 2000; Daugirdas and Blake 2007).
Rates of significant depression in hemodialysis patients ranged from 29 to 69 %
depending on method of identifying depression (symptom scale vs. structured psychiatric
interview) and location of study (Finkelstein and Finkelstein 2000; Sapilak et al. 2004;
Drayer, 2006; Cukor et al. 2007, 2008; Dumitrescu et al. 2009; Cengic and Resic 2010;
Zouari et al. 2011). Intensity of depressive symptoms predicts increased mortality in these
patients (Kimmel 2002).
There has been a significant increase in the prevalence of ESRD in Iran in recent years
(Zahiroddin et al. 2005; Navidian et al. 2006; Nazemian et al. 2008; Zamanzadeh et al.
2007). Zahiroddin et al. (2005) found that 69 % of hemodialysis patients experienced
depression, with 45 % suffering from chronic depression. Navidian et al. (2006), Nazemian
et al. (2008), and Zamanzadeh et al. (2007) also reported high rates of depression in
hemodialysis patients, requiring intervention and treatment.
Given the high rates of depression in hemodialysis patients and its link to poor physical
health outcomes and decreased quality of life, then treatment studies in these patients are
necessary. Medication for depression is not contraindicated in hemodialysis patients, nor is
psychotherapy. While pharmacological treatments are usually first tried to address the
problems that hemodialysis patients face, research suggests that such intervention alone is
often not sufficient (Zamanzadeh et al. 2007). Response to psychotherapy for depression is
also not that robust in hemodialysis patients (Duarte et al. 2009). In addition, the rate of
both antidepressant treatment and psychotherapy is low in hemodialysis populations in the
Middle East, due in part to religious and cultural factors (Al Zaben et al. 2015).
Treatments that are cost-effective, culturally based, easy to implement, and have low
risk and limited side effects might be particularly useful in this population. Effective
nontraditional treatments such as aromatherapy, relaxation, Hatha yoga exercises, and
music therapy have been reported in dialysis patients in particular (Imanishi et al. 2009;

123
J Relig Health

McCaffrey et al. 2009; Fitzgerald et al. 2007) and in patients with other chronic diseases
(Vahabi 2003; Yousefinejad Ostadkelayeh et al. 2005; Smolen et al. 2002; Aragon et al.
2002; Chang and Chen 2005; Sendelbach et al. 2006). Religiously integrated psy-
chotherapies have also been found to be effective in patients with chronic medical illness,
especially in those who are more religious (Koenig, 2012; Koenig et al., 2015).
Music therapy has also been used to treat a wide variety of psychological, psychiatric,
and physical disorders, particularly in those with chronic physical disability (Hallam et al.
2009). For example, a number of studies have reported music therapy as a safe and efficient
intervention for improving mood, alleviating stress, and reducing irritability and loneliness
among those with health problems (Guétin et al. 2009; Karimi et al. 2012; Kim et al. 2006;
Mirbagher Ajorpaz et al. 2012; Nanbakhsh et al. 2009; Sheibani Tazraji et al. 2010; Zare
et al. 2009). Listening to music may help to relax these patients, facilitate a mental focus
on pleasant sensations, and distract them from ruminating about their condition.
One type of music therapy involves listening to the Holy Qur’an being recited (Majidi
2004). The Qur’an itself states that it is a book of healing: ‘‘We have sent down in the
Qur’an that which is healing and a mercy to those who believe’’ (17:82), and another verse
indicates that it is a source of guidance and cure for illness: ‘‘O mankind, there has to come
to you instruction from your Lord and healing for what is in the breasts and guidance and
mercy for the believers’’ (10:57).
The Prophet Mohammad stressed the importance of reading the Qur’an aloud (Qur’an
recitation vs. silent reading): ‘‘The comparison between a silent reader and a reciter (Qari)
is like a bottle of perfume when it is closed and when it is opened.’’ (Kamali 2005). A
number of studies in the Iranian context (as reported in Persian journals) have reported the
effectiveness of Holy Qur’an recitation (as a form of music when read aloud by the reader)
in relieving anxiety (Majidi 2004; Heidari and Shahbazi 2013; Akbari et al. 2012,
Babamohamadi et al. 2015). Listening to the Qur’an being recited adds religious content to
the pleasant, uplifting musical tone of the voice, adding further to the relaxation, focus on
pleasant sounds, and distraction from negative ruminations about their condition.
Ansari Jaberi et al. (2005) were one of the first to report that listening to the recitation of
the Holy Qur’an may be helpful in reducing depression (p \ 0.0001), an effect that was
particularly robust in those having a strong belief in the Holy Qur’an. These findings
suggest that Holy Qur’an recitation might be employed as a nonpharmacological treatment
to complement existing therapies in the treatment of dialysis patients suffering from
depression.

