MedicalResearch.com Interview with:
Dr. Tyler J. VanderWeele
Tyler J. VanderWeele, PhD, Department of Epidemiology
Harvard T. H. Chan School of Public Health,
Boston, MA 02115
MedicalResearch.com: What is the background for this study?
Response: Suicide is one of the ten leading causes of death in the United States, and in recent years the suicide rate has been increasing. A recent report from the National Center for Health Statistics indicated that the suicide rate per year per 100,000 people had increased from 10.5 in 1999 to 13.0 in 2014.
MedicalResearch.com: What are the main findings?
Response: We examined the association between religious service attendance and suicide, and found that women who attend religious services once or more per week were more than 5 times less likely to subsequently commit suicide. There was also some evidence that this varied by religious affiliation: Protestant women who attended services once or more per week were approximately 3 times less likely to subsequently commit suicide, whereas Catholic women who attended services once or more per week were about 20 times less likely to commit suicide.
MedicalResearch.com: What should readers take away from your report?
Response: Other studies have suggested that religious service attendance can have powerful effects on health, including longevity, depression, and cancer survival. This study provides evidence that religious service attendance is protective against suicide as well. Our results do not imply that health care providers should prescribe attendance at religious services. Decisions about religious participation are made on the grounds of personal experience, beliefs, upbringing, evidence, values, relationships and so on. However, for patients who are already religious, service attendance might be encouraged as a form of meaningful social participation. Religion and spirituality may be an underappreciated resource that psychiatrists and clinicians could explore with their patients, as appropriate.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We attempted to identify some of the mechanisms that might explain the association between religious service attendance and lower suicide risk. Those who attended religious services tended to subsequently have more social support, were less depressed, and consumed less alcohol. While each of these explained some of the association, we were surprised that they were not more prominent. Our speculation is that an important mechanism relating religious service attendance and lower suicide risk might be the belief that suicide is morally wrong, but this would require other studies that assessed such moral beliefs. Feeling close to God has also been proposed as a mechanism that may prevent suicide but this too would require future research to assess.
Although our study results were based on rigorous design and analysis, suicide is a relatively rare outcome and so one needs a very large sample to adequately study it. We examined the association among 89,708 women in the Nurses’ Health Study, but it would also be good if the results could be replicated in other large studies, especially those concerning differences across religious affiliation.
MedicalResearch.com: Is there anything else you would like to add?
Response: The National Center for Health Care Statistics indicated an increase in the suicide rate from 10.5 in 1999 to 13.0 in 2014. During this same period, the Gallup Poll indicates a decline in weekly religious service attendance from 43% in 1999 to 36% in 2014. While a calculation like this requires a great deal of extrapolation from the data, if we use our estimates from this study and apply it to the general population, this would suggest that of the increase in the suicide rate between 1999 and 2014, nearly 40% of this could be attributed to the decline in religious service attendance.
Suicide has been considered a major public health issue for some time. It is one of the ten leading causes of death in the United States. Efforts have been and continue to be made to prevent suicide. In light of this, one rather striking feature of the contemporary discussion of suicide in the United States is the proposal, and in some states legislation, to allow physician-assisted suicide. From a public health perspective, suicide is viewed as a cause of great concern, but when placed within a medical context, are we then to consider it acceptable? There seems something morally anomalous when we attempt to prevent suicide in one context but facilitate it in another. I think this is an important issue for the medical and public health communities to work through.
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Association Between Religious Service Attendance and Lower Suicide Rates Among US Women
Tyler J. VanderWeele PhD, Shanshan Li ScD, Alexander C. Tsai MD, Ichiro Kawachi PhD
JAMA Psychiatry. doi:10.1001/jamapsychiatry.2016.1243 Published online June 29, 2016.
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