Religion and Suicide Risk: A Systematic Review

Psychological autopsies: religious and spiritual factors for suicide in cases and controls

Introduction

In recent years, there has been a growing body of evidence supporting the notion that spirituality and religion can improve one's physical and mental health. Studies show that religion and spirituality play a significant role in the suicidal path. Considering the dearth of data on the patterns of suicidal thoughts, acts and related factors in Pakistan, a country with a large Muslim population and stigma with sociocultural perceptions of religious notions, the current study investigated the role of religious and spiritual factors of suicide using psychological autopsies.

Method

Purposive sampling was used to gather retrospective data records from police stations and hospital forensic departments in Rawalpindi and Islamabad, Pakistan, between January 2021 and July 2022. In total, 60 samples (30 cases and 30 controls) were used in this autopsies investigation. As with the majority of case control studies, the study sample cases were matched with the controls. At least two close bereaved family members served as the primary information sources, and data was gathered using the Semi Structured Interview Protocol for Psychological Autopsies.

Results

According to statistical analysis, both the suicide cases and the controls were comprised mostly of Muslim individuals. They follow Islam and hold the view that suicide is prohibited, forbidden, and haram in Islam. Regarding spirituality and religion, the majority of cases, according to the respondents interviewed, were not spiritual at all, while the controls are slightly spiritual. While the majority of both cases and controls had reduced interest in or practice of religious activities over the past year, a higher number of cases rarely performed and attended the religious services/activities as compared to controls.

Discussion

It was thus evident that the cases lacked significant engagement in spiritual and religious activities, and their attendance at such gatherings had notably decreased in the year preceding the suicide attempt. This decline in involvement in spiritual and religious practices might be linked to decreased levels of satisfaction, sense of belongingness, which could raise the risk of suicide. Therefore, in nations where Muslims predominate, culturally relevant suicide prevention initiatives including spiritual and religious treatments aimed at reducing the risk of suicide should be considered.

International trends in male youth suicide and suicidal behaviour

OBJECTIVE

Suicide and suicidal behaviour strongly contribute to overall male youth mortality. An understanding of worldwide data contextualises suicide and suicidal behaviour in young men within any given country.

METHOD

Members and colleagues of the World Federation of Societies of Biological Psychiatry's Task Force on Men's Mental Health review the relevant data from several regions of the world. The review identifies notable findings across regions of relevance to researchers, policymakers, and clinicians.

RESULTS

Male suicide and suicidal behaviour in adolescence and emerging adulthood within North America, Latin America and the Caribbean, Europe, the Mediterranean and the Middle East, Continental Africa, South Asia, East Asia, China, and Oceania share similarities as well as significant points of divergence.

CONCLUSIONS

International data provide an opportunity to obtain a superior understanding of suicide and suicidal behaviour amongst young men.

Pediatric suicide: Review of a preventable tragedy

Concepts of suicide are explored in this issue with a focus on suicide in children and adolescents. The epidemiology of pediatric suicide in the United States is reviewed; also, risk and protective factors, as well as prevention strategies, are discussed. Suicide in the pediatric athlete and the potential protective effect of exercise are examined. In addition, this analysis addresses the beneficial role of psychological management as well as current research on pharmacologic treatment and brain stimulation procedures as part of comprehensive pediatric suicide prevention. Though death by suicide in pediatric persons has been and remains a tragic phenomenon, there is much that clinicians, other healthcare professionals, and society itself can accomplish in the prevention of pediatric suicide as well as the management of suicidality in our children and adolescents.

Religion and mental health: an Eastern Mediterranean region perspective

In the last decade, spirituality gained increasing recognition, with an individualized approach to the significance of symptoms and the purpose of treatment. Many psychiatrists started adopting the term "biopsychosocial-spiritual" management. Modern psychological therapies have drawn from the principles of ancient Eastern traditions. However, the spiritual beliefs within Islam and their impact on mental well-being have yet to be studied sufficiently. The Eastern Mediterranean region is largely Muslim and shares similar cultural beliefs. This paper explores some of these beliefs and their impact on perceptions of mental health and help-seeking behavior. The paper will focus primarily on the religious ideologies, the concepts of punishment and reward from Allah (God) in the context of the high stigma associated with mental illness in the region, and the knowledge, attitudes, and perceptions toward people with mental illness. We will explore cultural beliefs in possession, evil eye, and black magic and how they influence treatment adherence. Traditional and faith healers remain very popular in this part of the world and are often the first line of treatment for people presenting with mental illness. Suicide and self-harming are particularly sensitive areas due to their religious implications in life and death, as well as the afterlife. Despite the global interest in the Eastern Mediterranean region, there still is a shortage of research on the intercultural aspects of this region, especially regarding mental health assessments. In this regard, we will explore some published literature from Qatar and draw comparisons with regional findings.

Roles of Loneliness, Stress, and Religiosity in Suicide Ideation Among Nigerian Older Adults

Suicidal behavior in older adults is a fundamental public health problem globally and the highest suicide rates occur in low- and middle-income countries (LMICs). However, there is limited research on suicidality among older adults, especially in sub-Saharan Africa. We sought to find out whether loneliness, stress and religiosity would be associated with suicide ideation in a sample of sub-Saharan African older adults (N = 500; aged 51-70 years, Mage = 58.97, SD = 6.16; 45.6% women). They completed the Beck Suicidal Ideation Scale, the UCLA Loneliness Scale-version 3, Perceived Stress Scale, and Religiosity Scale. Regression results showed that whereas suicidal ideation could be increased by loneliness and stress, religious older adults were less likely to report suicidal ideation. Interventions aimed at managing and protecting the mental health of older adults during their transition to late adulthood should guard them against loneliness and buffer their resilience and coping strategies with the connectedness that religiosity offers.

Labor market discrimination and suicidal ideation: A longitudinal study of Korean women

This study investigates the impact of gender discrimination in the labor market on suicidal ideation among Korean women, taking into consideration women's multiple social locations and their discriminatory experiences across various aspects of employment. Analysis using waves 4 to 8 data of the Korean Longitudinal Survey of Women and Family, with response rates ranging from 68.3% to 78.2%, indicates that gender discrimination in hiring, dismissal, promotion, job allocation, training, wage, and sexual harassment is strongly associated with suicidal thoughts among women. This relationship remains significant even after controlling for stress, depression, and other forms of discrimination. Subgroup analysis further highlights that women with lower income levels are particularly susceptible to the adverse effects of gender discrimination. The findings underscore the importance of policy intervention to mitigate labor market discrimination against women as a crucial step in preventing suicides among Korean women.

The Interpersonal Psychological Theory of Suicide in Italian University Students: Validation of the INQ-15 and the ACSS-FAD

In the frame of the interpersonal psychological theory of suicide (IPTS), Interpersonal Needs Questionnaire (INQ-15) assesses thwarted belongingness (TB) and perceived burdensomeness (PB), related to suicidal ideation (SI); Acquired Capability for Suicide Scale-Fearlessness About Death (ACSS-FAD) measures this component which contributes to lethal self-harm. The objective was to evaluate the psychometric properties of INQ-15 and ACSS-FAD in a population of Italian university students. Since the Italian INQ-15 was already validated, we translated ACSS-FAD through a multistage procedure and administered both to 1,665 Italian university students. Factor analysis confirmed a two-factor-related model of INQ-15, one factor of ACSS-FAD, and good reliability for both. We proved the association between INQ-15 and current SI and between ACSS-FAD and lifetime suicidal planning and/or suicide attempt. The convergent and discriminant validities were in line with those of previous studies. Both tools are valid and reliable to assess the constructs associated with suicide outcomes according to IPTS.