Objective

Given that there are few if any studies that have examined the effectiveness of listening to
the Holy Qur’an being recited on depressive symptoms in hemodialysis patients, we
designed the present study. The hypothesis is that hearing the words and content of the
Qur’an as well as the sound created by its recitation in the traditional cantillation voice will
help to reduce depressive symptoms in this population.

123
 J Relig Health

Methods

The present study was a clinical trial involving 60 hemodialysis patients randomly
assigned to either an experimental or a control group. Participants were patients on the
dialysis ward at Shahid Mahalati hospital in Tabriz, Iran. Inclusion criteria were ages
18–65 years, a BDI score of 20 or greater, willingness to listen to recitation of the Holy
Qur’an, having command of the Arabic language (on which the Qur’an is based), having a
history of hemodialysis treatment for at least 6 months, hemodynamic stable, not using
antidepressant drugs, not having acute mental problems or impaired level of consciousness,
and providing informed consent to participate in the study. Exclusion criteria were mental
disabilities or hearing impairment, a history of mental illness or hospitalization in the
psychiatric hospital (since the aim was to assess the impact of the intervention on
hemodialysis patients whose depression was a result of their current medical condition,
rather than a result of psychiatric illness, particularly that which was severe enough to
require hospitalization), and significant change in medical or psychiatric condition during
the course of the study (preventing further participation or completion of the follow-up
assessment). History of mental illness was self-defined and indicated by participants on a
checklist they completed on admission to the clinic/hospital. For the purpose of data
collection, two questionnaires were employed: (1) a demographic questionnaire asking
about the patients’ gender, age, marital status, financial status, educational level, and
duration of hemodialysis in years and (2) the Beck Depression Inventory (BDI-II) (Beck
et al. 1961). The BDI-II includes 21 items with a 0–3 response rating and a total score
ranging from 0 to 63. Scores between 0 and 9 on the BDI-II indicate the absence of
depression; scores of 10–19 indicate mild depression; 20–29, moderate depression; 30–39,
relatively severe depression; and 40–63, severe depression. The BDI-II is one of the most
commonly used measures of depressive symptoms in medical patients, and its validity and
reliability have been documented in a number of studies (Koo et al. 2003; Eryilmaz et al.
2005).
The BDI-II was self-completed at baseline before the start of dialysis and the first
session, and then again 1 month from baseline when the intervention was completed. The
Holy Qur’an recitation was implemented among the patients in the experimental group
following a protocol commonly used in similar studies (Guétin et al. 2009; Zare et al.
2009). Chapter (or surah) ‘‘Ya-Sin’’ from the Holy Qur’an was recited with the voice of
Shateri (a well-known reciter of the Qur’an). This chapter was selected based on consul-
tation with scholars on the Qur’an. Ya-Sin is the 36th surah (or chapter) of the Qur’an. It is
considered the ‘‘heart’’ of the Quran, and is the most important Holy Scripture that Iranian
use in their daily life to inspire, guide them, and provide hope in God.
Participants in the experimental group listened to the Qur’an recitation using an MP3
player with headphones. The Qur’an recitation was listened to three times a week for
20 min each during the 1-month intervention. The 20 min was played five minutes before
the beginning of dialysis and continued until 15 min after the start of dialysis. At the
completion of the 1-month intervention, the BDI-II was self-completed again by all the
patients in the experimental and control groups. The control group received no interven-
tion. The study was begun after registering the trial in the Iranian Registry of Clinical
Trials (registration number IRCT201312108665N2) and obtaining approval from the
university Research Ethics Committee (permit number 92/388666, 1/7/2014). Informed
written consent was obtained from all participants before enrolling them in the trial.

