Personality,spirituality, suicide,and self-injury proneness among lesbian,gay, and bisexual adults

The present study sought to clarify gaps in current knowledge integrating personality, spirituality, and risk for suicide/self-harm among sample of 336 lesbian, gay, and bisexual community members. It was hypothesised that Neuroticism would positively predict, and Extraversion and Agreeableness would negatively predict, measures of suicide and self-injury proneness. Additionally, it was predicted that spirituality, defined as Spiritual Life Integration (SLI) and Social Justice Commitment, would interact with personality traits to attenuate risk for suicide and self-injury. Results supported the role of Neuroticism, and identified an unexpected predictor of Conscientiousness, at the main effect level. Moderation patterns were observed such that Agreeableness and Extraversion interacted with SLI to attenuate risk, such that high levels of each trait and high levels of spirituality were protective against suicide and self-injury proneness. Theoretical and practical implications with emphasis on counselling intervention implementation and future research are discussed.     

Spirituality Moderates Hopelessness,Depression, and Suicidal Behavior among Malaysian Adolescents

Suicide is an important public health problem for adolescents, and it is essential to increase our knowledge concerning the etiology of suicide among adolescent students. Therefore, this study was designed to examine the associations between hopelessness, depression, spirituality, and suicidal behavior, and to examine spirituality as a moderator between hopelessness, depression, and suicidal behavior among 1376 Malaysian adolescent students. The participants completed measures of depression, hopelessness, daily spiritual experience, and suicidal behavior. Structural equation modeling indicated that adolescent students high in hopelessness and depression, but also high in spirituality, had less suicidal behavior than others. These findings reinforce the importance of spirituality as a protective factor against hopelessness, depression, and suicidal behavior among Malaysian adolescent students.     

Protective Factors Against Suicide Attempt Risk Among African American Women Experiencing Intimate Partner Violence

Protective factors (hope, spirituality, self-efficacy, coping, social support–family, social support–friends, and effectiveness of obtaining resources) against suicide attempts were examined in economically, educationally, and socially disadvantaged African American women (100 suicide attempters, 100 nonattempters) who had experienced recent intimate partner violence. Significant positive associations were found between all possible pairs of protective factors. Bivariate logistic regressions revealed that higher scores on each of the seven protective factors predicted nonattempter status; multivariate logistic regressions indicated that higher scores on measures of hope or social support–family showed unique predictive value for nonattempter status. Further, the multivariate model accurately predicted suicide attempt status 69.5% of the time. Partial support was found for a cumulative protective model hypothesizing a linear relationship between the number of protective factors endorsed and decreased risk for suicide attempts. Implications of these findings for community-based preventive intervention efforts and future research are discussed.     

Spirituality Among College Freshmen: Relationships to Self‐Esteem,Body Image,and Stress

The authors investigated the relationships between spirituality, body image, self‐esteem, and stress in 204 college freshmen who identified themselves as being highly spiritual. A positive relationship was found between spirituality and self‐esteem. Although self‐esteem was found to be negatively related to stress, spirituality served as a buffer in this relationship. When gender of participants was examined, men and women did not differ in spirituality. Greater spirituality was related to lower body surveillance, an aspect of body image, for men, but it was not related to body image for women. Overall, however, women experienced greater body image dissatisfaction than did men.     

Childbearing depressive symptomatology in high–risk pregnancies: The roles of working models and social support

Guided by both attachment and social support theories, the authors conducted a longitudinal investigation exploring the concomitant effects of perceptions of spouse support (anticipated and received spouse support) and internal working models of attachment (positive–self and positive–other), on childbearing depressive symptomatology. Distinct main and interaction effects for attachment dimensions and perceived support variables were hypothesized for high– and low–risk pregnancies. Participants in the final sample were 200 pregnant women who completed the self–report between the 25th and the 29th weeks of pregnancy, and 8 weeks after childbirth. Controlling for initial levels of depressive symptoms and health conditions, results demonstrated the protective role of high levels of received support and of positive–other models on childbirth depressive symptoms. Moreover, received support and models of positive–other were found to interact with health conditions, producing distinct moderation effects: Received support was found to be a significantly stronger protective factor for childbearing depression among women with low–risk pregnancies; positive–other models were found to be a significantly stronger protective factor among women with high–risk pregnancies. The implications of these findings for the understanding of intrapersonal and interpersonal factors in successful coping with a health risk situation are discussed.     

Are Religiosity and Spirituality Associated with Obesity Among African Americans in the Southeastern United States (the Jackson Heart Study)?

