Gunnell et al's (Reference Gunnell, Harbord and Singleton2004) interesting study came with useful learning points. However, while known as important factors that influence development and amelioration of suicidal thoughts, ethnicity and religion were not included in the study. As the world has become a small, or big, village, and as we live in a multi-ethnic and multi-religious society, I feel this should be considered as an additional limitation to the study. The relationship between religion and suicide became famous through Durkheim's study in the 19th century.

In European countries, evidence suggests that the prevalence of suicide continues to vary in accordance with international differences in traditions, customs and religious practices (Reference Cavanagh, Masterton, Johnstone, Freeman and ZealleyCavanagh & Masterton, 1998). Cavanagh & Masterton suggested that the strength of these differences is decreasing because of homogenisation among countries. In my opinion, it is unlikely that this influence will completely disappear. In a modern secularised society, religion is still a meaningful and protective factor for many individuals in a suicidal crisis (Reference Lonnqvist, Gelder, López-Ibor and AndreasenLonnqvist, 2000).

Makinen & Wassermann (2001) believe that much of the difference in suicidal behaviour between national groups can be connected with differences in cultural outlook, and state that ‘traditionally religion has been considered to be the matrix of culture’.

Various factors that influence development and amelioration of suicidal thoughts do not function separately. I wonder, had ethnicity and religion been included, how would this have affected the outcome?