123
J Relig Health

Statistical Analyses

The characteristics of the sample were examined using descriptive statistics. To determine
the comparability of the two groups at baseline, the Student’s t test and Chi square statistic
were used. The Student’s t test was also used to examine between subject differences
between BDI-II scores at baseline and follow-up. A repeated-measures general linear
model (mixed factorial ANOVA) was constructed with Time 1 and Time 2 BDI-II scores
on the left side of the model and group (intervention vs. control) and covariates (if dif-
ferences between groups were significant at p = 0.05 at baseline) on the right side of the
model. The square root of the F value from the general linear model (equivalent to the
T value) and degrees of freedom were used to calculate the effect size (Cohen’s d) for
comparison to past and future studies. The significance level was set at p \ 0.05 for the
primary endpoint (i.e., the between-subjects difference at follow-up controlling for base-
line differences in the general linear model). Statistical analyses were done using SAS
(version 9.3; SAS Institute Inc., Cary, North Carolina).

Results

A total of 60 patients were approached to participate in the study, all of whom 60 agreed
(100 %). A total of 60 ESRD patients undergoing hemodialysis were randomized to either
the experimental group (n = 30) or the untreated control group (n = 30). Three partici-
pants in each group did not complete the follow-up evaluation at 1 month because of
deterioration in their medical or psychiatric condition that prevented further participation
or inability to complete the follow-up evaluation (n = 27 in experimental group, n = 27 in
control group). Table 1 presents the distribution of the participants by gender, age, edu-
cation, financial status, marital status, and length receiving dialysis at baseline. The only
difference between groups was that participants in the experimental group were signifi-
cantly younger than controls (50.2 vs. 56.4 years, p = 0.046).
Table 2 presents the mean and standard deviation of BDI-II scores at baseline and
follow-up. At baseline, average BDI-II scores in the intervention group were significantly
higher than in the control group (33.6 ± 6.7 vs. 29.3 ± 9.0, p = 0.051). Following the

Table 1 Baseline characteristics of overall sample, Qur’an recitation, and control groups
Total sample Qur’an recitation Controls p value
(n = 54) (n = 27) (n = 27)

Gender, female (%, N)a 42.6 (23) 48.1 (13) 37.0 (10) 0.41
Age, years (mean, SD) 53.3 (11.4) 50.2 (12.9) 56.4 (8.9) 0.05
Education, \diploma (%, N) 75.9 (41) 74.1 (20) 77.8 (21) 0.89
Financial status, poor (%, N) 55.6 (30) 48.2 (13) 63.0 (17) 0.27
Marital status, married (%, 88.9 (48) 88.9 (24) 88.9 (24) 1.00
N)
Months on dialysis (mean, 20.6 (14.0) 21.1 (13.9) 20.0 (14.3) 0.76
SD)
a
Column % (N)

123
 J Relig Health

Table 2 Means (SD) of depression scores (BDI-II) by treatment group

BDI-II Qur’an recitation Controls Difference p
Mean (SD) Mean (SD) Mean (95 % CI)

Baseline 33.6 (6.7) 29.3 (9.0) -4.3 (-8.7 to 0.0) 0.05

1 month 14.5 (4.8) 31.6 (9.2) 17.1 (13.0 to 21.1) \0.0001
Means compared using Student’s t test
BDI-II Beck Depression Inventory-II, SD standard deviation, CI confidence intervals

intervention, BDI-II scores in the experimental group decreased from 33.6 to 14.5, nearly a
20-point decrease, compared to a slight increase in the BDI-II from 29.3 to 31.6 in
untreated controls (14.5 ± 4.8 vs. 31.6 ± 9.2, p \ 0.0001, see Fig. 1).
Results from the repeated-measures general linear model in Table 3 indicated a sig-
nificant between-subjects treatment effect, independent of age (F = 9.3, p = 0.004,
Cohen’s d = 0.85).

Discussion

To our knowledge, this is the first study to demonstrate a significant effect of listening to
the Holy Qur’an being recited on depressive symptoms in hemodialysis patients in Iran.
The Cohen’s d of 0.85 indicates that the effect was a large one (Cohen 1988). Having to
live on hemodialysis is a constant challenge that patients with ESRD have to endure,
particularly since being on dialysis is associated with a number of serious physical and
mental dysfunctions (Baraz et al. 2005). The finding is consistent with research on reli-
gious psychotherapy in patients with chronic medical illness, although the effect size found
in the present study is considerably larger than reported in the former (Koenig et al. 2015).

