Religion and spirituality along the suicidal path

The inner experience of spiritual and religious feelings is an integral part of the everyday lives of many individuals. For over 100 years the role of religion as a deterrent to suicidal behavior has been studied in various disciplines. We attempt to systematize the existing literature investigating the relationship between religion/spirituality and suicide in this paper. After an overview of the attitudes of the dominant religions (e.g., Catholicism, Islam, and Buddhism) toward suicide, the three main theories that have speculated regarding the link between religion and suicide are presented: "integration theory" (Durkheim, 1897/1997), "religious commitment theory" (Stack, 1983a; Stark, 1983), and "network theory" (Pescosolido & Georgianna, 1989). Subsequent to this theoretical introduction, we report on studies on religion/spirituality keeping the suicidal path as a reference: from suicidal ideation to nonlethal suicidal behavior to lethal suicidal behavior. Studies presenting indications of religious beliefs as a possible risk factor for suicidal behavior are also presented. The last section reviews possible intervention strategies for suicidal patients and suicide survivors. Indications for future research, such as more studies on nonreligious forms of spirituality and the use of qualitative methodology to achieve a better and deeper understanding of the spiritual dimension of suicidal behavior and treatment, are offered.     

Between Hippocrates and God: Ugandan mental health professional's views on suicide

A negative attitude towards suicide is generally assumed to be predominant in low-income countries. In order to understand the negative attitude in general it is necessary to look at how religion and morality influence the attitudes. Our aim in this qualitative interview study was to investigate what attitudes professional mental health workers in Uganda bear towards suicide and suicidal persons. The professionals argue for their attitude by employing religious, communal and medical ethics arguments, which draw both in a negative and positive direction. The professionals are in general unambiguously negative towards suicide and positive towards suicidal people who are mentally ill. In cases other than mental illness non-accepting attitudes surface. This is discussed against previous research showing that effective treatment of suicidal people is to be based on a trusting and accepting relationship.     

Religious Commitment,Attitudes Toward Suicide,and Suicidal Behaviors Among College Students of Different Ethnic and Religious Groups in Malaysia

The variation in suicide patterns across ethnic groups with different religious background is a puzzling social phenomenon. This study sought to examine the impact of religious commitment and attitudes toward suicide on suicidal behaviors of college students across major ethnic and religious groups in a multicultural society of Malaysia. A total of 139 college students completed Religious Commitment Inventory-10, Attitudes Toward Suicide Scale, and Suicidal Behavior Questionnaire-Revised. Findings showed significant discrepancies in attitudes toward suicide, but not suicidal behaviors across ethnic and religious groups. Suicide acceptance significantly affected suicidal behaviors as well. Although religious commitment is not associated with suicidal behaviors, its deviation is reflected in students’ acceptance of suicide. Additionally, college students’ suicide risk, lifetime, and recent suicide ideation, as well as their likelihood of future suicide attempt can be associated with their acceptance of suicide. The influence of attitudes toward suicide and religion, therefore, should be taken into consideration while implementing suicide prevention programs as it helps shape the norms about suicide among youths.     

Suicide method runs in families: a birth certificate cohort study of adolescent suicide in Taiwan

Suicide method used by adolescents was examined to determine if it was the same as that employed by their suicidal parents. Six hundred eighty adolescents completed suicide between 1997 and 2007, of whom 12 had parents who had previously died by suicide. The suicide method used by these adolescents was compared with that employed by their suicidal parent and that of a matched peer control adolescent with no exposure to parental suicide and living in the same area. In 10 of the 12 suicidal parent-adolescent dyads, the same suicide method was employed by parent and adolescent. Of seven adolescents whose age at parental suicide was 15 years or above, six used the same suicide method as their suicidal parent had. On the contrary, of 12 exposure-nonexposure suicidal adolescent dyads, the same method was used in only four. Adolescents exposed to parental suicide are more likely to use the suicide method employed by their suicidal parents than the method used by adolescent peers with no exposure to parental suicide.     