Mobilizing Meaning: Religion and Spirituality Among Future Generations

Religion and spirituality have long been known to impact both physical and mental health. Considering religion and spirituality as possible additions to social determinants of health, this article examines the current state of religion and spirituality in the United States and also discusses the ways in which they can contribute to the mental health of children and adolescents. Further, this article also discusses new approaches within religion and spirituality to address the changing needs of future generations.

Assessment of Suicide Risk and Cultural Considerations in Forcibly Displaced Migrant Youth

Migrant youth who face forced displacement from their home countries have an emergent mental health burden, placing them at increased suicide risk. As such, it is crucial for pediatric providers to include suicide screening and assessment in their care for this population. Migrant families seek safety but, in many cases, encounter adverse events and psychosocial inequities in the migration journey and in the host community. Factors such as trauma, acculturative stress, and intersectionality influence suicide risk in migrants. Summative traumatic events contribute to the mental health load and worsen suicidal outcomes in migrant youth. Acculturative stress can lead to social marginalization in the host country, further adding to the existing mental health burden. Finally, intersectionality encompasses complex sociocultural influences, which shape the development of cultural identity in migrant youth and influence suicide risk. By examining these factors, the author advances cultural considerations in screening and assessment for suicide risk in migrant youth through evidence-based tools in pediatric clinical practice. Barriers to access to mental health services, stigma, and distrust of the health care system within the host community are also addressed. The author establishes recommendations for early suicide screening and prevention within this population through trauma-informed care, active advocacy, and cultural sensitivity.

Religiosity, Financial Risk Taking, and Reward Processing: An Experimental Study

The present study investigated the extent to which financial risk-taking (FRT) perspectives and religiosity influenced an individual's performance on financial decision-making tasks under risk and/or uncertainty. It further investigated the potential to measure this interaction using electro-encephalogram (EEG) assessments through reward-related event-related potentials (P3 and FRN). EEG data were collected from 37 participants undergoing four decision-making tasks comprising the Balloon Analogue Risk Task (BART), Iowa Gambling Test (IGT), Mixed-Gamble Loss-Aversion Task (MGLAT), and MGLA-Success Task (MGLAST). The present study found that BART performance may be affected by an interaction of FRT perspectives and religiosity. The physiological effects of task feedback were also distinguished between religious and non-religious individuals objectively with EEG data. Overall, while religiosity and FRT may not significantly influence IGT and MGLA performance, and interact with BART in a complex way, physiological reaction towards feedback after BART performance appears to be strongly affected by religiosity and FRT perspectives.

Examining the Etiology of Asian American Suicide in the United States

Research highlights racial and ethnic disparities in suicide, but Asian American suicide receives very little attention in the literature. This is the first comprehensive, large-scale, nationally representative study of completed suicide among Asian Americans in the United States. Descriptive and multilevel regression techniques compared the risk factors for completed suicide across 227,786 Asian American, White, African American, Hispanic, and American Indian suicide decedents from 2003 to 2019. Results indicated that Asian American suicide decedents were significantly less likely than their counterparts to have several risk factors for suicide. Asian Americans were less likely to be male, uneducated, and unmarried. Asian Americans were less likely to use alcohol and drugs, to have mental health problems, and to die by firearm, relative to other suicide methods. Asian Americans were less likely to have a history of prior suicide attempts, to have intimate partner problems, and to have criminal legal problems. Conversely, Asian Americans were more likely to reside in places with higher levels of concentrated disadvantage, residential instability, racial and ethnic heterogeneity, and population density. The results underscore the need for race-specific suicide prevention strategies that, for Asian Americans in particular, take into account cultural values and barriers to help-seeking behavior.

Exploring Religion as a Path to Meaning: The Role of "Pastrotherapy" in Supporting Young People's Quest for a Good Life in Nigeria

This paper examines suicide prevalence among Nigerian youth struggling to find meaning in life. Frustrated by unattainable ideals, they experience despair. The study explores religion's role in providing support for meaning-seeking individuals. Utilizing an explorative approach, the paper highlights how religion can play a role in offering solidarity, morality, and hope as vital resources for creating a meaningful life. It introduces "Pastrotherapy" as a pastoral care approach to addressing existential questions. Findings emphasize the importance of religious communities and leaders in promoting resilience and addressing underlying causes of despair. This study reveals how religious beliefs and practices support Nigerian youth facing existential challenges, shedding light on the intersection of religion, meaning-making, and mental health.

The relationship between spirituality and suicide in young adults: the mediating role of early maladaptive schemas in Turkey

Suicide rates among young adults are high. There are many reasons for this. In this study, the effect of early maladaptive schemas on the relationship between spirituality and suicide among young adults was examined. The sample of 413 (326 females and 87 males) ranged in age from 18 to 30 (M = 20.8, SD = 2.02). Spiritual orientation, suicide probability (suicidal ideation) scale, and Young Schema Scale Short Form-3 (social isolation and defectiveness) were used in the study. Data were analysed with the SPSS 22.0 PROCESS program. As a result, social isolation and defectiveness have been found to mediate between spirituality and suicidal ideation.

Fearlessness about death and suicidal ideation: Religious identity matters

INTRODUCTION

Religion is a salient aspect of patient background in treatment (The psychology of religion and coping: Theory, research, practice; Guilford Press). However, research investigating the role of religion in suicide is lacking and inconsistent (Journal of Religion and Health, 57, 2478-2499). The current study (1) clarifies the association between religious identity and fearlessness about death in a psychiatric sample and (2) tests whether religious identity moderates the association between fearlessness about death and suicidal ideation.

METHODS

Participants were 155 patients seeking treatment in a partial hospital program. Religious identity was assessed using the Identities in Treatment Scale (The Behavior Therapist). Fearlessness about death was assessed with two relevant items from the acquired capability with rehearsal for suicide scale (Psychological Assessment, 28, 1452-1464), as in prior studies (Suicide & Le-Threatening Behavior, 50, 1230-1240; Journal of Affective Disorders Reports, 12, 100492).

RESULTS

Fearlessness about death interacted with religious identity to predict suicidal ideation, b = 0.47, 95% C.I. [0.02, 0.91], p = 0.042. Conditional effects showed that greater fearlessness about death was associated with greater suicidal ideation among non-religious patients, b = -0.56, 95% C.I. [-0.88, -0.24], p = 0.001, but not in religious patients, b = -0.09, 95% C.I. [-0.41, 0.22], p = 0.559.

CONCLUSIONS

Our results suggest that fearlessness about death is a risk factor for suicidal ideation, but only among those who do not identify as religious. Results from this study inform theories of suicide and elucidate the influence of religious identity on links among suicide risk factors and suicide-related outcomes.

Stigma, Support, and Ideation About Suicide in Indonesian Twitter: A Topic Modelling Study

Stigma surrounding suicide is a massive problem in Indonesia. Thus, it is important to study how conversations about suicide take place. We take a machine learning approach and study tweets with suicide keywords to understand how people converse about suicide or express suicide ideation. Tweets with suicide-related keywords were extracted from May to June 2023. 20,057 tweets were subject to topic modelling with an 11-topic solution. While most topics contain negative messages, no purely stigmatizing topics emerge, despite prior research suggesting overwhelming stigma. Various kinds of existential, emotional, and social tweets about suicide take place among Indonesian users, indicating that Indonesian Twitter users utilize the platform to express their thoughts and emotions. Notably, religious-spiritual keywords are highly prevalent, suggesting that in a highly religious society, there is a need for policy makers and awareness campaigns to frame their positive messaging within the society's religious context.

