SAN FRANCISCO, May 21 - A sense of religious affiliation may protect people from attempting suicide, but not from thinking about it, researchers said.

In a large population-based cohort, attendance at religious services at least once a year halved the risk of suicide attempts, Jitender Sareen, M.D., of the University of Manitoba in Winnipeg, and colleagues, reported here at the American Psychiatric Association meeting.

But a separate, nationally representative study showed that higher scores for spirituality and religious affiliation did not keep people from considering suicide.

"We're finding spirituality plays a big role in mental health," said Erica Smith, M.D., of the Medical College of Georgia in Augusta, at the poster presentation of her study.

Spirituality and religiosity are complex issues with varying definitions, commented David Baron, D.O., of Temple University in Philadelphia and program committee member.

"The sense of support -- that a higher power is taking care of things -- can be protective," he said. But "the importance is what it means to the individual."

Dr. Sareen agreed. "Spirituality is one component, but you have to look at the whole person."

His group analyzed the mental health and wellbeing portion of the 2002 Canadian Community Health Survey, a cross-sectional population-based survey of people age 15 or older living in private dwellings.

Among them, 63% reported spiritual values and 56.1% attended religious services at least once a year.

Religious affiliation was associated with 47% lower risk of having attempted suicide over the prior 12 months (odds ratio 0.53, 95% confidence interval 0.37 to 0.77).

Adjustment for demographic characteristics and social support strengthened the protective effect of attending religious services (OR 0.39, 95% CI 0.17 to 0.89).

However, spirituality alone -- without connection to organized religious services -- did not appear protective after adjustment for demographics and social support (OR 0.64, 95% CI 0.31 to 1.34).

Dr. Sareen attributed the effect, in part, to religious beliefs that may not be as common in those who feel connection to the divine but don't have strong ties to an organized religious group.

"Clinically what I see is that in some religions, if you commit suicide you're not going to have an afterlife," he said. "That comes up clinically."

But a sense of community and social support among members of a religious group are important as well, Dr. Sareen added.

In Dr. Smith's analysis of the National Comorbidity Survey Replication, spirituality and religiosity were not distinguished.

The survey included a nationally representative sample of 9,882 adults interviewed face-to-face by professional interviewers between February 2001 and April 2003.

Dr. Smith and co-author Erick Messias, M.D., Ph.D., developed a "spirituality scale" by summing responses to the following broad questions:

  • How often do you usually attend religious services?
  • In general, how important are religious or spiritual beliefs in your daily life?
  • When you have problems or difficulties in your family, work, or personal life, how often do you seek comfort through religious or spiritual means, such as praying, meditating, attending services, or talking to a religious adviser?
  • When you have decisions to make in your daily life, how often do you think about your religious or spiritual beliefs?

The prevalence of suicide ideation did not vary significantly across the 4- to 16-point range in spirituality scores (P=0.126), but prevalence of history of suicide attempts did (P=0.002).

In the logistic regression model, a higher spirituality score was strongly associated with fewer suicide attempts (P=0.01), and weakly linked to lower likelihood of having contemplated suicide (P=0.04).

Both Drs. Smith and Sareen concluded that spirituality and religiosity may be important to assess clinically, such as while taking the patient's history.

Dr. Sareen's study was funded by grant funds from the Canadian Institutes of Health Research.

Drs. Smith and Baron reported no conflicts of interest.

Primary source: American Psychiatric Association
Source reference:
Smith E, Messias E "Spirituality and suicide: results from the national comorbidity survey replication" APA 2009; Abstract NR5-088.

Additional source: American Psychiatric Association
Source reference:
Rasic D, et al "Religion, spirituality and suicide in a large community sample" APA 2009; Abstract SCR 15-45.

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