Religion and Suicide: Buddhism,Native American and African Religions,Atheism, and Agnosticism

Research has repeatedly demonstrated that religiosity can potentially serve as a protective factor against suicidal behavior. A clear understanding of the influence of religion on suicidality is required to more fully assess for the risk of suicide. The databases PsycINFO and MEDLINE were used to search peer-reviewed journals prior to 2008 focusing on religion and suicide. Articles focusing on suicidality across Buddhism, Native American and African religions, as well as on the relationship among Atheism, Agnosticism, and suicide were utilized for this review. Practice recommendations are offered for conducting accurate assessment of religiosity as it relates to suicidality in these populations. Given the influence of religious beliefs on suicide, it is important to examine each major religious group for its unique conceptualization and position on suicide to accurately identify a client’s suicide risk.     

Suicidal ideation,affective lability,and religion in depressed adults

Suicidal ideation is a strong precursor to suicidal acts and like depression is complex with many risk and protective factors. The purpose of this study is to determine if affect lability, positive and negative religion/spirituality (RS) are related to suicidal ideation and if RS mediates the relationship between affect lability and suicidal ideation. RS are used synonymously to reflect a multidimensional construct. In this cross-sectional study of 183 depressed psychiatric patients, we confirm that depression and affective lability both contribute to suicidal ideation. Positive RS is associated with lower suicidal ideation. Negative RS is associated with higher suicidal ideation; however, this occurs through its association with affective lability. Affective lability and negative aspects of RS are two factors related to suicide ideation that could be addressed in the treatment of depressed patients.     

Religion and suicidal ideation in a sample of Latin American immigrants

The present study explored the association of measures of religious activities and suicidal ideation in a sample of adult Latin American immigrants (145 women, 56 men). No relationship was found between religious affiliation and suicidal ideation. Self-perception of religiosity, influence of religion, and church attendance were significantly negatively associated with suicidal ideation. A multiple regression analysis showed that influence of religion was a significant predictor of suicidal ideation. The present findings lend empirical support to the notion that high religiosity may play a protective role against suicide.     

Religion and Suicide

Religion impacts suicidality. One’s degree of religiosity can potentially serve as a protective factor against suicidal behavior. To accurately assess risk of suicide, it is imperative to understand the role of religion in suicidality. PsycINFO and MEDLINE databases were searched for published articles on religion and suicide between 1980 and 2008. Epidemiological data on suicidality across four religions, and the influence of religion on suicidality are presented. Practice guidelines are presented for incorporating religiosity into suicide risk assessment. Suicide rates and risk and protective factors for suicide vary across religions. It is essential to assess for degree of religious commitment and involvement to accurately identify suicide risk.     

The Impact of Religiosity on Suicidal Ideation Among Youth in Central Mexico

Although over 100 years of research has been dedicated to understanding the connection between religiosity and suicide, many questions still remain. This is especially true among adolescent populations in countries outside the US. In 2008, over 700 students attending eight alternative high school centers in central Mexico completed a health survey designed to provide a comprehensive overview of their physical, mental, spiritual, and emotional health. This article reports on the findings of a secondary analysis study of those data and focuses on the protective influence of religiosity on suicidal ideation. The findings of this study are discussed in light of the network theory’s assertion that there is a belonging aspect to religion, and also to the idea that in religiously homogeneous communities of Mexico, religion can have a protective effect on the suicidal ideation of its members.     

Association Between Suicidal Ideation and Exposure to Suicide in Social Relationships Among Family,Friend, and Acquaintance Survivors in South Korea

Exposure to suicide in social relationships may be associated with suicidal ideation among survivors. In South Korea, which is known for having the highest suicide rate among OECD countries, exposure to suicide in social relationships can have serious consequences as social relationships are greatly emphasized in the society. The purpose of this study was to examine the association between survivors' suicidal ideation and their exposure to suicide in close relationships. Data collected through a telephone survey of a total of 1,000 men and women selected from across the nation using a stratified sampling method were analyzed. The results show that individuals who lost a family member, friend, or acquaintance in their lifetime are 4.5 times, 3.7 times, 2.2 times, respectively, more likely to have suicidal ideation in the past year compared to those without such experience. These findings suggest that special intervention for suicide survivors should be considered for those who experience suicide in close relationships.     

