Relationship of religion with suicidal ideation, suicide plan, suicide attempt, and suicide death: a meta-analysis

BACKGROUND

Suicide is a significant public health problem and one of the leading causes of death worldwide. The effect of religion on suicidal behaviors (i.e., ideation, plan, attempt, and death) is an important issue worthy of consideration.

METHODS

Major electronic databases, including MEDLINE, Web of Science, and Scopus, were searched for the articles published until 26 April 2021. Reference lists were also screened. Observational studies addressing the associations between religion and suicidal behaviors were also examined. Between-study heterogeneity was investigated using the χ2, τ2, and I2 statistics. The probability of publication bias was explored using the Begg and Egger tests, as well as trim-and-fill analysis. The effect size was expressed as odds ratio (OR) with 95% confidence intervals (CIs) using a random-effects model.

RESULTS

Out of 11 389 identified studies, 63 articles were eligible, involving 8,053,697 participants. There was an inverse association between religion and suicidal ideation OR  =  0.83 (95% CI: 0.78, 0.88; P < 0.001), suicidal plan OR  =  0.93 (95% CI: 0.83, 1.04; P =  0.200), suicide attempt OR  =  0.84 (95% CI: 0.79, 0.89; P < 0.001), and completed suicide OR  =  0.31 (95% CI: 0.14, 0.72; P =  0.006). There was a no evidence of publication bias.

CONCLUSIONS

The results of this meta-analysis support the notion that religion can play a protective role against suicidal behaviors. Nonetheless, the effect of religion on suicidal behaviors varies across countries with different religions and cultures. Although this association does not necessarily imply causation, an awareness of the relationship between religion and suicide risk can be of great help in suicide prevention policies and programs.

Psychometric Properties of the Five-Item Francis Attitude Towards Christianity Scale in Colombian Psychiatric Outpatients

This study aimed to know the psychometric properties of the five-item Francis scale of the attitude towards Christianity (Francis-5) by assessing psychiatric outpatients in Santa Marta, Colombia. A sample of 260 adult patients participated. The exploratory and confirmatory factor analyses revealed an excellent one-dimensional structure with high internal consistency. It was concluded that the Francis-5 exhibited good indicators of validity and reliability in Colombian psychiatric outpatients.

Comparison of religiosity and spirituality in patients of depression with and without suicidal attempts

AIM

This study is aimed to compare the religiosity and spirituality of patients with first-episode depression with suicidal ideation and those with recent suicidal attempts. Additional aim was compare the religiosity and spirituality of patients with first-episode depression with healthy controls.

METHODS

Patients of first episode depression with suicidal ideation and healthy controls were assessed by Centrality of Religiosity Scale (CRS), Duke University Religion Index (DUREL), Brief Religious coping scale (R-COPE), and Spiritual Attitude Inventory (SAI).

RESULTS

Patients with depression were divided into two groups based on the presence (n = 53) or absence (n = 62) of suicidal attempts in the previous 14 days. Both the patients with and without suicide attempts were matched for depression severity. Both the patient groups did not differ in terms of religiosity and spirituality as assessed using CRS and SAI. Both depression groups had lower scores on religiosity as compared to healthy controls as assessed on CRS. The two groups also had a lower score on the "sense of hope" which is a part of SAI, when compared to healthy controls. Compared to patients without suicide attempts (i.e., ideators group) and healthy controls, subjects with suicide attempts more often used negative religious coping. Total numbers of lifetime suicide attempts in the attempt group were associated with the ideology domain of the CRS.

CONCLUSION

Compared with healthy controls, patients with depression have lower levels of religiosity and spirituality. In the presence of comparable severity of depression, higher use of negative religious coping is associated with suicide attempts.

Religiosity and Spirituality of patients with severe mental disorders

BACKGROUND

Religion and spirituality form an integral part of life, yet have been poorly studied in patients with mental illness.