Sexual and Gender Minority Status and Suicide Mortality: An Explainable Artificial Intelligence Analysis

Objectives: Suicide risk is elevated in lesbian, gay, bisexual, and transgender (LGBT) individuals. Limited data on LGBT status in healthcare systems hinder our understanding of this risk. This study used natural language processing to extract LGBT status and a deep neural network (DNN) to examine suicidal death risk factors among US Veterans. Methods: Data on 8.8 million veterans with visits between 2010 and 2017 was used. A case-control study was performed, and suicide death risk was analyzed by a DNN. Feature impacts and interactions on the outcome were evaluated. Results: The crude suicide mortality rate was higher in LGBT patients. However, after adjusting for over 200 risk and protective factors, known LGBT status was associated with reduced risk compared to LGBT-Unknown status. Among LGBT patients, black, female, married, and older Veterans have a higher risk, while Veterans of various religions have a lower risk. Conclusion: Our results suggest that disclosed LGBT status is not directly associated with an increase suicide death risk, however, other factors (e.g., depression and anxiety caused by stigma) are associated with suicide death risks.

Identifying unique subgroups in suicide risks among psychiatric outpatients

BACKGROUND

The presence of psychiatric disorders is widely recognized as one of the primary risk factors for suicide. A significant proportion of individuals receiving outpatient psychiatric treatment exhibit varying degrees of suicidal behaviors, which may range from mild suicidal ideations to overt suicide attempts. This study aims to elucidate the transdiagnostic symptom dimensions and associated suicidal features among psychiatric outpatients.

METHODS

The study enrolled patients who attended the psychiatry outpatient clinic at a tertiary hospital in South Korea (n = 1, 849, age range = 18-81; 61% women). A data-driven classification methodology was employed, incorporating a broad spectrum of clinical symptoms, to delineate distinctive subgroups among psychiatric outpatients exhibiting suicidality (n = 1189). A reference group of patients without suicidality (n = 660) was included for comparative purposes to ascertain cluster-specific sociodemographic, suicide-related, and psychiatric characteristics.

RESULTS

Psychiatric outpatients with suicidality (n = 1189) were subdivided into three distinctive clusters: the low-suicide risk cluster (Cluster 1), the high-suicide risk externalizing cluster (Cluster 2), and the high-suicide risk internalizing cluster (Cluster 3). Relative to the reference group (n = 660), each cluster exhibited distinct attributes pertaining to suicide-related characteristics and clinical symptoms, covering domains such as anxiety, externalizing and internalizing behaviors, and feelings of hopelessness. Cluster 1, identified as the low-suicide risk group, exhibited less frequent suicidal ideation, planning, and multiple attempts. In the high-suicide risk groups, Cluster 2 displayed pronounced externalizing symptoms, whereas Cluster 3 was primarily defined by internalizing and hopelessness symptoms. Bipolar disorders were most common in Cluster 2, while depressive disorders were predominant in Cluster 3.

DISCUSSION

Our findings suggest the possibility of differentiating psychiatric outpatients into distinct, clinically relevant subgroups predicated on their suicide risk. This research potentially paves the way for personalizing interventions and preventive strategies that address cluster-specific characteristics, thereby mitigating suicide-related mortality among psychiatric outpatients.

Revisiting Associations Among Parent and Adolescent Religiosity and Early Adolescent Suicide Risk in the United States

The contributions of religion to reduced suicide risk have been studied in adults and adolescents, though to our knowledge no comprehensive investigation has been conducted in early adolescents, at a time coinciding with emergence of suicide risk trajectories. In this largest study to date on this topic, we aimed to characterise the contributions of various measures of "private" and "public" religiosity to early adolescent suicide ideation (SI) and suicide attempt (SA) histories using information from a large, epidemiologically informed U.S. sample of adolescents (N = 7068; mean age = 12.89 years, 47% female) and their parents. In all youth, parent-reported adolescent religious importance was associated with reduced odds of SA (OR = 0.75, CI = 0.61-0.92, P = .005). Muslim youth were more likely (OR = 1.52, CI = 1.02-2.22, P = .033), and Catholic youth were less likely (OR = 0.80, CI = 0.67-0.95, P = .014), to report SI. A variety of sex differences were noted, with significant protective associations of adolescent self-reported religiosity on SI and SA, religious service attendance on SI, and religious importance on SI, in female-but not male-youth; and significant protective associations of religious importance on SA in male-but not female-youth. Against expectations, there was no evidence that parent religiosity moderated the link between youth religiosity and SI or SA. These results shed light on the roles of cultural and familial context in youth suicide risk, which may ultimately be targeted in screening and interventional approaches.

Global trends in youth suicide from 1990 to 2020: an analysis of data from the WHO mortality database

Background

Suicide is a serious but preventable public health concern at the global level, showing relevant geographical differences. This study aims to monitor global temporal and geographical patterns in suicide mortality in pre-adolescents, adolescents, and young adults (i.e., aged 10-24 years), from 1990 to 2020 or the most recent available year.

Methods

Using the World Health Organisation mortality database, we conducted an analysis on a subset of 52 countries with valid and high-quality data. We computed age-standardised suicide rates (ASR) by sex, country, and calendar year, and performed a joinpoint regression analysis to identify significant changes in the temporal suicide trends over the studied period.

Findings

High variability in suicide rates and trends was observed, with a male-to-female ratio of two to five. Between 1990 and 2020, most European countries reported declining suicide trends, with some exceptions. In particular, alarming trends emerged in the United Kingdom, with annual rises of 2.5% (95% CI: 1.6-3.5) since 2005 among males and 8.5% (95% CI: 4.7-12.6) since 2012 among females. The most favorable trends and lowest suicide rates were in Southern Europe, with 3.1/100,000 persons in Italy (2020) and 3.5/100,000 persons in Spain (2021) among males, and 0.9/100,000 persons in Italy (2020) and 1.1/100,000 persons in Romania (2019) among females. Conversely, the highest rates were in Central-Eastern Europe, with 10.2/100,000 males in the Russian Federation (2019) and 10.0/100,000 males in Poland (2002). Higher suicide rates and significant increases were reported in not European areas. The highest ASR was 15.5/100,000 males in the United States of America, with an annual increase of 3.8% (95% CI: 3.1-4.5) among males in 2009-2020 and 6.7% (95% CI: 5.6-7.8) among females in 2007-2017, followed by a levelling off.

Interpretation

Temporal and geographical comparisons of suicide mortality should be interpreted with caution due to potential misclassification or under-reporting of suicide deaths in some countries.

Funding

None.