There are several lines of evidence that suggest religiosity and spirituality are protective factors for both physical and mental health, but the association with obesity is less clear. This study examined the associations between dimensions of religiosity and spirituality (religious attendance, daily spirituality, and private prayer), health behaviors and weight among African Americans in central Mississippi. Jackson Heart Study participants with complete data on religious attendance, private prayer, daily spirituality, caloric intake, physical activity, depression, and social support (n = 2,378) were included. Height, weight, and waist circumference were measured. We observed no significant association between religiosity, spirituality, and weight. The relationship between religiosity/spirituality and obesity was not moderated by demographic variables, psychosocial variables, or health behaviors. However, greater religiosity and spirituality were related to lower energy intake, less alcohol use, and less likelihood of lifetime smoking. Although religious participation and spirituality were not cross-sectionally related to weight among African Americans, religiosity and spirituality might promote certain health behaviors. The association between religion and spirituality and weight gain deserves further investigation in studies with a longitudinal study design.     

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.     

The association of depression and sense of belonging with suicidal ideation among older adults: applicability of resiliency models

Suicide among older people, especially men, is a significant problem. In this study the applicability of the compensatory, the risk-protective, the challenge, and the protective-protective models of resiliency for the prediction of suicidal ideation from depression (the risk factor) and sense of belonging to the community (the protective factor) was investigated. A total of 351 retired Australians (130 males and 221 females), with a mean age of 71.31 years (SD = 7.99), completed the Zung Depression Scale, the suicide subscale of the General Health Questionnaire, and the Sense of Belonging Instrument. When sense of belonging (psychological) was the protective factor, results indicated support for the risk-protective model for men and women, and for the compensatory model for women only. In contrast, when sense of belonging (antecedents) was the protective factor, support was evident for the compensatory model for men and women, and for the challenge model for women only. Results indicate that interventions should be developed to enhance sense of belonging among aging adults.     

Social risk and protective factors for suicide attempts in low income African American men and women

A case-control study was conducted to examine a broad array of potential social risk and protective factors for suicide attempt among 200 African American men and women receiving care at a large, public, urban hospital. Specifically, we examined the effect of the following potential risk factors for suicide attempt: life hassles, partner abuse, partner dissatisfaction, and racist events; as well as the following potential protective factors: effectiveness of obtaining resources, social embeddedness, and social support. Using logistic regression, suicide attempter status was predicted by two independently significant social variables: one risk factor (life hassles) and one protective factor (social support). Male versus female suicide attempters were not distinguished by the social variables. These findings, which support the utility of an ecological conceptualization of risk and protective factors for suicide attempt, help to clarify the independently significant social environment risk and protective factors for suicide attempts among economically disadvantaged African Americans in particular. Research on both risk factors and protective factors provide a basis for culturally competent interventions aimed at reducing both the risk of future suicide attempts and completions.     

Cultural considerations in adolescent suicide prevention and psychosocial treatment

Ethnic groups differ in rates of suicidal behaviors among youths, the context within which suicidal behavior occurs (e.g., different precipitants, vulnerability and protective factors, and reactions to suicidal behaviors), and patterns of help-seeking. In this article, the authors discuss the cultural context of suicidal behavior among African American, American Indian and Alaska Native, Asian American and Pacific Islander, and Latino adolescents, and the implications of these contexts for suicide prevention and treatment. Several cross-cutting issues are discussed, including acculturative stress and protective factors within cultures; the roles of religion and spirituality and the family in culturally sensitive interventions; different manifestations and interpretations of distress in different cultures; and the impact of stigma and cultural distrust on help-seeking. The needs for culturally sensitive and community- based interventions are discussed, along with future opportunities for research in intervention development and evaluation.     

Metaanalysis of Mood and Substance Use Disorders in Proximal Risk for Suicide Deaths

Evidence for proximal risk factors for suicide is based on case–control psychological autopsy studies, with these reports showing that mood and substance use disorders are the most prevalent mental disorders among suicide decedents worldwide and are associated with marked risk. However, moderators of risk and the degree of risk associated with (nonalcohol) drug use disorder are unknown. A comprehensive search was used to identify 35 case–control psychological autopsy studies published worldwide over a 30‐year period that were metaanalyzed using random effects models. Major depression, odds ratio (95% confidence interval) = 9.14 (5.53, 15.09), and drug use disorder, OR (95% CI) = 7.18 (3.22, 16.01), had large effect sizes, among other results. Risk estimates associated with major depression were greater in studies with a larger proportion of women and those conducted in Asia compared with other regions. There was no evidence of publication bias or that any one study had a disproportionate impact on findings. Risk for suicide associated with major depression appears to be moderated by sex and/or world region. Drug use disorder is a potent risk factor, illustrating the importance of assessing drug use in clinical risk assessment.     