AIM

This study evaluated the religious and spiritual practices, a sense of purpose/connection, religious/spiritual belief and sense of hope/control among clinically stable patients diagnosed with schizophrenia, bipolar disorder, and depression and compared the same with healthy controls. It also aimed to evaluate the association of residual psychopathology with various dimensions of religiosity and spirituality.

MATERIALS AND METHODS

Patients diagnosed with schizophrenia, bipolar disorder, and major depressive disorder, in a state of clinical remission were assessed on the Spiritual Attitude Inventory and compared with a healthy control group.

RESULTS

A total of 284 participants were recruited, which included patients with major depressive disorder (n = 72), bipolar disorder (n = 75), schizophrenia (n = 63), and healthy controls (n = 74). The groups were matched for age and gender. As compared to healthy controls, participants with any severe mental disorder had significantly lower participation in organized religious activities. In terms of existential well-being, all patient groups had significantly lower scores than the healthy control group. Patients with severe mental disorders significantly more frequently used negative religious coping than the healthy controls and also had lower scores on the sense of purpose. No significant difference was observed between the three patient groups on various dimensions of religiosity and spirituality as assessed in the present study. In patients with schizophrenia, higher use of negative religious coping was associated with greater residual psychopathology.

CONCLUSION

Considering the association of negative religious coping with residual psychopathology, there is a need to incorporate psychological interventions to address religious and spiritual issues for patients with various severe mental disorders.

Path Analysis Testing the Development of Personality and Psychological Well-being Model

The purpose of this study was to test the development of personality and psychological well-being model. This was a cross-sectional, descriptive design. The 448 participants were recruited from older adults living in a Midwest community in the United States. After Institution of Research Board approval, the trained researchers explained this study to older adults who lived in the community. After agreeing to participate, they signed an informed consent form. The structured questionnaires were used to perform data collection. Path analysis was used to examine this model. SPSS 23 version was employed to examine the instruments' reliabilities and descriptive data. In this model, family interaction and spiritual well-being had significant influences on personality, which had a significant influence on selecting coping strategies. Using different coping strategies influenced on the outcome variables (e.g., psychological well-being and suicidal ideation). The family interaction and spiritual well-being played a critical role on the outcome variables.

The association of religiosity with suicidal ideation and suicide attempts in the United Kingdom

OBJECTIVE

The goal was to analyze the association of religiosity with suicidal ideation and suicide attempts in a UK nationally representative sample.

METHODS

This study used cross-sectional data from 7403 people who participated in the 2007 Adult Psychiatric Morbidity Survey (APMS). Religion was assessed with the question 'Do you have a specific religion?' with 'yes' and 'no' answer options. Lifetime and past 12-month suicidal ideation and suicide attempts were assessed. The association between religiosity and suicidality was studied in multivariable logistic regression models adjusted for sociodemographic, behavioural, and psychopathological factors.

RESULTS

Compared to those without a religion, the prevalence of past 12-month suicidal ideation (3.2% vs. 5.4%), past 12-month suicide attempts (0.4% vs. 0.9%), lifetime suicidal ideation (11.2% vs. 16.4%), and lifetime suicide attempts (3.6% vs. 6.0%) was lower among those with a religion. In the fully adjusted model, having a religion was significantly associated with lower odds for all types of suicidality except past 12-month suicide attempts: suicidal ideation (past 12-month: OR = 0.71, 95% CI = 0.51-0.99; lifetime: OR = 0.83, 95% CI = 0.69-0.99) and suicide attempts (past 12-month: OR = 0.71, 95% CI = 0.35-1.45; lifetime: OR = 0.69, 95% CI = 0.53-0.90).

CONCLUSION

There is a negative association between religiosity and suicidality in the UK. Future studies should focus on the underlying mechanisms.