40 Qur'an Recitation
Controls
35
Depression (BDI-II)

30

25

20

15

10

0
0 1
Time (months)

Fig. 1 Effect of Qur’an recitation versus control condition (no treatment) on average depressive symptoms
(Beck Depression Inventory-II) with standard error bars

123
J Relig Health

Table 3 Effect of Qur’an recitation on depressive symptoms from baseline to 1 month later (between
subjects)
F value p Effect size (Cohen’s d)

BDI-II total 9.30 0.004 0.85

F values from general linear model (GLM). Analyses controlled for baseline age
BDI-II Beck Depression Inventory-II

The present study, however, compared Qur’an recitation with a control group that received
no active intervention (whereas the study cited compared religious psychotherapy with a
control group receiving standard psychotherapy).
Because of the less than optimum response to pharmacological treatment (Zamanzadeh
et al. 2007), researchers have begun to examine the effects of alternative therapies (e.g.,
aromatherapy, relaxation, Hatha yoga exercises, and music therapy) that may help to
complement traditional treatments. These alternative therapies have been shown to be cost-
effective, easy to implement, and have limited side effects (Imanishi et al. 2009;
McCaffrey et al. 2009; Fitzgerald et al. 2007).
Theologians, clinicians, and researchers have strongly encouraged the use of religion-
based therapies, such as listening to the Holy Qur’an recited, as a way to boost the effects
of traditional therapies in Muslim countries (Guétin et al. 2009; Kim et al. 2006; Sheibani
Tazraji et al. 2010; Ansari Jaberi et al. 2005; Chan et al. 2010; Maratos 2008; Nelson et al.
2002). Kim and colleagues have also found that other forms of music therapy (which
Qur’an recitation is grouped under) were effective in relieving anxiety and improving
quality of life in hemodialysis patients (Kim et al. 2006).
How might listening to the Holy Qur’an being recited help to reduce dialysis patients’
depressive symptoms? In a review of the literature, Welch and Austin noted that depression
and anxiety are the most common emotional disorders in ESRD patients, affecting survival
and quality of life (Welch and Austin 2000). Edema, changes in tissue integrity, problems
with vascular access, and loss of productivity negatively impact patients’ self-confidence
and self-esteem (Kimmel 2002). Listening to the Holy Qur’an being recited may stimulate
the release of endorphins in the brain, which are known to have positives effect on mood
and memory. Furthermore, music therapy has been shown to reduce the release of epi-
nephrine and norepinephrine from the adrenal gland, affecting blood pressure, heart rate,
and mood state (Moreno 1985). An early review of the literature by Henry found that
listening to relaxing music alpha waves in the brain that are associated with enhanced
mood (Henry 1995). Listening to the Qur’an being recited in Arabic using a traditional
cantillation voice (by experienced reciters such as Shateri) may also have a similar effect,
restoring harmony between the body and soul (Maarefat 1993).
We believe that listening to the Qur’an being recited is effective because of its ability to
soothe and relax, refocus the mind on positive experiences, and distract the mind from
negative thoughts and ruminations, all helping to reduce the stress and relieve depression
(in Muslim patients). Finally, the beneficial effect observed in the present study may have
also been due to the intervention being offered during hemodialysis treatment, rather than
at another time, since it might have helped to reduce the stress associated with receiving
this treatment or even just being in the clinic/hospital.

123
 J Relig Health

Conclusions

The present study found that listening to the Holy Qur’an being recited for 20 min three
times per week for 1 month significantly reduced depressive symptoms in hemodialysis
patients in Iran, independent of age. Further research is needed to replicate these results in
hemodialysis patients in Iran and other Muslim countries, and in patients with chronic
diseases more generally, as well as address questions related to mechanism. Did the
intervention work to change beliefs? Did it change behavior? Did it increase spiritual
growth? Would the same effects have been achieved by simply listening to music, or was it
related to the religious content? Might listening to other chapters in the Qur’an have
worked as well? In conclusion, Holy Qur’an recitation is a simple, easy-to-implement, and
cost-effective therapy for reducing depression in this often distressed population of patients
with poor quality of life and high rates of depression.

Acknowledgments This study was based on a master’s thesis in Critical Care Nursing and a research plan
approved by the Nursing and Allied Health School at Semnan University of Medical Sciences. We would
also like to warmly thank the patients who participated in this study, as well as Semnan University of
Medical Sciences who kindly gave permission and financial support for the study.

