Wednesday 22 November 2017

Can religion help lower the risk of death by suicide?

Identifying the factors that cause someone to take his or her own life is a growing area of research

Support of like-minded people in the community provides assistance
Support of like-minded people in the community provides assistance

Patricia Casey

Increasingly in mental health research, the focus is on not what makes us ill, but what prevents us becoming ill. These preventive factors are collectively termed resilience.

Resilience research is relatively new in medicine but is growing. For example, everybody knows the benefits of exercise, a little red wine, low fat intake and so on in reducing heart disease. High fibre diets may have a role in reducing our risk of bowel cancer. In mental health, having good personal supports helps reduce the risk of depression.

Suicide is one area where much of the focus has been on what causes it. Numbered among the risk factors are mental illness, untreated or poorly treated alcohol misuse, poor supports and alcohol dependence.

Emile Durkheim, the father of sociology, wrote in his famous book 'Suicide' (published in English in 1954 and still available) that having a sense of shared values reduced the risk, while the opposite, what he called anomie, increased it.

He also identified other risk and protective factors such as loneliness, false expectations that are derived from the perspective of the majority, migration and so on as placing people at risk.

Although he was no enthusiast for organised religion, Durkheim gave it credit for acting as the transmitter of values that groups of people could adhere to, hence reducing anomie.

There has always been a belief that religious adherence reduced suicide and a number of studies in the past decade examined this by comparing suicide rates between countries with different religious traditions.

These types of studies have limitations, one being that they examine the data on suicide from the various countries at one point in time. These are known as cross-sectional studies.

A better method is to take a group and follow them through for several years – the longer the better – and check how many have died by suicide. This is known as a longitudinal study. In doing this, a researcher can examine a number of factors such as age, social class, number of friends/family and so on that might influence the outcome, in this instance the number dying by suicide.

A study published in the April issue of the 'British Journal of Psychiatry' examined whether those who attended religious services frequently (defined as at least 24 times per year) were less likely to die by suicide than those who did not attend so frequently. They were able to control for a variety of risk variables such as previous suicide attempts, gender and so on.

The authors, Evan Kleinman and Richard Liu, from George Mason University, Virginia, analysed data on more than 20,000 individuals, representative of the general population in the USA. They then linked the database of this group to the mortality (death) database of that same group covering a 16-year period.

They found that over this time period, and controlling for variables known to be related to suicide, those who attended religious services at least 24 times each year were at a 67pc lower risk of suicide than those who did not.

In fact, being male and attending religious services were the only two factors that were predictive of suicide in the course of the follow-up period, one reducing the risk the other increasing it. This replicates the finding of other studies as described above.

This is not to say that those who are religious do not take their lives or that they are totally protected simply by attending services regularly.

In this country we have had reports of priests taking their lives.

Many of us know of deeply devout people being overwhelmed and ending their lives. However, the findings show that, on average, their risk is lower.

So, why might religious attendance protect against suicide?

There are a number of possibilities on which the authors correctly speculate. One is that those who attend religious service so frequently have inevitably internalised the injunction against suicide that is present in mono-theistic faiths. Another is that the support of like-minded people in the religious community provides assistance when people are despairing.

Those who are not religious adherents will say that being a member of a football team or of a political party would provide the same protection.

But this fails to consider whether the support of a group that plays games together is similar in quality to that given by a religious community bound by similar beliefs and aspirations.

Clearly no single longitudinal study is conclusive.

Yet work such as this is important and undoubtedly there will be further studies examining this important question.

In clinical practice we psychiatrists obviously cannot prescribe church attendance.

But this study illustrates that religious observance is a legitimate area for examination in psychiatry, just as are substance misuse, relationships and life stressors.

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