Suicidal ideation and attitudes toward suicide

Although hopelessness and depression are known risk factors for suicide, most individuals who are hopeless or depressed never make a suicide attempt. In this study, we tested the hypothesis that college students' (n = 230) attitudes toward suicide (the degree to which they see it as an acceptable option under some circumstances) would moderate the link between both hopelessness and depressive symptoms and their levels of suicidal ideation. This moderation hypothesis was supported, but only among men. Specifically, among men, levels of hopelessness and depressive symptoms were significantly related to suicidal ideation among only those with relatively positive attitudes toward suicide.     

Educating parents about youth suicide: knowledge, response to suicidal statements, attitudes, and intention to help

This study evaluated the video Youth Suicide: Recognising the Signs as a parent educational medium. Before and after viewing the video, parents (N = 112) of young people answered questionnaires measuring their (1) knowledge of suicidal signs, (2) responses to a young person showing suicidal signs, (3) attitude to suicide, and (4) intentionalitv toward suicidal people. After the video, parents' knowledge of suicidal signs, responses toward a suicidal person, and intention to help improved. Their attitude was more rejecting of suicide. Knowledge and intentionality predicted response to suicidal statements, but no relationships existed between attitude and the other variables. Implications for youth suicide education programs are discussed.     

The Impact of Exposure to Peer Suicidal Self‐Directed Violence on Youth Suicidal Behavior: A Critical Review of the Literature

There is considerable evidence that being exposed to the suicide or suicidal behavior of another can increase the risk for suicide. Significant relationships between media coverage and youth suicide have been documented in the professional literature. Exposure to familial suicidal behavior has also been established as a risk factor for youth suicidal behavior; However, peer suicide exposure is not as clear cut as research results in this area have been mixed. In the current paper the empirical literature focused on the associations between exposure to peer suicides and suicide attempts and youth suicidal behavior is critically reviewed. Effect sizes were computed for each of the 23 studies included in the review to allow for cross‐study comparisons. The results demonstrate that having a friend or acquaintance attempt suicide is significantly related to risk for suicidal thoughts and behavior. However, the support for the relationship between the suicide of a peer and youth suicidal behavior was less consistent. Implications for clinical practice and suicide postvention as well as areas of future research are discussed.     

Youth suicide risk and sexual orientation

Using a broad suicide risk assessment (suicidal ideation, hopelessness, hostility) with 100 youth ages 17 to 19, this study examined the relationship between sexual orientation and youth suicide risk. Participants were compared across sexual orientation, as well as level of perceived external support, which may be a mitigating variable in suicide risk. The suicide risk demonstrated by sexual minorities in this study was no greater than that of their heterosexual peers. Youth who reported more external support demonstrated lower overall suicide risk and, specifically, lower levels of hostility, hopelessness, and suicidal ideation. The results indicated that suicide risk is not determined by demographic criteria alone, and may be influenced by psychosocial variables, such as support.     

Method choice, intent, and gender in completed suicide

Women who commit suicide use less violent methods, such as drugs and carbon monoxide poisoning, than do men, who more often use violent methods such as guns and hanging. Theories that attempt to explain this finding focus on gender differences in suicidal intent, socialization, emotions, interpersonal relationships, orientation and access to methods, and neurobiological factors. Data from a psychological autopsy study were used to test the theory that women who commit suicide use less violent means because they are less intent on dying. Although women were significantly less likely to use a violent method than men, there was no difference in the lethality of their suicidal intent.     

A cross-cultural investigation of the communication of suicidal intent in Swedish and Turkish adolescents

A recent study found that Swedish adolescents were more disapproving of a suicidal disclosure by a fictional friend than their Turkish counterparts. Given this finding, the present study investigated whether or not more adolescents in Turkey than in Sweden disclose their own suicidal thoughts to someone, to whom adolescents disclose their suicidal thoughts, what reactions such disclosures produce, and reasons for not disclosing suicidal feelings among 966 Swedish and 956 Turkish high school students. A questionnaire was used to collect information about different aspects of suicidal disclosures. More Turkish than Swedish adolescent suicide ideators disclosed their thoughts. More Turkish than Swedish students believed also that young people thinking about and planning suicide tell others of their plans and thereby ask for help. An overwhelming majority of adolescents in both groups revealed their thoughts to peers. The social reactions to suicidal disclosures in both samples were mainly positive. The two most common reasons for not disclosing in both groups involved interpersonal hopelessness. Adolescents who disclosed their past suicidal thoughts to someone reported having lower current suicidal ideation than those who had not. In line with favorable social attitudes towards suicidal disclosures and lower suicidal mortality rates in Turkey compared with Sweden, more Turkish than Swedish adolescents reported having disclosed their own suicidal thoughts to someone in their social milieu.     