Desire for a sense of power and religious suicide in psychobiographical research: combining personality and sociocultural theories

The article presents two theoretical perspectives that provide a helpful framework in psychobiographical research, especially when psychobiographies concern religious suicide. The first is typical in contemporary psychology, a subjective analysis focused on the individual, looking at life course/lifetime in the light of personality psychology. The second one is represented by anthropological research on the concept of honour-shame and the sociological works of E. Durkheim. Contemporary psychobiography should consider sociocultural context and refer to social sciences (anthropology, sociology). This applies in particular to the psychobiographies of people representing a world of values different from the Western world, i.e. non-WEIRD people. The problem is especially true of monotheistic religions that grew up in the world of honour-shame cultural code (Middle East, Mediterranean culture). The natural human need for psychological power is then woven into a specific set of beliefs and values that may, in extreme cases, favour the decision to commit suicide. Suicide acts seen in this perspective are no longer the act of sick or socially alienated people but often the act of fully healthy, conscious, educated and socially integrated people. Such a dramatic decision may become the only way to regain a sense of dignity, strength and control.

Prevalence of Suicidal Behavior Among Students in South-East Asia: A Systematic Review and Meta-Analysis

OBJECTIVES

Estimation of rates of suicidal behaviors (ideation, plan, and attempt) would help to understand the burden and prioritize prevention strategies. However, no attempt to assess suicidal behavior among students was identified in South-East Asia (SEA). We aimed to assess the prevalence of suicidal behavior (ideation, plan, and attempt) among students in SEA.

METHODS

We followed PRISMA 2020 guidelines and registered the protocol in PROSPERO (CRD42022353438). We searched in Medline, Embase, and PsycINFO and performed meta-analyses to pool the lifetime, 1-year, and point prevalence rates for suicidal ideation, plans, and attempts. We considered the duration of a month for point prevalence.

RESULTS

The search identified 40 separate populations from which 46 were included in the analyses, as some studies included samples from multiple countries. The pooled prevalence of suicidal ideation was 17.4% (confidence interval [95% CI], 12.4%-23.9%) for lifetime, 9.33% (95% CI, 7.2%-12%) for the past year, and 4.8% (95% CI, 3.6%-6.4%) for the present time. The pooled prevalence of suicide plans was 9% (95% CI, 6.2%-12.9%) for lifetime, 7.3% (95% CI, 5.1%-10.3%) for the past year, and 2.3% (95% CI, 0.8%-6.7%) for the present time. The pooled prevalence of suicide attempts was 5.2% (95% CI, 3.5%-7.8%) for lifetime and 4.5% (95% CI, 3.4%-5.8%) for the past year. Higher rates of suicide attempts in the lifetime were noted in Nepal (10%) and Bangladesh (9%), while lower rates were reported in India (4%) and Indonesia (5%).

CONCLUSIONS

Suicidal behaviors are a common phenomenon among students in the SEA region. These findings call for integrated, multisectoral efforts to prevent suicidal behaviors in this group.

Childhood Adversity and Passive Suicidal Ideation in Later Life in the United States: Does Religious Attendance Matter?

This study examines whether adverse childhood experiences are associated with passive suicidal ideation in later life and whether religious attendance moderates this association among U.S. older adults. To this end, logistic regression analyses were conducted using data from the 2016 Health and Retirement Study. The results show that poor childhood health, lack of parental affection, and childhood trauma are all positively associated with passive suicidal ideation in later life. However, religious attendance modifies the association between childhood health and passive suicidal ideation. For instance, poor childhood health is associated with greater odds of passive suicidal ideation only for older adults who never attend religious services, while this is not the case for those who attend religious services. Yet, the associations of parental affection and childhood trauma with passive suicidal ideation do not appear to differ by religious attendance. We discuss the theoretical implications of these findings for views about childhood adversity, religion, and suicide risk in later life.

Suicide Among Monotheistic Religions: Between Sacrifice, Honour and Power

This article discusses the problem of suicide in monotheistic religions (Judaism, Christianity and Islam), focusing on their early existence and considering the original contribution of Christianity. The first part presents the main theses of E. Durkheim on altruistic suicide and the concept of honour. This provides an opportunity to examine the problem of suicide in monotheistic religions from a more comprehensive perspective and recognise a certain specificity of suicide that was absent in altrusitic suicide. The analysis of the problem in relation to the concept of honour is also a valuable starting point for complementary psychological theories. The second part of the article is a more detailed discussion of suicide in Judaism, Christianity and Islam. The results provide a better understanding of the origins and nature of suicide in monotheistic religions whilst opening up a discussion on the possibility of suicide prevention.

Is Irreligion a Risk Factor for Suicidality? Findings from the Nashville Stress and Health Study

Suicide is a public health problem and one of the leading causes of death in the United States. Research exploring the linkages between religion and spirituality has received intermittent attention. Data was derived from the Nashville Stress and Health Study (2011-2014), a cross-sectional probability survey of black and white adults from Davidson County, Tennessee (n = 1252). Results indicate that those with no perceived belief in divine control had a higher likelihood of suicidality. This study provides a fresh perspective on the links between religious factors and suicidality by (a) considering multiple religious and spiritual domains and (b) focusing on the association between irreligion and suicidality.

Spirituality, Religiosity and Mental Health: A Clinical-care Approach

No abstract present.

Faith-Based Organizations' Support of Veteran Congregants at Risk for Mental Health Conditions and Suicide: A Qualitative Study of Clergy Experiences in Los Angeles County

Faith-based organizations (FBOs) are often "gatekeepers" to mental health care for congregants at risk of mental illness and suicide, especially U.S. military Veterans, but data to inform better collaboration are needed. We conducted focus groups with clergy in Los Angeles County to understand the mental health support FBOs provide and barriers to collaboration with the mental healthcare system. Clergy detailed strategies used to support the mental health of Veteran congregants. Barriers included stigma, limits in clergy training, and incomplete knowledge about community and VA mental health resources. Results suggest strategies to improve collaboration between FBOs and the mental healthcare system in Los Angeles County.

The Prohibition of Suicide and Its Theological Rationale in Catholic Moral and Canonical Tradition: Origins and Development

This paper analyzes the nuances of the Roman Catholic Church's opposition to suicide. First, we analyze biblical suicide cases, showing that these were not usually met with clear condemnation. Next, we show the development of the Roman Catholic Church's moral teachings, with special attention to Augustine. The canon law of the Middle Ages still made some distinctions regarding motivation, but at this point, Roman Catholic funerals started to be refused to those having committed suicide as discouragement to others. This was maintained by the Council of Trent. In the twentieth century, the Roman Catholic Church followed modern psychiatry in attributing suicide to mental illness, and the ban on Roman Catholic funerals was lifted. Currently, the Roman Catholic Church tries to discourage suicide while accompanying people in need.

The Impact of Suicidality and Spirituality on Substance Use Day Treatment Discharge

PURPOSE

Although spirituality seems to protect against suicidality and substance misuse, in 2022 81% of United States residents believe in God and yet prevalence of these global health issues are increasing. 12-Step programs are inherently spiritual in their approach to recovery.

METHOD

We used a clinically mined dataset built from everyday clinical data that a substance use day treatment program in a midwestern state of the USA originally collected for their treatment purposes. Data included information from 444 client files from three day treatment sites within the same agency. Using logistic regression, we analyzed the relationships between suicidality, spirituality, and treatment discharge.

RESULTS

Suicidality and spirituality, including 12-Step involvement prior to treatment, did not have a statistically significant effect on substance use day treatment discharge. However, treatment length and age were associated with completed treatment.

DISCUSSION AND CONCLUSION

While spirituality and suicidality are important concepts with relevance to recovery, they did not affect whether clients completed substance use day treatment. However, because recovery is not just about abstinence or risk reduction, suicidality and spiritually likely have relevance for the overall recovery process.

