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Suicide and religion

  • Christopher C. H. Cook (a1)
Summary

Much of the evidence that religion provides a protective factor against completed suicide comes from cross-sectional studies. This issue of the Journal includes a report of a new prospective study. An understanding of the relationship between spirituality, religion and suicide is important in assessing and caring for those at risk.

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Copyright
References
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1 Royal College of Psychiatrists. Self Harm, Suicide and Risk: Helping People who Self-Harm (College Report CR158). Royal College of Psychiatrists, 2010.
2 Koenig, HG King, DE Carson, VB Handbook of Religion and Health (2nd edn). Oxford University Press, 2012.
3 Lubin, G Glasser, S Boyko, V Barell, V Epidemiology of suicide in Israel: a nationwide population study. Soc Psychiatry Psychiatr Epidemiol 2001; 36: 126–7.
4 Thompson, MP Ho, CH Kingree, JB Prospective associations between delinquency and suicidal behaviors in a nationally representative sample. J Adolesc Health 2007; 40: 232–7.
5 Kleiman, EM Liu, RT. Prospective prediction of suicide in a nationally representative sample: religious service attendance as a protective factor. Br J Psychiatry 2014; 204: 262–6.
6 Cook, CCH (ed.). Controversies on the place of spirituality and religion in psychiatric practice. In Spirituality, Theology and Mental Health. SCM Press, 2013.
7 King, M Marston, L McManus, S Brugha, T Meltzer, H, Bebbington, P Religion, spirituality, and mental health: results from a national study of English households. Br J Psychiatry 2013; 202: 6873.
8 Bettenson, H O'Meara, J St Augustine: City of God. Penguin, 1984.
9 Koch, HJ. Suicides and suicide ideation in the Bible: an empirical survey. Acta Psychiatr Scand 2005; 112: 167–72.
10 Council on Social Responsibility of the Methodist Church in Ireland. From Despair to Hope. Veritas, 2002.
11 Ali, AY. The Holy Qur'an: Translation and Commentary. IPCI: Islamic Vision, 2000.
12 Coghlan, C Ali, I. Suicide. In Spirituality and Psychiatry (eds Cook, C Powell, A Sims, A): 6180. RCPsych Publications 2009.
13 Rasic, DT Belik, SL Elias, B Katz, LY Enns, M Sareen, J, et al. Spirituality, religion and suicidal behavior in a nationally representative sample. J Affect Disord 2009; 114: 3240.
14 Cook, CCH. Recommendations for Psychiatrists on Spirituality and Religion (Position Statement PS03/2013). Royal College of Psychiatrists, 2013.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Suicide and religion

  • Christopher C. H. Cook (a1)
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eLetters

Influence of Religion on Suicide Prevention

K.A.L.A. Kuruppuarachchi, Senior Professor of Psychiatry
13 June 2014

The editorial on Suicide and religion(Cook 2014) and the article on Prospective prediction of suicide in a nationally representative sample: religious service attendance as a protective factor(Kleiman and Liu 2014)point out an important area in suicide prevention programmes.

Obviously suicide is a major concern globally and developing countries are no exception. For instance suicide rates were very high in Sri Lanka. When considered the suicide rates amongst the youth Sri Lanka also recorded the highest in the world(Wasserman et al. 2005). Fortunately the rates seem to be coming down. In addition to undetected depression, several other factors might have been contributing to high suicide rates in Sri Lanka including the methods used in self harm, societal changes, disruption of traditional protective family structure, poor problem solving ability amongst the attempters etc.

Most studies with regard to suicide prevention programmes focus on the vulnerability factors. Importance of the role of protective factors for example capability of problem solving , better relationships with the close associates and the family members in reducing stress has been highlighted(Wasserman et al. 2008).

The benefits of the religious factors and spiritual development in mental wellbeing have been demonstrated. Spiritually augmented cognitivebehavioural therapy has shown positive outcomes in patients management(D'Souza & Rodrigo 2004). On the other hand disadvantages of not paying attention to factors such as enhancing positive emotions, character development, life satisfaction and spirituality have been discussed(Cloninger 2006). Mindfulness-based cognitive therapy(MBCT) is incorporated in relapse prevention programmes in depression (Teasdale et al 2000). Therapists have tried incorporating religious beliefs in thepatients management ( Kuruppuarachchi & Lawrence 2006).The consequences of religious practices and psychiatry and the merits of improving the knowledge and awareness amongst psychiatrists in this area have been emphasized(Koenig 2008).

There are several compounding variables associated with/giving rise to suicidal behavior. It is also note- worthy that people with certain belief systems and personality characteristics seem to attend religious places and participate in religious activities and rituals more often, which can also influence suicidal behaviour. Certainly many religions install hope, improve the feeling of cohesion, enhance social support which help to combat the stress in adversities. On the other hand it also helps to shape the personality characteristics in a better way. In countries like Sri Lanka one may observe that many people in all walks of life gather in temples on Sundays or specific days designated for religious activities in the hope of spiritual and moral development. Religions appear to enhance the mental wellbeing. People tend to share their distressing emotions with others at the temple/religious places which may be therapeutic in certain conditions/situations such as bereavement.