References
Akbari, M., Darakeh, M., Mohamadi, J., & Rezaei, H. (2012). Effectiveness of Holy Quran in reducing
anxiety of prisons. Teb & Tazkieh, 20(3,4), 25–31. [Persian].
Al Zaben, F., Khalifa, D. A., Sehlo, M. G., Al Shohaib, S., Shaheen, F., & Koenig, H. G. (2015). Depression
in patients with chronic kidney disease on dialysis in Saudi Arabia. International Urology and
Nephrology, 54(2), 713–730.
Ansari Jaberi, A., Negahban Bonabi, T., Saiadi Anari, A. R., & Aghamohamad Hasani, P. (2005). The effect
of the koran reciting on the depressed patients in psychiatry department of Moradi hospital in Raf-
sanjan. Scientific Journal of Kurdistan University of Medical Sciences, 10(2), 42–48.
Aragon, D., Farris, C., & Byers, J. F. (2002). The effects of harp music in vascular and thoracic surgical
patients. Alternative Therapies in Health and Medicine, 8(5), 52–54.
Babamohamadi, H., Sotodehasl, N., Koenig, H. G., Jahani, C., & Ghorbani, R. (2015). The effect of Holy
Qur’an recitation on anxiety in hemodialysis patients: A randomized clinical trial. Journal of Religion
and Health, 54(5), 1921–1930. doi:10.1007/s10943-014-9997-x.
Baraz, S., Mohammadi, E., & Boromand, B. (2005). Effect on quality of life and physical care of patients
treated with maintenance hemodialysis. Hayat, 11(24–25), 51–62. [Persian].
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring
depression. Archives of General Psychiatry, 4, 561–571.
Cengic, B., & Resic, H. (2010). Depression in hemodialysis patients. Bosnian Journal of Basic Medical
Sciences, 10(Suppl 1), S73–S78.
Chan, M. F., Chan, E. A., & Mok, E. (2010). Effects of music on depression and sleep quality in elderly
people: A randomized controlled trial. Complementary Therapies in Medicine, 18, 150–159. doi:10.
1016/j.ctim.2010.02.004.
Chang, S. C., & Chen, C. H. (2005). Effects of music therapy on women’s physiologic measures anxiety and
satisfaction during caesarean delivery. Research in Nursing & Health, 28(6), 453–461. doi:10.1002/
nur.20102.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence
Erlbaum Associates.
Cukor, D., Coplan, J., Brown, C., Friedman, S., Cromwell-Smith, A., Peterson, R. A., et al. (2007).
Depression and anxiety in urban hemodialysis patients. Clinical Journal of the American Society of
Nephrology, 2(3), 484–490. doi:10.2215/CJN.00040107.
Cukor, D., Coplan, J., Brown, C., Peterson, R. A., & Kimmel, P. L. (2008). Course of depression and anxiety
diagnosis in patients treated with hemodialysis: A 16-month follow-up. Clinical Journal of the
American Society of Nephrology, 3(6), 1752–1758. doi:10.2215/CJN.01120308.