Suicide literacy mediates the path from religiosity to suicide stigma among Muslim community adults: Cross-sectional data from four Arab countries

BACKGROUND

The majority of research attention has been devoted to the link between religiosity and suicide risk, and a considerable amount of studies has been carried out on how stigma impacts individuals with mental health problems of different kinds. However, the interplay between religiosity, suicide literacy and suicide stigma has seldom been empirically researched, especially quantitatively. We sought through this study to redress the imbalance of research attention by examining the relationship between religiosity and suicide stigma; and the indirect and moderating effects of suicide literacy on this relationship.

METHOD

A cross-sectional web-based survey was conducted among Arab-Muslim adults originating from four Arab countries (Egypt: N = 1029, Kuwait: N = 2182, Lebanon N = 781, Tunisia N = 2343; Total sample: N = 6335). The outcome measures included the Arabic Religiosity Scale which taps into variation in the degree of religiosity, the Stigma of Suicide Scale-short form to the solicit degree of stigma related to suicide, and the Literacy of Suicide Scale explores knowledge and understanding of suicide.

RESULTS

Our Mediation analyses findings showed that literacy of suicide partially mediated the association between religiosity and stigmatizing attitude toward suicide. Higher religiosity was significantly associated with less literacy of suicide; higher literacy of suicide was significantly associated with less stigma of suicide. Finally, higher religiosity was directly and significantly associated with more stigmatization attitude toward suicide.

CONCLUSION

We contribute the literature by showing, for the first time, that suicide literacy plays a mediating role in the association between religiosity and suicide stigma in a sample of Arab-Muslim community adults. This preliminarily suggests that the effects of religiosity on suicide stigma can be modifiable through improving suicide literacy. This implies that interventions targeting highly religious individuals should pay dual attention to increasing suicide literacy and lowering suicide stigma.

Suicides among Children and Adolescents in Paraguay: An 18-year National Exploratory Study (2004-2022)

BACKGROUND

Suicide and suicide attempts are impacting events for patients and their relatives, and these behaviors are still taboo among adults and may be even more traumatic when involving children and adolescents.

AIM

In this study we aimed to describe suicide rates among children and adolescents in Paraguay over the last decades as well as associated factors such as sociodemographic characteristics and methods used for suicide.

METHODS

This was an observational and exploratory study describing the frequency and characteristics of suicide among children and adolescents in Paraguay between 2004 and 2022. Official records of all deaths by suicide were reviewed, and statistical analyses were performed. In addition, an attempt was made to predict the number of suicides in the next 5 years using a mathematical model based on simple linear regression.

RESULTS

In the 18-year period observed, 940 suicides among children and adolescents were recorded. The mean age was 15.05 ± 1.8 years old. Of these, 51.17% were male, 74.6% were from urban areas, and 22.2% were from the Greater Asunción and Central Department of Paraguay. The most frequently used method of suicide was intentional self-inflicted injury by hanging, strangulation, or suffocation, which all represented 75.3% of the cases. Our mathematical modeling based on simple linear regression determined that the expected yearly number of national suicides in the pediatric population for the following years, from 2023 to 2027, will range between 72 and 81.

CONCLUSION

This study is the first large national epidemiological report on the emerging issue of suicide among children and adolescents in Paraguay. It may be a relevant source of information for mental health professionals, health authorities, and decision makers to develop national prevention strategies and actions against suicide among youths.

Validation of a culturally sensitive, Swahili-translated instrument to assess suicide risk among adults living with HIV in Tanzania

In Tanzania, there are high rates of suicidal thoughts and behavior among people living with HIV (PLWH), yet few instruments exist for effective screening and referral. To address this gap, we developed and validated Swahili translations of the Columbia Suicide Severity Rating Scale (C-SSRS) Screen Version and two accompanying scales assessing self-efficacy to avoid suicidal action and reasons for living. We administered a structured survey to 80 PLWH attending two HIV clinics in Moshi, Tanzania. Factor analysis of the items revealed four subscales: suicide intensity, self-efficacy to avoid suicide, fear and social concern about suicide, and family and spirituality deterrents to suicide. The area under the receiver operating curve showed only suicide intensity, and fear and social concern met the prespecified cutoff of ≥0.7 in accurately identifying patients with a plan and intent to act on suicidal thoughts. This study provides early evidence that brief screening of intensity of suicidality in the past month, assessed by the C-SSRS Screen Version, is a strong, resource-efficient strategy for identifying suicide risk in the Tanzanian setting. Patients who report little fear of dying and low concern about social perceptions of suicide may also be at increased risk.

Suicide under the Nazi-regime: A Case-control Study among Amsterdam Jews

OBJECTIVE

Jewish suicides increased heavily under Nazi-rule. This research investigated risk factors for dying from suicide according to sociodemographic characteristics, local context, and time periods.

METHODS

Nazi-registration of Amsterdam residents of Jewish origin in 1941 linked to death and suicide lists. The added suicides after the Nazi-invasion (1940, n = 115) and the suicides when deportation trains ran (1942/1943, n = 182) were each matched to 25 controls using sex and age. Suicide was compared across migrant, occupational, marital, and religious status and neighborhood religiosity. Conditional logistic regression was applied, stratified by time period.

RESULTS

In 1940, immigrant (cf. native born, odds ratio (OR) 1.89, 95%CI 1.21-2.96, p = .005) and married Jews (cf. previously married) showed higher suicide risk; members of Israelite Congregations (cf. nonmembers, OR 0.35, 95%CI 0.22-0.56, p < .001) showed reduced risk. Jews living in low synagogue rate neighborhoods showed higher risk compared to those living in neighborhoods without any synagogues (OR 2.48, 95%CI 1.65-3.72, p < .001) while those living in high synagogue rate neighborhoods showed no increased risk (OR 0.58, 95%CI 0.30-1.11, p = .10). In 1942/1943, the association between religious status (OR 1.07, 95%CI 0.67, 1.72, p = .77), synagogue rate (OR 1.27, 95%CI 0.91-1.77, p = .16), immigrant status (OR 1.30, 95%CI 0.92-1.84, p = .14) and suicide attenuated; Jews in managerial/professional occupations (cf. workers) or unmarried (cf. married) showed higher risk.

CONCLUSIONS

In 1940, immigrants' higher suicide risk likely indicates greater fear of Nazis while religious affiliation's lower risk might indicate a protective effect of religious belief. In 1942/1943, risk differences markedly attenuated likely indicating increased fear of Nazis among all Jews.HighlightsReligiously affiliated Jews showed reduced risk of dying from suicide after the Nazi-invasionJewish immigrants showed higher risk of dying from suicide after the Nazi-invasionBy 1942/1943, these risks attenuated indicating fear of the Nazis spread and nullified religion's protection.

Suicide and Self-Harm Among Immigrant Youth to Ontario, Canada From Muslim Majority Countries: A Population-Based Study

OBJECTIVE

To examine the association between Muslim religious affiliation and suicide and self-harm presentations among first- and second-generation immigrant youth.

METHODS

We performed a population-based cohort study involving individuals aged 12 to 24 years, living in Ontario, who immigrated to Canada between 1 January 2003 and 31 May 2017 (first generation) and those born to immigrant mothers (second generation). Health administrative and demographic data were used to analyze suicide and self-harm presentations. Sex-stratified logistic regression models generated odds ratios (OR) for suicide and negative binomial regression models generated rate ratios (aRR) for self-harm presentations, adjusting for refugee status and time since migration.

