Spiritual Dimensions of Suicide Prevention

This blog was originally posted on 11/8/16.  Please also see this published version of Dr Parry's letter the American Journal of Psychiatry. 

As emphasized in the leading editorial and attendant articles on suicide,(1)  and by the former NIMH Director, Thomas Insel, M.D., in contrast to the medical advancements in reducing infectious diseases, significant progress in reducing suicide rates has been elusive.

Other relevant studies underscore potential strategies for reducing suicide risk: 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 for particularly recurrence of major depression (associated with a thicker cortex and measures of increased white matter connectivity in the brain) over a 30-year period.(2)  Also, among women 30-55 years 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 compared with women never attending religious services.(3)  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 emphasized by the former Director of the American Suicide Foundation, Paula Clayton, M.D.

Psychiatrists originated from priests or shamans (surgeons from barbers), as Jerome Frank described 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.(4 ) 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 aetiology, diagnosis, prognosis and treatment.”(5)  

In the Intensive Care Unit, my independent interviews with two adolescent males who had made life-threatening suicide attempts revealed that, although they did not have the risk factors of previous personal or family history of depression or suicide attempts, had no identifiable life stressors of illness, accidents, deaths or relationship break-ups, and had supportive family and friends, they each shared that they had no sense of the “meaning or purpose of life.”

Thus it behooves psychiatrists to develop a bio-psycho-social-spiritual approach to diagnosis and treatment as suggested initially by the internist, George Engel, M.D.

Barbara L. Parry, M.D.
Professor of Psychiatry
University of California, San Diego

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

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References
1. Lytle MC, Silenzio VM, Caine ED. Are There Still Too Few Suicides to Generate Public Outrage? JAMA Psychiatry. 2016;73:1003-1004.
2. Miller L, Bansal R, Wickramaratne P, Hao X, Tenke CE, Weissman MM, Peterson BS. Neuroanatomical correlates of religiosity and spirituality: a study in adults at high and low familial risk for depression. JAMA Psychiatry. 2014;71:128-135.
3. VanderWeele TJ, Li S, Tsai AC, Kawachi I. Association Between Religious Service Attendance and Lower Suicide Rates Among US Women. JAMA Psychiatry. 2016;73:845-851.
4. Koenig HG. Association of Religious Involvement and Suicide. JAMA Psychiatry. 2016;73:775-776.
5. Carey G. Towards wholeness: transcending the barriers between religion and psychiatry. Br J Psychiatry. 1997;170:396-397.