123
J Relig Health

Daugirdas, J. T., & Blake, P. G. (2007). Handbook of dialysis (4th ed., pp. 455–456). Boston: Lippincott
Williams & Wilkins.
Drayer, R. A. (2006). Characteristics of depression in hemodialysis patients: Symptoms, quality of life and
mortality Risk. General Hospital Psychiatry, 28, 306–312.
Duarte, P. S., Miyazaki, M. C., Blay, S. L., & Sesso, R. (2009). Cognitive–behavioral group therapy is an
effective treatment for major depression in hemodialysis patients. Kidney International, 76(4),
414–421.
Dumitrescu, A. L., Gârneaţă, L., & Guzun, O. (2009). Anxiety, stress, depression, oral health status and
behaviours in Romanian hemodialysis patients. Romanian Journal of Internal Medicine, 47(2),
161–168.
Eryilmaz, M. M., Ozdemir, C., Yurtman, F., Cilli, A., & Karaman, T. (2005). Quality of sleep and quality of
life in renal transplantation patients. Transplantation Proceedings, 32(5), 2072–2076. doi:10.1016/j.
transproceed.2005.03.084.
Feroze, U., Martin, D., Reina-Patton, A., Kalantar-Zadeh, K., & Kopple, J. D. (2010). Mental health,
depression, and anxiety in patients on maintenance dialysis. Iranian Journal of Kidney Diseases, 4,
173–180.
Finkelstein, F. O., & Finkelstein, S. H. (2000). Depression in chronic dialysis patients: Assessment and
treatment. Nephrology, Dialysis, Transplantation, 15(12), 1911–1913. doi:10.1093/ndt/15.12.1911.
Fitzgerald, M., Culbert, T., Finkelstein, M., Green, M., Johnson, A., & Chen, S. (2007). The effect of gender
and ethnicity on children’s attitudes and preferences for essential oils: A pilot study. Explore (NY),
3(4), 378–385. doi:10.1016/j.explore.2007.04.009.
Gerogianni, S. K., & Babatsikou, F. P. (2014). Psychological aspects in chronic renal failure. Health Science
Journals, 8(2), 205–214.
Guétin, S., Soua, B., Voiriot, G., Picot, M. C., & Hérisson, C. (2009). The effect of music therapy on mood
and anxiety–depression: An observational study in institutionalized patients with traumatic brain
injury. Annals of Physical and Rehabilitation Medicine, 52(1), 30–40. doi:10.1016/j.annrmp.2008.08.
009.
Hallam, S., Cross, I., & Thaut, M. (2009). The Oxford handbook of music psychology. New York: Oxford
University Press.
Heidari, M., & Shahbazi, S. (2013). Effect of Quran and music on anxiety in patients during endoscopy.
Knowledge & Health, 8(2), 67–70. [Persian].
Henry, L. L. (1995). Music therapy: A nursing intervention for the control of pain and anxiety in ICU: A
review of the research literature. Dimensions of Critical Care Nursing, 14(6), 295–304.
Imanishi, J., Kuriyama, H., Shigemori, I., Watanabe, S., Aihara, Y., Kita, M., et al. (2009). Anxiolytic effect
of aromatherapy massage in patients with breast cancer. Evidence-Based Complementary and Alter-
native Medicine, 6(1), 123–128. doi:10.1093/ecam/nem073.
Kamali, A. (2005). Subject interpretation of Quran. Tehran: Maaref Publication. [Persian].
Karimi, R., Shabani, F., Dehghan Nayeri, N., Zareii, K., Khalili, G., & Chehrazi, M. (2012). Effect of music
therapy on physiological pain responses of blood sampling in premature infants. Hayat, 18(2), 76–86.
[Persian].
Kim, K., Lee, M., & Sok, S. (2006). The effect of music therapy on anxiety and depression in patients
undergoing hemodialysis. Taehan Kanho Hakhoe Chi, 36(2), 321–329.
Kimmel, P. L. (2002). Depression in patients with chronic renal disease. What we know and what we need to
know. Journal of Psychosomatic Research, 53(4), 951–956. doi:10.1016/S0022-3999(02)00310-0.
Koenig, H. G. (2012). Religious vs. conventional psychotherapy for major depression in patients with
chronic medical illness: Rationale, methods, and preliminary results. Depression Research and
Treatment, Article ID 460419. doi:10.1155/2012/460419.
Koenig, H. G., Pearce, M. J., Nelson, B., Shaw, S. F., Robins, C. J., Daher, N., et al. (2015). Religious vs.
conventional cognitive-behavioral therapy for major depression in persons with chronic medical ill-
ness. Journal of Nervous and Mental Disease, 203(4), 243–251.
Koo, J. R., Yoon, J. W., Kim, S. G., Lee, Y. K., Oh, K. H., Kim, G. H., et al. (2003). Association of
depression with malnutrition in chronic hemodialysis patients. American Journal of Kidney Diseases,
41(5), 1037–1042. doi:10.1016/S0272-6386(03)00201-4.
Maarefat, M. H. (1993). The discipline and rhythm in Quran. Journal of Mirase Javidan, 3, 10–17.
Majidi, S. A. (2004). Recitation effect of Holy Quran on anxiety of patients before undergoing coronary
artery angiography. Journal of Gilan University of Medical Sciences, 13(49), 61–67. [Persian].
Maratos, A., Gold, C., Wang, X., & Crawford, M. (2008). Music therapy for depression. Cochrane Database
of Systematic Reviews, (1), CD004517. doi:10.1002/14651858.CD004517.pub2.