Including the 'Spiritual' Within Mental Health Care in the UK, from the Experiences of People with Mental Health Problems

Spirituality as a dimension of quality of life and well-being has recently begun to be more valued within person-centred treatment approaches to mental health in the UK. The aim of this paper is to provide indicators of the extent to which accessing a spiritual support group may be useful within mental health recovery from the view point of those in receipt of it. The study design was a small-scale exploratory study utilising mixed methods. Quantitative methods were used to map the mental health, general well-being and social networks of the group. These were complimented by a semi-structured open-ended interview which allowed for Interpretative Phenomenological Analysis (IPA) of the life-history accounts of nine individuals with mental health problems who attended a 'spirituality support group'. Data from unstructured open-ended interviews with five faith chaplains and a mental health day centre manager were also analysed using thematic analysis. The views of 15 participants are therefore recounted. Participants reported that the group offered them: an alternative to more formal religious organisations, and an opportunity to settle spiritual confusions/fears. The 'group' was also reported to generally help individual's subjective feelings of mental wellness through social support. Whilst the merits of spiritual care are appealing, convincing services to include it within treatment may still be difficult.

Cronbach's α reliability, concurrent validity, and factorial structure of the Death Depression Scale in an Iranian hospital staff sample

OBJECTIVE

Death depression is an important component in the process of death and dying. Death depression is the second element of death. Depression is one of the important features in death distress. The aim of this study was to explore the performance of the Farsi version of the Death Depression Scale with an Iranian convenience sample of nurses (n = 106).

METHODS

Nurses were selected using a convenience sampling method, and completed the Death Depression Scale (DDS), Death Concern Scale (DCS), Collett-Lester Fear of Death Scale (CLFDS), Reasons for Death Fear Scale (RDFS), Templer's Death Anxiety Scale (DAS), and Death Obsession Scale (DOS).

RESULTS

The results of exploratory factor analysis on DDS identified 4 factors (56.16% of variance). Factor 1 labeled "Death sadness", Factor 2 labeled "Death finality/end and Death dread/fear", Factor 3 labeled "Death despair and Death depression", and Factor 4 labeled "Death loneliness". Cronbach's α coefficient was 0.84, Spearman-Brown coefficient 0.85, and Guttman Split-Half coefficient 0.81 The DDS correlated 0.40 with the DCS, 0.39 with the CLFDS, 0.50 with the DAS, 0.35 with the RDFS, and 0.44 with the DOS, indicating good construct and criterion-related validity. Concurrent validity for the DDS with the other scales were significant.

CONCLUSIONS

The DDS has good validity and reliability, and it can use in clinical and research settings.

Religion and Suicide Risk: A Systematic Review

Although religion is reported to be protective against suicide, the empirical evidence is inconsistent. Research is complicated by the fact that there are many dimensions to religion (affiliation, participation, doctrine) and suicide (ideation, attempt, completion). We systematically reviewed the literature on religion and suicide over the last 10 years (89 articles) with a goal of identifying what specific dimensions of religion are associated with specific aspects of suicide. We found that religious affiliation does not necessarily protect against suicidal ideation, but does protect against suicide attempts. Whether religious affiliation protects against suicide attempts may depend on the culture-specific implications of affiliating with a particular religion, since minority religious groups can feel socially isolated. After adjusting for social support measures, religious service attendance is not especially protective against suicidal ideation, but does protect against suicide attempts, and possibly protects against suicide. Future qualitative studies might further clarify these associations.

Self-Reported Religiosity in Kuwaiti and American College Students

In previous research, Kuwaiti students obtained higher scores than American students on a religiosity scale. For the present study, the self-reported religiosity of Kuwaiti and American students was assessed using a single item. The respondents were 154 Kuwaiti students ( M age = 20.8 yr., SD = 2.4) and 154 American college students ( M age = 21.8 yr., SD = 5.0; 82% women in both samples). The Kuwaiti students responded in Arabic and the American students in English to the question: “What is your level of religiosity in general?” using an 11-point Likert format anchored by 0 and 10. The high score indicates high religiosity. The Kuwaiti students obtained a significantly higher mean score for religiosity than did their American counterparts (6.5 vs 4.5), indicating that religiosity is more important in the lives of the present sample of Kuwaiti students than in their American counterparts. A single-item self-rating scale may be useful in brief surveys such as epidemiological studies.