RESULTS

Of 1,070,248 immigrant youth (50.1% female), there were 129,919 (23.8%) females and 129,446 (24.2%) males from Muslim-majority countries. Males from Muslim-majority countries had lower suicide rates (3.8/100,000 person years [PY]) compared to males from Muslim-minority countries (5.9/100,000 PY) (OR: 0.62, 95% CI, 0.42-0.92). Rates of suicide between female Muslim-majority and Muslim-minority groups were not different (Muslim-majority 1.8/100,000 PY; Muslim-minority 2.2/100,000 PY) (OR: 0.82, 95% CI, 0.46-1.47). Males from Muslim-majority countries had lower rates of self-harm presentations than males from Muslim-minority (<10%) countries (Muslim majority: 12.2/10,000 PY, Muslim-minority: 14.1/10,000 PY) (aRR: 0.82, 95% CI, 0.75, 0.90). Among female immigrants, rates of self-harm presentations were not different among Muslim-majority (30.1/10,000 PY) compared to Muslim-minority (<10%) (32.9/10,000 PY) (aRR: 0.93, 95% CI, 0.87-1.00) countries. For females, older age at immigration conferred a lower risk of self-harm presentations.

CONCLUSION

Being a male from a Muslim-majority country may confer protection from suicide and self-harm presentations but the same was not observed for females. Approaches to understanding the observed sex-based differences are warranted.

Nordic region suicide trends 2000-2018; sex and age groups

BACKGROUND AND AIM

Overall, suicide rates in the Nordic region, Denmark, Finland, Iceland, Norway and Sweden, have declined in the past 40 years. The aim of this study was to determine trends in suicide mortality from 2000 to 2018.

METHODS

Data were obtained from official suicide statistics for men and women, 15 years and older. Gender and age groups in four calendar periods were analyzed using Joinpoint Estimated Regression Coefficient.

RESULTS

The crude regional suicide rate was 17.1, 2000-2004, decreased to 14.1 per 100,000 inhabitants in 2015-2018. Age-standardized rates are 13.6-11.3. The crude rate decreased by 19.5% (16.3% age-standardized), 19.3% for males and 20.5% for females. The largest decrease was found in Finland (34.9%), the smallest in Norway (1.4%). In males, the exception was an increased suicide rate among all Icelandic except 15-24-year olds, and in 45-64 year-old Norwegians. Among females, an increase was seen among 15-24-year olds in all countries except Iceland, in all age groups in Norway, and in 25-44-year olds in Sweden. In males, a decline of the suicide rated lower than 10% was noted in 25-44 olds in Norway and in 15-64 year-olds in Sweden.

DISCUSSION

A robust decrease was observed in the overall regional suicide rate in recent years. Exceptions are rising rates in Icelandic males, in Norwegian females, and the youngest female groups in all except Iceland. The small decline among middle-aged males in Norway and Sweden is of concern.

Trust in higher guidance and suicidality in Afghan students under the Taliban regime{fr}(Confianza en la orientación superior y suicidalidad en estudiantes afganos bajo el régimen Talibán)

Background/Objective

After years of war, political instability and natural catastrophes high rates of PTSD and depression have been found in the Afghan population. On this background, it was investigated whether religious beliefs (trust in higher guidance; TIHG) moderated the association between PTSD symptoms and/or depression and suicidal ideation.

Method

A total of 279 Afghan university students (61.6% women; aged 18 to 30 years) took part in this cross-sectional study between July and November 2022. Self-report measures of PTSD, depression, suicidal ideation, trust in higher guidance were used.

Results

Severe PTSD symptoms were reported by 58.4%, clinically relevant depression symptoms were reported by 55.2% and current suicidal ideation was reported by 44.4% of the sample. TIHG moderated the impact of PTSD symptoms, on suicidal ideation. TIHG and depression were unrelated.

Conclusion

PTSD symptoms, depression and suicidal ideation show an alarmingly high prevalence in this specific sample of Afghan students. TIHG seems to be a resilience factor of special importance.

Religious affiliation and oral health-related quality of life: a cross-sectional study based on a nationally representative survey in Germany

BACKGROUND

Studies have shown an association between a person's religiosity, and physical as well as psychological, health status. However, results differ between certain religious affiliations. While good oral health is important for our overall health and wellbeing, research on religious affiliation and oral health status, specifically oral health-related quality of life (OHRQoL), is lacking. Thus, our aim was to investigate the association between religious affiliation and OHRQoL.

METHODS

A nationally representative online survey (n = 3,075 individuals) was conducted in August/September 2021. The mean age was 44.5 years (SD: 14.8 years, 18 to 70 years) and 51.1% of the individuals were female. OHRQoL was measured using the Oral Health Impact Profile (OHIP-G5). Religious affiliation served as key explanatory variable. Several covariates were included in regression analyses.

RESULTS

Regressions revealed that compared to individuals with no religious affiliation, individuals belonging to Christianity had poorer OHRQoL (β = 0.31, p < 0.01), individuals belonging to Islam had poorer OHRQoL (β = 2.62, p < 0.01) and individuals belonging to another religious affiliation also had poorer OHRQoL (β = 1.89, p < 0.01).

CONCLUSION

Our study demonstrated an association between religious affiliation and OHRQoL. Individuals with specific religious affiliations should be addressed to avoid low OHRQoL.

The role of spirituality and religiosity on the suicidal ideation of medical students

BACKGROUND

There is solid evidence that spirituality and religiousness may reduce the suicidal ideation of individuals. However, studies are scarce on medical students.

AIMS

To investigate the relationship between spirituality, religiousness, and suicidal ideation among Brazilian medical students.

METHODS

This is a cross-sectional study including Brazilian medical students. Sociodemographic and health variables, suicidal ideation (item 9 of the Beck Depression Inventory - BDI), spiritual and religious Coping (Brief SRC), religiousness (Duke Religion Index), spiritual well-being - Meaning, Peace and Faith (FACIT SP-12), and depressive (PHQ-9) and anxiety (GAD-7) symptoms were assessed.

RESULTS

A total of 353 medical students were included, 62.0% presented significant depressive symptoms, 44.2% presented significant anxiety symptoms, and 14.2% presented suicidal ideation. In the adjusted Logistic Regression models, meaning (OR = 0.90, p = .035) and faith (OR = 0.91, p = .042) were associated with lower suicidal ideation, while negative spiritual and religious coping was associated with greater suicidal ideation (OR = 1.08; p = .006).

CONCLUSION

There was a high prevalence of suicidal ideation among Brazilian medical students. Spirituality and religiousness were associated with suicidal ideation in two different directions. These findings could help educators and health professionals to understand suicidal ideation among medical students, helping in the development of preventive strategies to mitigate such problem.

Effects of religion on the course of suicidality among geriatric patients with mood disorders

BACKGROUND

A growing volume of research suggests that religion protects against late-life suicide, but it remains unclear whether effects are relevant to clinical samples, which facets of religion are most relevant, and variations over the course of mood disorders (e.g. during periods of euthymia, depression, and/or heightened suicidality).

METHOD

Eighty adults aged 55-85 years with mood disorders completed assessments of religion (affiliation, service attendance, importance of religion, belief and faith in God), depression, and suicidality over time (M = 7.31 measurements over M = 727 days). We computed metrics to identify mean and maximum levels of depression and suicidality, and the number of episodes of significant depression and suicidality experienced by each participant.