It is important to be aware of this area in taking care of their patients and planning suicidal prevention programmes. We need to do moreresearch work in order to understand the influence of religious/spiritual factor on mental health.

References;

Cook CCH. Suicide and religion. British Journal of Psychiatry 2014; 204: 254-255.

Kleiman EM, Liu RT. Prospective prediction of suicide in a nationallyrepresentative sample: religious service attendance as a protective factor. British Journal of Psychiatry 2014; 204: 262-266.

Wasserman D, Cheng Q, Jiang G-X. Global suicide rates among young people aged 15-19. World Psychiatry 2005; 4(2): 114-120.

Wasserman D, Thanh HTT, Minh DPT, Goldstein M, Nordenskiold A, Wasserman C. Suicidal process, suicidal communication and psychosocial situation of young suicide attempters in a rural Vietnamese community. World Psychiatry 2008; 7: 47-53.

D'Souza RF, Rodrigo A. Spiritually augmented cognitive behavioural therapy. Australasian Psychiatry 2004; 12(2): 148-152.

Cloninger CR. The science of well-being : an integrated approach to mental health and its disorders. World Psychiatry 2006; 5(2): 71-6.

Teasdale JD, Segal ZV, Williams JM, Ridgeway VA, Soulsby JM, Lau MA. J Consult Clin Psychol 2000; 68(4): 615-23.

Kuruppuarachchi KALA, Lawrence TS. Incorporating spiritual and religious beliefs in taking care of the elderly with psychiatric problems - Some personal experiences. Indian Journal of Geriatric Mental Health 2006; 2(1): 51-54.

Koenig HG. Religion and mental health: what should psychiatrists do? Psychiatric Bulletin 2008; 32: 201-203.

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Conflict of interest: None declared

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The clinical implications of church attendance and suicide

Rob Poole, Professor of Social Psychiatry
16 May 2014

Kleiman and Lui1 have conducted a respectable study that suggests that people in the USA who attend church frequently are less likely to commit suicide than other people. Although the finding is interesting, it is not surprising. It is congruent with Durkheim's nineteenth century theory about the role of anomie.

Chris Cook2, in a moderately worded commentary, suggests that this finding has implications for British clinical practice. In my opinion, this is profoundly misguided.

Firstly, the finding is specific to the USA. America is a country with exceptionally high rates of religious involvement, where church attendance and social respectability are intimately linked. The social meaning of church attendance is completely different in the UK. Although Iguess that a UK study would be likely to yield similar findings, scientific rigour demands that this cannot be assumed.

Secondly, Cook says that the finding merits discussion with patients at risk of suicide. It is far from clear what he means by this. I doubt ifhe means to imply that psychiatrists should explain to patients abstractedepidemiological factors that might affect their actuarial risk of suicide.

It is always important to understand the social and emotional supports that tend to protect patients from taking their own lives. This is a matter of proper assessment. However, there are no grounds for psychiatrists to advocate church attendance to individuals who consult them. Kleiman and Lui have identified a demographic factor that appears tobe protective. They have not evaluated an intervention. Even if they had, in the UK setting proselytization of religion by medical practitioners is a serious breach of professional boundaries.

It is difficult to identify the line between evangelisation and ostensibly more benign types of religious intervention (for example, suggesting that church goers might attend more frequently), which illustrates why boundaries need to be clear rather than blurred. It is hard to understand how a discussion of church going as part of a psychiatric intervention could avoid promotion of a particular religious viewpoint. With regard to protection of patients, Cook cites the College Position Statement3 that he wrote, Recommendations for Psychiatrists on Spirituality and Religion: "much is properly left to the judgment of the psychiatrist". Everything we have learnt about boundary violations over the last 20 years tells us that this is an unreliable way of protecting patients, which is why some of us strongly disagree with the College Position paper.

Fortunately, Chris Cook and I are not simply trapped in a cycle of disagreement4. With colleagues from Bangor and Durham, we have been developing research to explore the boundary issues over religion and spirituality. Until that work is completed, and possibly thereafter, it isimportant to be clear that there is a serious difference of opinion over bringing religion into the clinical setting. This is determined by factorsother than religious faith, or the lack of it.

1. Kleiman EM, Liu RT. Prospective prediction of suicide in a nationally representative sample: religious service attendance as a protective factor. Br J Psychiatry 2014; 204: 262-6.

2. Cook CCH. Suicide and religion. Br J Psychiatry 2014, 204:254-255.

3. Cook CCH. Recommendations for Psychiatrists on Spirituality and Religion(Position Statement PS03/2013). Royal College of Psychiatrists, 2013.

4. Poole R, Cook CCH. "Praying with a patient constitutes a breach ofprofessional boundaries in psychiatric practice". 2011 Br J Psychiatry. 199: 94-98

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Conflict of interest: I am an atheist

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