This paper reports on an international study in 18 countries (n=5087) to observe how spirituality, religion and personal beliefs (SRPB) relate to quality of life (QoL). SRPB is assessed using the World Health Organization's QoL Instrument (the WHOQOL), where eight additional facets were included to more fully address these issues as they pertain to QoL, along with physical, social, psychological and environmental domains. The facets address issues such as inner peace, faith, hope and optimism, and spiritual connection. The results showed that SRPB was highly correlated with all of the WHOQOL domains (p<0.01), although the strongest correlations were found with psychological and social domains and overall QoL. When all of the domain scores were entered into a stepwise hierarchal regression analysis, all of the domains contributed to overall quality of life (N=3636), explaining 65% of the variance. When this was repeated for those people who reported poor health (N=588), it was found that only four domains explain 52% of the variance. The first was the level of independence, followed by environment, SRPB and physical. Gender comparisons showed that despite showing lower scores for facets in the psychological domain, such as negative feelings and poorer cognitions, women still reported greater feelings of spiritual connection and faith than men. Those with less education reported greater faith but were less hopeful. It is suggested that SRPB should be more routinely addressed in assessment of QoL, as it can make a substantial difference in QoL particularly for those who report very poor health or are at the end of their life.