RESULTS

Religious affiliation and importance of religion, but not service attendance, belief, or faith in God, were associated with lower mean and maximum depression. Conversely, all facets of religion predicted significantly lower mean and maximum levels of suicidality (rs ranging from -0.24 to -0.39), and substantially less likelihood of experiencing significant suicidality during the study (ORs ranging from 0.19 to 0.33). Service attendance, belief, and faith in God predicted less suicidality even among individuals who did not affiliate with a religious group.

CONCLUSIONS

Religious factors, particularly faith in God, are associated with substantially less suicidality over time among older adults with mood disorders, irrespective of religious affiliation.

Life-Satisfaction, Engagement, Mindfulness, Flourishing, and Social Support: Do they Predict Depression, Suicide Ideation, and History of Suicide Attempt in Late Life?

OBJECTIVE

Suicide is an outcome arising from a combination of risk and protective factors. Examining psychological resilience traits associated with successful aging may help to better understand late-life suicide and depression. We examined self-reported protective factors including mindfulness, life satisfaction and engagement, flourishing, and subjective and objective social support in a high suicide-risk sample of depressed older adults.

METHODS

Participants were 297 individuals aged 55+ (mean age: 64.2): 92 depressed suicide attempters, 138 depressed individuals who never attempted suicide, and 67 non-psychiatric comparisons. Using linear and binomial logistic regression, we examined the effects of a combined Protective Factor value on presence and severity of depression and suicidal ideation, and history of suicide attempt.

RESULTS

Relative to the non-psychiatric comparison group, all depressed participants had significantly lower Protective Factor values. Higher Protective Factor value was associated with lower likelihood of depression, depression severity, and likelihood of ideation, but was not associated with ideation severity or history of suicide attempt. Participants with one standard deviation higher Protective Factor had lower odds of ideation incidence by a factor of OR=0.68 (95%CI=0.48-0.96).

CONCLUSION

Resiliency characteristics relevant to psychological wellbeing and successful aging may mitigate the emergence of depression and suicidal ideation, as well as the severity of depression in late-life. The Resilience Factor used in this study can help clinicians nuance their appraisal of depression and suicide risk.

Gone Too Soon: priorities for action to prevent premature mortality associated with mental illness and mental distress

Globally, too many people die prematurely from suicide and the physical comorbidities associated with mental illness and mental distress. The purpose of this Review is to mobilise the translation of evidence into prioritised actions that reduce this inequity. The mental health research charity, MQ Mental Health Research, convened an international panel that used roadmapping methods and review evidence to identify key factors, mechanisms, and solutions for premature mortality across the social-ecological system. We identified 12 key overarching risk factors and mechanisms, with more commonalities than differences across the suicide and physical comorbidities domains. We also identified 18 actionable solutions across three organising principles: the integration of mental and physical health care; the prioritisation of prevention while strengthening treatment; and the optimisation of intervention synergies across social-ecological levels and the intervention cycle. These solutions included accessible, integrated high-quality primary care; early life, workplace, and community-based interventions co-designed by the people they should serve; decriminalisation of suicide and restriction of access to lethal means; stigma reduction; reduction of income, gender, and racial inequality; and increased investment. The time to act is now, to rebuild health-care systems, leverage changes in funding landscapes, and address the effects of stigma, discrimination, marginalisation, gender violence, and victimisation.

A Qualitative Examination of the Impact of Suicidal Thoughts and Behavior on Help-Seeking Among University Students in Colombia and Mexico

This study examined descriptions of suicidal thoughts and behavior (STB) to identify risk and protective factors that may present in clinical settings among university students from Latin America. Our focus was on answering the following key questions: How are suicidal thoughts and behavior described? What are reasons for wanting to die and for living? What impact do STBs have on motivations to seek or avoid psychological treatment? To this end, 55 qualitative interviews were completed with university students from Colombia and Mexico who recently endorsed emotional difficulties in the World Mental Health International College Student (WMH-ICS) surveys. Interviews were coded to identify themes specific to STBs. Findings revealed insight on symptom presentations and consequences of STBs. Participants described uncontrollable somatic symptoms during periods of high suicide risk, which serves as a relevant clinical marker for health providers. An important reason for living was to avoid suffering for family, which was protective against suicide and motivates familial involvement in treatment planning. Participants sought solutions to emotional problems after experiencing STBs, including psychological treatment. Cultural stigma of mental illness induced feelings of shame and burden, which led to avolition, avoidance, and nondisclosure of symptom severity. This study provides insight into the utility of evaluating cultural context in (a) detecting antecedents to STBs frequently reported as somatic symptoms, (b) identifying protective factors against suicide, and (c) recognizing how stigma of mental illness and suicide, shame avoidance, and familism might influence personal motivations to seek or avoid help for emotional distress.

Qualitative research in suicidology: a systematic review of the literature of low-and middle-income countries

BACKGROUND

Suicide is more prevalent among disadvantaged, discriminated, and marginalised people with the majority of global suicide deaths occurring in the low-and middle-income countries (LMICs). This can be attributed to sociocultural contexts and exacerbated by access to limited resources and services that can assist with early identification, treatment, and support. Accurate information on the personal experiences of suicide is lacking, as many LMICs legislate that suicide is illegal.

METHODS

This study aims to review the qualitative literature to explore the experiences of suicide in LMICs from the first-person perspective. Following the PRISMA-2020 guidelines, the search for qualitative literature published between January 2010 and December 2021 was undertaken. A total number of 110 qualitative articles from 2569 primary studies met the inclusion criteria. Included records were appraised, extracted, and synthesised.

RESULTS

The results provide lived experience insight into suicide from those living in LMICs, including understanding variations of the causes of suicides, the impacts on others exposed to suicide, existing support systems, and prevention measures to reduce suicide among LMICs. The study offers a contemporaryunderstanding of how people in LMIC experience suicide.

CONCLUSIONS

The findings and recommendations are derived from the similarities and differences within the existing knowledge base that is dominated by evidence from high-income countries. Timely suggestions for future researchers, stakeholders, and policymakers are provided.

Exploring the role of religion in the recovery experiences of suicide attempt survivors in Ghana

BACKGROUND

Religion performs a doubled edged role in a suicide crisis. On the one hand, it elicits empathic responses towards suicidal persons. On the other, it condemns and shames them. Although there is evidence that religion promotes better health and general wellbeing, little attention has been given to its role in recovery, especially after a suicide attempt. The current study explored how religion facilitated recovery among suicide attempt survivors.

METHODS

Using a semi-structured interview guide, we interviewed suicide attempt survivors who had attended a psychiatric unit. Thematic analysis was used to analyse the data.

RESULTS

Ten suicide attempters were interviewed, six females and four males. Three major themes were identified: Reasons in context, Religion in the recovery process and Renewed commitment to religious rituals/practices.

CONCLUSIONS

The role of religion in suicide prevention as a resource, is a complex one. Suicide preventionists need to carefully guide and gauge their prevention efforts in context where religion is rife to provide suicide attempt survivors the most effective religious resource in their recovery trajectory.

Changes in suicide in California from 2017 to 2021: a population-based study

BACKGROUND

Suicide is a major public health problem with immediate and long-term effects on individuals, families, and communities. In 2020 and 2021, stressors wrought by the COVID-19 pandemic, stay-at-home mandates, economic turmoil, social unrest, and growing inequality likely modified risk for self-harm. The coinciding surge in firearm purchasing may have increased risk for firearm suicide. In this study, we examined changes in counts and rates of suicide in California across sociodemographic groups during the first two years of the COVID-19 pandemic relative to prior years.

