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Letters to the Editor
Published Online: 1 April 2017

Spiritual Dimensions of Suicide Prevention

To the Editor: Bostwick et al. (1), in the November 2016 issue of the Journal, discussed the need to develop better suicide prevention strategies, and the former director of the National Institute of Mental Health, Thomas Insel, M.D., emphasized that, in contrast to medical advancements that have reduced the prevalence of infectious diseases, significant progress in reducing suicide rates has been elusive (2).
Other relevant studies underscore potential strategies for reducing suicide risk. One such study found that offspring of depressed parents at increased risk for major depression, who rated spirituality or religion as important to them, had increased resilience and a 90% decreased risk particularly for recurrence of major depression (associated with a thicker cortex and measures of increased white matter connectivity in the brain) over a 30-year period (3). Also, among women 30–55 years of age who participated in the Nurses’ Health Study, attendance at religious services once per week or more was associated with an incident suicide risk that was 84% lower than the risk for women who never attended religious services (4). In patients at high risk for suicide in the immediate aftermath of hospitalization, suicide risk can be reduced significantly by merely sending a postcard, as reported by Motto and Bostrom (5) and affirmed by the former director of the American Foundation for Suicide Prevention, Paula Clayton, M.D.
Psychiatrists evolved from priests or shamans (surgeons from barbers), as Jerome Frank delineated in Persuasion and Healing (previous required reading for psychiatric residents). Harold Koenig, M.D., and others have written on the importance of obtaining a spiritual history as part of the overall psychiatric evaluation (6). The former Archbishop of Canterbury, George Carey, calling for closer links between psychiatrists and clergy in the interests of both, and more importantly, in the interest of many patients, cites Andrew Sims’ remarks: “For too long psychiatry has avoided the spiritual realm, perhaps out of ignorance, for fear of trampling on patients’ sensibilities. This is understandable, but psychiatrists have neglected it at their patients’ peril. We need to evaluate the religious and spiritual experience of our patients in etiology, diagnosis, prognosis, and treatment” (7). In my interviews in the intensive care unit with patients who have made life-threatening suicide attempts despite the absence of identifiable risk factors (e.g., previous suicide attempts, personal or family history of depression, substance use, loss), adolescents often report they have no “meaning or purpose in life.”
To reduce suicide risks, it behooves psychiatrists to practice a bio-psycho-social-spiritual approach to diagnosis and treatment, as suggested initially by the internist George Engel, M.D.

Acknowledgments

The author thanks the Reverend Canon Richard Lief for his inspiration and L. Fernando Martinez, B.A., for his assistance with the references.

References

1.
Bostwick JM, Pabbati C, Geske JR, et al: Suicide attempt as a risk factor for completed suicide: even more lethal than we knew. Am J Psychiatry 2016; 173:1094–1100
2.
Insel TR, Scolnick EM: Cure therapeutics and strategic prevention: raising the bar for mental health research. Mol Psychiatry 2006; 11:11–17
3.
Miller L, Bansal R, Wickramaratne P, et al: Neuroanatomical correlates of religiosity and spirituality: a study in adults at high and low familial risk for depression. JAMA Psychiatry 2014; 71:128–135
4.
VanderWeele TJ, Li S, Tsai AC, et al: Association between religious service attendance and lower suicide rates among US women. JAMA Psychiatry 2016; 73:845–851
5.
Motto JA, Bostrom AG: A randomized controlled trial of postcrisis suicide prevention. Psychiatr Serv 2001; 52:828–833
6.
Koenig HG: Association of religious involvement and suicide. JAMA Psychiatry 2016; 73:775–776
7.
Carey G: Towards wholeness: transcending the barriers between religion and psychiatry. Br J Psychiatry 1997; 170:396–397

Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 398
PubMed: 28366088

History

Accepted: January 2017
Published online: 1 April 2017
Published in print: April 01, 2017

Keywords

  1. Suicide
  2. Religion

Authors

Details

Barbara L. Parry, M.D. [email protected]
From the Department of Psychiatry, UC San Diego, La Jolla, Calif.

Notes

Address correspondence to Dr. Parry ([email protected]).

Funding Information

The author reports no financial relationships with commercial interests.

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