Suicide is among the 10 leading causes of death in the United States. The major world religions have traditions prohibiting suicide.

Tyler J. VanderWeele, PhD., of the Harvard T.H. Chan School of Public Health, Boston, and coauthors looked at associations between religious service attendance and suicide from 1996 through June 2010 using data from the Nurses' Health Study. The analysis included 89,708 women and self-reported attendance at religious services.

Among the women, who were mostly Catholic or Protestant, 17,028 attended more than once per week, 36,488 attended once per week, 14,548 attended less than once per week and 21,644 never attended based on self-reports at the study's 1996 baseline. Authors identified 36 suicides during follow-up.

Compared with women who never attended services, women who attended once per week or more had a five times lower risk of subsequent suicide, according to the results.

The authors note their study used observational data so, despite adjustment for possible confounding factors, it still could be subject to confounding by personality, impulsivity, feeling of hopelessness or other cognitive factors. The authors also note women in the study sample were mainly white Christians and female nurses, which can limit the study's generalizability.

"Our results do not imply that health care providers should prescribe attendance at religious services. 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," the study concludes.

Editorial: Association of Religious Involvement and Suicide
"What should mental health professional do with this information? ... Thus, the findings by VanderWeele et al underscore the importance of a obtaining spiritual history as part of the overall psychiatric evaluation, which may identify patients who at one time were active in a faith community but have stopped for various reasons. ... Nevertheless, until others have replicated the findings reported here in studies with higher event rates (i.e., greater than 36 suicides), it would be wise to proceed cautiously and sensitively," writes Harold G. Koenig, M.D., of Duke University Medical Center, Durham, NC, in a related editorial.

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