Religion, spirituality and suicidality

Several reviews express and support the claim that religiosity can protect against suicide ideation, suicide attempts, and completed suicide. The main question of the present project is how religiosity in its broadest sense (religiosity, spirituality, and meaning making, R/S/M) interacts with suicidal behavior in psychiatric populations. Subquestions focus on (1) which dimensions have been examined worldwide; (2) which dimensions are most protective or inductive for suicidality; and (3) intensive exploration of the longitudinal characteristics of specific dimensions of R/S in relation to suicidality. Chapter 1 provides a systematic evaluation of all empirical evidence on the potential influence of R/S/M and its dimensions on suicidality for psychiatric patients worldwide. The previously found protective character of R/S/M in general for suicidality was corroborated for psychiatric patients by a significant outcome in the meta-analysis for several aspects of R/S/M. Some distressing aspects of R/S/M were related to increased suicidality. Chapter 2 reports an in-depth exploration of the literature to test the hypothesis that ‘moral objections to suicide (MOS), especially the conviction of going to hell after committing suicide, exert a restraining effect on suicide and suicidality.’ MOS counteract especially the development of suicidal intent and attempts, and possibly the lethality of suicidal attempts. Chapter 3 examines for a total of 155 in- and outpatients with major depression from a Christian mental health care institution which specific dimensions of religiosity and spirituality (R/S), when compared, correlate with suicidality. The following religious factors were assessed: religious service attendance, frequency of prayer, religious salience, type of God representation, and moral objections to suicide (MOS). MOS were found to exhibit a unique and prominent (negative) association with suicide ideation and the lifetime history of suicide attempts. The type of God representation was an independent statistical predictor of the severity of suicide ideation, specifically a positive-supportive God representation was negatively correlated with suicide ideation. Chapter 4 provides results from a follow-up assessment for the same population. Supportive R/S was persistently associated with lower suicidality. Chapter 5 further challenges the stereotype that religiosity and spirituality (R/S) are commonly considered and treated as relatively stable over time. In an exploratory experience sampling method (ESM) study, the variability of three R/S parameters concerning affective representations of God and spiritual experiences in a psychiatric population was assessed. All three examined R/S parameters varied significantly within the day. Chapter 6 continues this exploration. The same experience sampling (ESM) data were used to examine over six days (mean of 42 assessments) the association between symptoms of depression, suicidality, specific positive-supportive affective R/S, and positive psychology variables. Symptom network plots on a group level and for four selected individuals were analyzed using dynamic time warping (DTW) analysis. Three selected R/S variables were included. R/S variables were connected to positive psychology variables with a bridge function of inner peace in the group-level undirected network. The results of this study suggested that religiosity and spirituality can function as meaningful factors in depression and suicidality in religiously or spiritually engaged persons. Experienced inner peace had a positive association with reasons to live. This study also provided proof-of-principle for effective analysis of ESM data using DTW. In conclusion, suicidality is a clinically important and multifaceted phenomenon. R/S/M can exhibit an attenuating as well as a reinforcing effect on suicidality, with different dimensions functioning differently between individuals and their cultural and R/S/M contexts. Dimensions of R/S/M prove to be dynamic, both over time and in their interrelations with suicidality. Exploring individual religious or spiritual engagement with special attention to its longitudinal unfolding over the course of a psychiatric episode could prove important in treating suicidality and depression.