Spirituality,Forgiveness, and Quality of Life: Testing a Mediational Model with Military Veterans with PTSD

Combat-related posttraumatic stress disorder (PTSD) can be a debilitating condition that has been linked with problems with forgiveness and impaired quality of life (QOL) in physical, psychological, social, and environmental domains. However, an amassing base of research studies also suggests that spirituality can be a vital resource for veterans exposed to severe traumas. Drawing on multidimensional assessments of spirituality and QOL, this study therefore tested direct/indirect associations between spirituality, forgiveness, and QOL among 678 military veterans with PTSD. When controlling for demographic risk factors, combat exposure, and PTSD symptom severity, structural equation modeling results revealed (a) an overall positive effect for spirituality on QOL and (b) that forgiveness fully mediated this link. These findings align with contemporary models of military trauma and suggest that forgiveness could be a critical pathway for promoting QOL as veterans attempt to recover from their posttraumatic symptomatology in treatment settings. Implications for clinical practice and future research are discussed in the article.     

Religion, Spirituality, and Health Service Use by Older Hospitalized Patients

Background: Religious and spiritual beliefs and practices are common among medical inpatients, and may impact length of hospital stay (LOS) and other health services (HSU) during hospitalization. Methods: 812 consecutively admitted patients age 50 or over to Duke University Medical Center were assessed. Measures of religiousness and spirituality included religious TV/radio (RTV), self-rated religiousness (SRR), observer-rated spirituality (ORS), and daily spiritual experiences (DSE). The primary outcome was LOS. Results: RTV and SRR predicted longer LOS, whereas ORS and DSE predicted shorter LOS (p 0.05). Effects of RTV onLOS were stronger among women, but explained by worse health status. The effects of DSE on LOS were stronger among non-whites. Among those reporting high DSE, diagnostic tests and total procedures also tended to be less common. Conclusions: Religious activities, attitudes, and spiritual experiences are weak predictors of LOS and HSU during hospitalization. Whether the prediction is positive or negative depends on the religious or spiritual characteristic.     

Spirituality as a 1‐Year Prospective Predictor of Violence Perpetration and Drug Use Among Youth at Continuation High Schools1

This paper presents the results of a 1‐year prospective study of violence perpetration, drug use, and spirituality among continuation high school youth. Spirituality was found to predict later violence perpetration and drug use as a single predictor. However, it failed to predict violence or drug use in models that also entered 6 other variables; particularly, baseline levels of violence and drug use, and morality of drug use. It is possible that current measures of spirituality predict later violence perpetration and drug use as a result of tapping attitudes about morality. Controlling for baseline spirituality, male gender, low morality of drug use, violence perpetration, and drug use predicted later spirituality. Spirituality appears to be affected by drug use and violence, but not the converse. The protective influence of spirituality is not supported, at least as currently measured.     

Spirituality and Religion: Neglected Factors in Preventing Veteran Suicide?

The Clay Hunt Suicide Prevention for American Veterans Act, enacted in 2015, aimed to increase access to treatment for U.S. military veterans; however, poor attendance at aftercare and high rates of treatment refusal suggest that, even when treatment is accessible, it may not be acceptable. Often, it is difficult to acknowledge the need for help and to commit to treatment. The stigma of mental illness diminishes the self-respect of individuals with mental health problems and may be especially acute for veterans because of the centrality of resilience in military culture. This stigma also can jeopardize current employment or prospects for future employment. This paper proposes a partial answer to the question, “What more might be done to engage and effectively treat veterans who are at high risk of suicide?” The meaning of spiritual and/or religious expression in human development, well-being, and social functioning has long been of great interest to theorists in disciplines as diverse as sociology, theology, and psychology. Some empirical studies have further suggested that certain religious and/or spiritual beliefs, practices, and/or affiliations may be protective against suicide. This paper (a) summarizes these perspectives, (b) considers how clinical inquiry into the role of religion and/or spirituality in the lives of veterans at high risk of suicide fits into the suicide prevention program of the U.S. Department of Veterans Affairs, and (c) offers specific recommendations to practitioners.     

Religious Involvement and Domestic Violence Among U.S. Couples

A small but growing literature focuses on the links between religion and family violence. Several recent studies report that regular religious attendance is inversely related to abuse among both men and women. After outlining a series of theoretical arguments regarding possible direct and indirect links between religious involvement and domestic violence, we analyze these relationships using data from Wave 1 of the National Survey of Families and Households (NSFH-1). Among the key findings: (1) regular religious attendance is inversely associated with the perpetration of domestic violence; (2) among men, this protective effect is evident only among weekly attenders, whereas among women, the protective effect also surfaces among monthly attenders; (3) although the estimated net effects of religious attendance are generally somewhat larger in models of self-reports of domestic violence, this link also remains strong and statistically significant in models of partner reports of violence; and (4) moreover, the inverse association between religious attendance and abuse persists even with statistical controls for measures of (a) social integration and social support, (b) alcohol and substance abuse, and (c) low self-esteem and depression. We conclude by discussing a number of implications of these findings, and by identifying several promising directions for future research.     

