Clinicians urged to personalize and culturally adapt suicide prevention and treatment
All aspects of religiosity, spirituality, and meaning-making (R/S/M) relate to suicidality in people with a psychiatric diagnosis or a recent suicide attempt, according to a systematic review and meta-analysis published in Harvard Review of Psychiatry, part of the Lippincott portfolio from Wolters Kluwer.
"Protective dimensions seemed to exert relatively stable effects across different religions and life views," Bart van den Brink, MD, PhD, of the Department of Emergency Psychiatry at GGz Centraal, Amersfoort, The Netherlands, and his colleagues report. "For example, moral objections to suicide were protective against suicidality for both Buddhists and Christians."
Large global meta-analysis examined multiple dimensions of R/S/M
The researchers identified 108 studies published in English that quantitatively analyzed relationships between R/S/M and suicidal behavior. The studies reported on 30,610 subjects with an average age of 30. Two studies included subjects from all over the world, whereas 40 were conducted in North America, 30 in Europe, and 29 in Asia. Three regions that are highly diverse, spiritually and religiously, were markedly underrepresented: Africa (0 studies), Australia/Oceania (1 study), and South America (6 studies, all from Brazil).
R/S/M variables were categorized into four dimensions:
- Belonging—For example, affiliation with a religious or spiritual group and the strength of that affiliation.
- Behaving—For example, moral objections to suicide, religious salience (how important religion is in an individual's life and how committed they are to their beliefs), religious service attendance, involvement in a religious or spiritual organization, and prayer.
- Believing and Meaning—For example, a sense of meaning or purpose in life and trust in a higher power.
- Bonding—Spiritual and religious well-being, religious coping, concept of god, and religious/spiritual experiences.
R/S/M had a small but significant overall protective effect against suicidality
The team used 231 effect sizes from 75 of the 108 studies, representing 17,561 subjects, in a meta-analysis of the direct impact of R/S/M on suicidal behavior. Christianity was the most prevalent religious affiliation across the study samples (62%). Atheism/agnosticism, Hinduism, Islam, and Judaism were most prevalent in only 1.3% to 3.4% of samples.
For specific R/S/M variables with nine or more effect sizes, a post hoc crude pooled effect size was calculated. From those post hoc analyses, key conclusions were:
- R/S/M in general (Fisher Z = −0.13; P = .006), the behaving dimension (Fisher Z = −0.06; P = .001) and the believing and meaning dimension (Fisher Z = −0.26; P = .003) were significantly and negatively related to suicidality.
- Within the behaving dimension, moral objections to suicide and high religious salience were significantly negatively associated with suicidality.
- Religious attendance and organizational involvement were not associated with lower levels of suicidality; in fact, religious affiliation was significantly associated with slightly higher levels.
"An attentive examination of R/S/M, including its dimensions and dynamics, is important for everyone providing help and support to psychiatric patients, especially mental health professionals and clergymen," Dr. van den Brank’s group writes. "Exploration of R/S/M and identifying empowering resources within particular religious traditions and life views will decrease stigmatizing and support the development of effective suicide prevention efforts and interventions to support suicidal persons."