METHODS

We used California-wide death data to summarize suicide and firearm suicide across race/ethnicity, age, education, gender, and urbanicity. We compared case counts and rates in 2020 and 2021 with 2017-2019 averages.

RESULTS

Suicide decreased overall in 2020 (4123 deaths; 10.5 per 100,000) and 2021 (4104; 10.4 per 100,000), compared to pre-pandemic (4484; 11.4 per 100,000). The decrease in counts was driven largely by males, white, and middle-aged Californians. Conversely, Black Californians and young people (age 10 to 19) experienced increased burden and rates of suicide. Firearm suicide also decreased following the onset of the pandemic, but relatively less than overall suicide; as a result, the proportion of suicides that involved a firearm increased (from 36.1% pre-pandemic to 37.6% in 2020 and 38.1% in 2021). Females, people aged 20 to 29, and Black Californians had the largest increase in the likelihood of using a firearm in suicide following the onset of the pandemic. The proportion of suicides that involved a firearm in 2020 and 2021 decreased in rural areas compared to prior years, while there were modest increases in urban areas.

CONCLUSIONS

The COVID-19 pandemic and co-occurring stressors coincided with heterogeneous changes in risk of suicide across the California population. Marginalized racial groups and younger people experienced increased risk for suicide, particularly involving a firearm. Public health intervention and policy action are necessary to prevent fatal self-harm injuries and reduce related inequities.

Associations of self-isolation, social support and coping strategies with depression and suicidal ideation in U.S. young adults during the COVID-19 pandemic

There have been concerns about the psychological impact of COVID-19-related stressors on young adults. However, there remains limited information regarding how psychosocial factors and coping strategies correlate with suicidal ideation in young adults during the pandemic. We studied a cross-sectional, observational online survey using a probability-based, nationally representative sample of U.S. young adults aged 18 to 29 (N = 1077). We performed weighted logistic regression to evaluate how self-isolation, social support and coping strategies (exposures) were associated with depression and suicidal ideation (outcomes), adjusting for age, gender, race, educational level and sexual orientation. The method of multiple imputations for addressing missing data was executed through chained equations. A total of 296 participants had depression, while 323 had suicidal ideation. Individuals who consistently self-isolated exhibited nearly threefold higher odds of depression compared to those without self-isolation. Social support was consistently protective against depression and suicidal ideation. Coping through positive reframing was protective against depression and suicidal ideation, whereas substance use, self-blame and behavioural disengagement had the opposite impact. Providing social support may help prevent suicidal ideation among young adults during the pandemic. Interventions that focus on developing young adults' coping strategies, such as through positive reframing, are recommended to develop positive and healthy relationships. Healthcare providers should advise against substance use, self-blame and behavioural disengagement.

The Near-Death Experience and Suicidal Ideation

The near-death experience (NDE) most generally refers to a state of altered consciousness with various features that can occur during real or presumed near-death circumstances and/or life-threatening incidents. Some NDEs are associated with a nonfatal suicide attempt. This paper discusses how a belief by suicide attempters that their NDEs are a true portrayal of objective spiritual reality can at least in some cases be positively associated with a persistence or increase of suicidal ideation and on occasion lead to further suicide attempts, while also exploring why at other times such a belief may reduce the risk of suicide. The formulation of suicidal ideation associated with NDEs among some of those who did not initially try to kill themselves is also explored. Various examples related to NDEs and suicidal ideation are provided and discussed. Furthermore, this paper also offers some theoretical insights related to this matter and points out some specific therapeutic concerns based on this discussion.

The Relationship Between Religious Orientation, Coping Strategies and Suicidal Behaviour

The aim of this study was to investigate the relationship between religious orientation, coping strategies and suicidal behaviour among secondary school adolescents and college students. A total of 196 participants (73 adolescents and 123 adults college students) completed the online survey consisting of the Religious-Orientation Scale-Revised, Brief COPE and Suicidal Behaviours Questionnaire-Revised. Adolescents in secondary school had higher odds of suicidal thoughts and behaviour than college students (OR 4.40, 95% CI: 1.133, 17.094, p = 0.032). Individuals who employed an avoidant coping strategy had higher odds of suicidal thoughts and behaviour after adjusting for other relevant variables, which indicated that when a person engages in avoidant coping strategy, it is most likely that they have a higher odds of suicidal thoughts and behaviour (OR 1.118, 95% CI: 1.050, 1.189, p < 0.001). There is an urgent need to initiate psychological interventions to reduce suicide behaviour risk among Malaysian secondary school adolescents.

COVID-19 Stress, Religious Affiliation, and Mental Health Outcomes Among Adolescents

PURPOSE

To examine the relationship between religious affiliation, stressors due to the COVID-19 pandemic, and mental health challenges in a representative sample of adolescents.

METHODS

The sample was composed of 71,001 Utah adolescents who participated in a survey by the Utah Department of Health in 2021. Data are representative of all Utah adolescents in grades 6, 8, 10, and 12. Bootstrapped mediation was used to test indirect effects of religious affiliation on mental health challenges through COVID-19 stressors.

RESULTS

Religious affiliation was related to significantly lower rates of teen mental health challenges as measured by suicidal thoughts, suicide attempts, and depression. For religiously affiliated adolescents, the rate of considering and attempting suicide was nearly half of that of unaffiliated adolescents. In mediation analyses, affiliation was indirectly related to mental health challenges (suicide ideation, suicide attempt, and depression) through stressors from COVID-19, including affiliated adolescents experiencing the following: less anxiety, fewer family fights, fewer school difficulties, and fewer skipped meals. However, affiliation was positively related to becoming sick with COVID-19 (or having COVID-19 symptoms), which was related to more suicidal thoughts.

CONCLUSIONS

Findings suggest that adolescent religious affiliation may be a promotive factor that decreases mental health challenges through a reduction in COVID-19-related stressors, except religious individuals may be more likely to become sick. To increase positive mental health outcomes among adolescents during pandemic times, consistent and clear policies that facilitate religious connections that also align with good physical health measures will be critical.

Adaptation, Validity, and Reliability of the Patient Health Questionnaire (PHQ-9) in the Kurdistan Region of Iraq

AIM

The Patient Health Questionnaire (PHQ-9) is widely used for detecting and screening depression in Iraq. However, no psychometric assessment has been performed on any Iraqi version. This study aims at studying the reliability and validity of the Iraqi Kurdish version of the PHQ-9 as tool for identifying depression.

METHODS

A cross-sectional study design was used; data were collected from 872 participants (49.3% female and 51.7% male) at Primary Health Care Centers (PHCCs) in the host community as well as from Internal Displaced Persons (IDPs) and refugee camps. Sociodemographic information was obtained; PHQ-9 for the diagnosis and screening of depression and Self Reporting Questionnaire 20 items (SRQ-20) for the screening of common mental illnesses were administered. Validity and reliability analyses were performed.

RESULTS

In total, 19% of the participants had a PHQ-9 total score equal to or higher than the clinical cut-off of 10 for diagnosing depressive disorder. The internal consistency of the PHQ-9 was good (Cronbach's alpha coefficient was 0.89). Good concurrent validity for PHQ-9 compared with SRQ-20 (71%, p < 0.001) was found.

CONCLUSIONS

The PHQ-9 demonstrates good psychometric properties and proves to be a good tool for detecting and screening depression.