123
 J Relig Health

McCaffrey, R., Thomas, D. J., & Kinzelman, A. O. (2009). The effects of lavender and rosemary essential
oils on test-taking anxiety among graduate nursing students. Holistic Nursing Practice, 23(2), 88–93.
doi:10.1097/HNP.0b013e3181a110aa.
Mirbagher Ajorpaz, N., Shahshahani, M., & Dianati, M. (2012). The effect of music on the anxiety and some
physiological indices of patients before general surgery. Behbood Journal, 15(2), 90–95. [Persian].
Moreno, J. J. (1985). Music therapy: An integrated approach. The Arts in Psychotherapy, 12(1), 17–23.
doi:10.1016/0197-4556(85)90004-8.
Nanbakhsh, F., Zadeh Mohammadi, A., Jalili, N., & Ahmadnejad, E. (2009). The effect of music in reducing
the pain and stress during delivery. Urmia Medical Journal, 20(3), 209–214. [Persian].
Navidian, A., Arbabi Sarjou, A., & Kikhai, A. (2006). Frequency of mental disturbances in hemodialysis
patients referred to hemodialysis ward of Khatamol Anbia Hospital in Zahedan. Journal of Guilan
University of Medical Sciences, 58(15), 61–67. [Persian].
Nazemian, F., Ghafari, F., & Poorghaznein, T. (2008). Evaluation of depression and anxiety in hemodialysis
patients. Medical Journal of Mashhad University of Medical Sciences, 3(51), 171–176. [Persian].
Nelson, C. J., Rosenfeld, B., Breitbart, W., & Galietta, M. (2002). Spirituality, religion, and depression in
the terminally ill. Psychosomatics, 43(3), 213–220. doi:10.1176/appi.psy.43.3.213.
Sapilak, B. J., Steciwko, A., & Kurpas, D. (2004). Anxiety and depressive symptoms developing at
chronically hemodialysis patients in lower Silesia (Poland). American Journal of Nephrology, 24,
46–61.
Sendelbach, S., Halm, M., Doran, K., Miller, E., & Gaillard, P. (2006). Effect of music therapy on phys-
iological outcomes for patients undergoing cardiac surgery. Journal of Cardiovascular Nursing, 21(3),
194–200.
Sheibani Tazraji, F., Pakdaman, S., Dadkhah, A., & Hasanzadeh Tavakoli, M. (2010). The effect of music
therapy on depression and loneliness in old people. Iranian Journal of Ageing, 5(16), 54–60. [Persian].
Smolen, D., Topp, R., & Singer, L. (2002). The effect of self-selected music during colonoscopy on anxiety,
heart rate and blood pressure. Applied Nursing Research, 15(3), 126–136. doi:10.1053/apnr.2002.
34140.
Vahabi, Y. (2003). The effect of music therapy and relaxation on hospitalized CCU patients’ anxiety.
IJPCP, 8(3), 75–82. [Persian].
Welch, J. L., & Austin, J. K. (2000). Stressors, coping and depression in hemodialysis. Journal of Advanced
Nursing, 33, 200–207. doi:10.1111/j.1365-2648.2001.01654.x.
Yousefinejad Ostadkelayeh, A., Madadi, A., Majedzadeh, S., Shabannia, R., Sadeghian, N., Zarinara, A.,
et al. (2005). The effect of music therapy on chronic pain in patients with cancer. The Journal of
Qazvin University of Medical Sciences, 9(1), 39–42. [Persian].
Zahiroddin, A., Hayati, M., Jadidi, M., & Samimi, S. (2005). Depression in hemodialysis patients. Journal of
Ardabil University of Medical Sciences, 5(3), 256–259. [Persian].
Zamanzadeh, V., Heydarzade, M., Ashvandi, K. H., & Lak, D. S. (2007). Relationship between quality of
life and social support in hemodialysis patient. Medical Journal of Tabriz University of Science, 7(29),
49–54. [Persian].
Zare, M., Ebrahimi, A. A., & Birashk, B. (2009). The effect of music therapy on reducing agitation in
patients with Alzheimer’s disease in Shahryar city nursing home. Advances in Cognitive Science,
11(2), 55–62. [Persian].
Zouari, L., Elleuch, M., Feki, I., Allouch, C., Yaich, S., Ben Thabet, J., et al. (2011). Depression in chronic
hemodialysis patients: About 106 cases. Tunisian Medical, 89(2), 157–162.

123