The cycle of schizoaffective disorder, cognitive ability, alcoholism, and suicidality

In this study we investigated the putative role of cognitive dysfunction, diagnosis (schizoaffective versus schizophrenia disorder), and alcoholism as risk factors for suicidal behavior among individuals with DSM-TV schizophrenia or schizoaffective disorders. Subjects received cognitive tests and medical records were reviewed for evidence of a history of suicide attempts or suicidal ideation. Discriminant analysis was used to identify cognitive test performance measures that distinguished those with versus those without suicidal behavior. None of the cognitive measures discriminated between the two groups. The rates of suicidal behavior (suicidal ideation and suicide attempts) did not differ between participants with versus those without comorbid alcohol use. An association was found between suicidal behavior and the diagnosis of schizoaffective disorder. It was concluded that the history of prominent mood syndromes characteristic of schizoaffective disorder contributes to increased risk of suicidal behaviors. Cognitive dysfunction and/or alcoholism did not contribute additionally to risk in this study.     

Associations between delinquency and suicidal behaviors in a nationally representative sample of adolescents

Suicide was the second leading cause of death for 14-17 years olds in 2002. Prior studies indicate that suicidal behaviors are especially common among juvenile delinquents, yet this association has not been examined in a national sample. The 2003 Youth Risk Behavior Surveillance System was used to examine associations between suicidal behaviors and delinquency in a nationally representative sample of 14-17 year olds. Results indicated that delinquent adolescents were more likely to have seriously considered suicide (adjusted odds ratio [AOR] = 5.44), made a suicide plan (AOR = 4.90), attempted suicide (AOR = 10.08), and required medical treatment after attempting suicide (AOR = 14.61) compared to their nondelinquent counterparts. Delinquency was significantly related to suicidal behaviors for boys and girls, but the magnitudes of effects were larger for girls. This finding suggests that delinquent youth, particularly delinquent girls, should be targeted in interventions to reduce suicidal behaviors.     

Dimensions of Religion Associated with Suicide Attempt and Suicide Ideation in Depressed,Religiously Affiliated Patients

There is substantial evidence to support the claim that religion can protect against suicide ideation, suicide attempts, and completed suicide. There is also evidence that religion does not always protect against suicidality. More insight is needed into the relationship between suicidal parameters and dimensions of religion. A total of 155 in‐ and outpatients with major depression from a Christian Mental Health Care institution were included. The following religious factors were assessed: religious service attendance, frequency of prayer, religious salience, type of God representation, and moral objections to suicide (MOS). Multiple regression analyses were computed. MOS have a unique and prominent (negative) association with suicide ideation and the lifetime history of suicide attempts, even after controlling for demographic features and severity of depression. The type of God representation is an independent statistical predictor of the severity of suicide ideation. A positive‐supportive God representation is negatively correlated with suicide ideation. A passive‐distressing God representation has a positive correlation with suicide ideation. High MOS and a positive‐supportive God representation in Christian patients with depression are negatively correlated with suicide ideation. Both are likely to be important markers for assessment and further development of therapeutic strategies.     

Laboratory measured behavioral impulsivity relates to suicide attempt history

The purpose of this study was to examine the relationship between laboratory behavioral measured impulsivity (using the Immediate and Delayed Memory Tasks) and suicidal attempt histories. Three groups of adults were recruited, those with either: no previous suicide attempts (Control, n = 20), only a single suicide attempt (Single, n = 20), or multiple suicidal attempts (Multiple, n = 10). As hypothesized, impulsive responses increased with the number of suicide attempts (Control < Single < Multiple). This study helps to demonstrate how laboratory behavioral measures of impulsivity can be used to discriminate groups based on suicidal histories among samples not currently exhibiting significant suicidal behaviors.