Spirituality Is a Powerful Tool in Suicide Prevention

Because hope is something we can’t live without

WWhen John presented to McLean Hospital, he raised almost every red flag in the book for suicide risk. As a Caucasian, middle-aged male with chronic depression, a history of substance dependence, ongoing marital struggles, multiple medical conditions, significant physical pain, and access to firearms, his clinical team was concerned. Worse, John, who requested that his last name not be included for privacy reasons, was not responding well to his current treatment. None of his psychiatric medications or therapists were hitting the mark.

So, we called for a spiritual care consult.

To the surprise of his clinical team, John started to improve after the consult. He was still depressed, but within weeks he became noticeably less edgy and he started to engage in therapy.

Why the change?

In a nutshell, John had become more hopeful for the future. By discussing his situation in spiritual terms, he had tapped into the (literally) age-old process of religious coping, which involves harnessing the divine to deal with emotional distress. In drawing upon spirituality to cope, John started to accept his medical and marital woes and envision that, overall, his life could somehow improve over time.

Weekly religious service attendance was associated with a fivefold lower rate of suicide compared to individuals who never attend.

Data from national studies suggests that John is not alone. One review of the literature determined that 100% of all published studies on spirituality/religion and suicide have found that the former protects against the latter.

A few years ago, one of my colleagues at the Harvard School of Public Health, Dr. Tyler VanderWeele, published a study in JAMA Psychiatry, which found that weekly religious service attendance was associated with a fivefold lower rate of suicide compared to individuals who never attend.

Why might spirituality protect against suicide?

Greater social engagement is probably one factor, since spiritual activities are often done with friends. Lower incidence of alcohol and substance use among churchgoers may also contribute. And moral objections to suicide on religious grounds certainly cannot be ignored. But perhaps the most pertinent aspect of spirituality that prevents suicide is hopefulness.

Across the gamut of religious traditions, spirituality can engender the perspective that things happen for some reason and serve a greater purpose. This, in turn, deploys our attention toward the potential for a brighter future, which can create a sense of optimism even when one’s situation seems dire.

Consider that despite our unparalleled wealth and success as a nation, suicide rates have increased 25% over the past 20 years, such that today, according to the U.S. Center for Disease Control, suicide is the second leading cause of death among individuals under 35. Counterintuitively, achievement and wealth do not facilitate a sense of optimism. On the other hand, the simple perspective that there is something greater than us can generate a hopeful disposition.

Regretfully, mental health professionals often ignore spirituality in treating suicidal patients, since training programs seldom teach clinicians how to address this domain. Furthermore, despite a clear need for more research in this area of study, the National Institute of Mental Health is presently funding only one study that even considers the role of spirituality in suicide.

While not everyone wants to access spiritual care, since some prefer secular approaches to treatment, hope is something we cannot live without. So, if we are to address the growing suicide epidemic, perhaps the combined fields of behavioral and mental health should be open to some divine assistance? As John experienced, tapping a relationship with a higher power can make a big difference.

Director of the McLean Hospital Spirituality & Mental Health Program and Assistant Professor in the Department of Psychiatry at Harvard Medical School

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