Role of Religion and Spirituality in Stress Management Among Nurses

Religion and spirituality play a significant role as coping resources under stressful circumstances. Nursing professionals confront with a variety of stressors repeatedly and are found to employ religious/spiritual coping techniques in managing the negative impact of work stress. The present review explores different religious and spiritual coping strategies utilized by nurses of different socio-cultural and religious backgrounds and highlights the importance of treating religion and spirituality as two separate entities in studying their stress-buffering effect. The MEDLINE, CINAHL, PsycINFO, PsycArticles databases and Google Scholar were searched from 2006 to 2017 with the key words nursing, stress, religious coping, religiosity and spirituality. Various notions of the divine/transcendent aspect of life have led to lack of consensus over a functional definition of religion as well as spirituality. This is found to be the core element of methodological inadequacy in studying individuals’ reliance on religion and spirituality during stress. Further, most of the existing measures do not adequately explore spirituality as a construct independent of religion. Measures should be more culture sensitive to discover culturally enriched religious practices and rituals adopted by individuals belonging to different socio-cultural milieu to overcome stress. The role of religion and spirituality in stress resilience, emotion regulation and burnout among nurses around the globe needs further empirical support. Multiple levels at which religious and spiritual coping may moderate/mediate the relationship between work stress and behavioral/emotional outcomes among human service personnel who face high emotional labor demands should be more comprehensively analyzed.     

The Prevalence of Spirituality, Optimism, Depression, and Fatalism in a Bi-ethnic Stroke Population

To provide insight into the reduced post-stroke all-cause mortality among Mexican Americans, we explored ethnic differences in the pre-stroke prevalence of (1) spirituality, (2) optimism, (3) depression, and (4) fatalism in a Mexican American and non-Hispanic white stroke population. The Brain Attack Surveillance in Corpus Christi (BASIC) project is a population-based stroke surveillance study in Nueces County, Texas. Seven hundred ten stroke patients were queried. For fatalism, optimism, and depression scales, unadjusted ethnic comparisons were made using linear regression models. Regression models were also used to explore how age and gender modify the ethnic associations after adjustment for education. For the categorical spirituality variables, ethnic comparisons were made using Fisher's exact tests. Mexican Americans reported significantly more spirituality than non-Hispanic whites. Among women, age modified the ethnic associations with pre-stroke depression and fatalism but not optimism. Mexican American women had more optimism than non-Hispanic white women. With age, Mexican American women had less depression and fatalism, while non-Hispanic white women had more fatalism and similar depression. Among men, after adjustment for education and age, there was no ethnic association with fatalism, depression, and optimism. Spirituality requires further study as a potential mediator of increased survival following stroke among Mexican Americans. Among women, evaluation of the role of optimism, depression, and fatalism as they relate to ethnic differences in post-stroke mortality should be explored.     

Contributors to suicidal ideation among bipolar patients with and without a history of suicide attempts

This study was designed to develop models for vulnerability to suicidal ideation in bipolar patients. Logistic regression models examined correlates of suicidal ideation in patients who had versus had not attempted suicide previously. Of 477 patients assessed, complete data on demographic, illness history, and personality variables were available on 243. The regression models achieved positive predictive values of 55% and 59% for the attempter (N = 92) and nonattempter groups (N = 151), respectively. Depression was cross-sectionally associated with suicidal ideation in both the attempter and nonattempter groups but made a smaller contribution among attempters. Poor psychosocial adaptation and the personality factor "openness" were stronger contributors to suicidal ideation among prior attempters while anxiety and extraversion appeared protective against ideation. Among nonattempters, depression, anxiety, and neuroticism were the predominant influences on suicidal ideation. Bipolar patients with suicidal ideation may benefit from different treatment strategies depending on their prior attempt status.     

2005 Shneidman Award Address. Integratively assessing risk and protective factors for adolescent suicide

This article briefly reviews key issues in adolescent suicide risk assessment and proposes that assessing risk and protective factors in combination has the best probability of informing the field's understanding of this complex problem. Several newer measures are described along with summaries of their psychometric properties. A recommended protocol utilizing 4 developmentally appropriate, valid, and reliable self-report measures is suggested as a parsimonious way of gathering information on the range of risk and protective factors. Finally, a novel approach of employing short-term longitudinal studies to test models of adolescent suicide attempts is described along with a rationale for not focusing research efforts on completed suicide. Implications of this approach for prevention efforts conclude the article.