Religious Activities and Suicide Prevention: A Gender Specific Analysis

religions Article Religious Activities and Suicide Prevention: A Gender Specific Analysis Steven Stack 1 2 Center for Suicide Research, Troy, MI 48098, USA; Wayne State University, Detroit, MI 48202, USA Received: 12 February 2018; Accepted: 4 April 2018; Published: 13 April 2018



 Abstract: The present analysis contributes to the existing literature on religion and suicide in three interrelated ways: (1) providing an analysis of suicide completions whereas most research is based on non-lethal levels of suicidality; (2) assessing the relationship with concrete individual level data on completed suicides instead of aggregated data marked by the ecological fallacy issue; and (3) providing gender specific analyses to determine if the relationship is gendered. METHODS. Data come from the U.S. Public Health Service, National Mortality Followback Survey. They refer to 16,795 deaths including 1385 suicides. Significant others of the deceased were interviewed to measure all variables. The dependent variable is a binary variable where 1 = death by suicide and 0 = all other causes. The central independent variable is an index of religious activities. Controls are included for five categories of confounders (1) psychiatric morbidity; (2) help-seeking behavior; (3) Opportunity factors such as firearms; (4) social integration; and (5) demographics. RESULTS. Multivariate logistic regression analysis determined that controlling for 16 predictors of suicide, a one unit increase in religious activities reduced the odds of a suicide death by 17% for males and by 15% for females. The difference in coefficients is not significant (Z = 0.51). Other significant predictors of suicide deaths included suicide ideation (OR = 8.87, males, OR = 11.48, females) and firearm availability (OR = 4.21, males, OR = 2.83, females). DISCUSSION. Religious activities were found to lower suicide risk equally for both men and women. Further work is needed to assess pathways, including suicide ideation, between religious activities and lowered suicide risk. This is the first U.S. based study to test for a gendered association between religion and suicide at the individual level of analysis. Keywords: suicide; religiousness; gender 1. Introduction According to the Centers for Disease Control, an estimated 8.3 million American adults seriously consider suicide, 2.2 million adults report making suicide plans and more than one million adults report attempting suicide in the past year (Crosby et al. 2011). However, fewer than 45,000 die through suicide each year, with 42,773 suicides in 2014 (Heron 2016). Some factors are holding most suicidal persons back from actually ending their lives. One such factor can be religion. Since the classic work of 19th century sociologist (Durkheim [1987] 1966), religion has often been found to be a protective factor against suicide (for reviews see Lester 2000; Stack 2000; Colucci and Martin 2008; Stack and Kposowa 2016). However, religion does not always serve as a protective factor in ecological studies and there is some evidence that its protective feature varies by region of the world. In a cross-national study of 42 nations over 1981–2007, Hsieh (2017) reports that aggregate mean levels of religious participation are more apt to be associated with lower national suicide rates in English speaking nations, Latin America, Eastern Europe and Northern Europe. Religion may actually aggravate suicide risk in East Asia, Western Europe and Southern Europe Religions 2018, 9, 127; doi:10.3390/rel9040127 www.mdpi.com/journal/religions Religions 2018, 9, 127 2 of 12 (Hsieh 2017). Work at the concrete individual level is much less common and is unavailable in many nations. This leaves the nature of the religion—suicide deaths relationship somewhat ambiguous on a global level. Research on religion and suicide is marked by a series of limitations. These include the use of aggregated data, a focus on non-lethal levels of suicidality such as ideation and attempts, and the relative lack of gender specific analyses. The present study addresses these three issues by analyzing U.S. national data on completed suicides, using individual level data on suicide and religion and testing for a gendered relationship between religion and suicide. First, most of the work on religion and suicide falls short of assessing religion’s impact on actual deaths by suicide (Kleiman and Liu 2018; Koenig et al. 2001, 2012; Lester 2000; Stack 2000; Stack and Kposowa 2016). The majority of studies deal with other levels of suicidality, notably suicide ideation and suicide attempts (Koenig et al. 2001, 2012). For example, Kleiman and Liu (2018) report that only three studies were found that explored the association between religious activities and actual deaths by suicide at the concrete individual level. Most of the research assesses the links between a measure of religion and one of the following measures of suicidality: suicide ideation, suicide attempts, suicide plans, or suicide acceptability (Koenig et al. 2001, 2012; Stack 2000; Stack and Kposowa 2016). An over focus on non-lethal suicidality can be misleading. Some patterns of suicidality vary according to the level of suicidality. For example, females have a higher rate of suicide attempts than males but the reverse is true if we turn to actual suicide completions (Lester 2000; Stack 2000). Second, most of the work that does deal with death rates by suicide is based on ecological data (e.g., Chon 2017; Colucci and Martin 2008; Hsieh 2017; Phillips 2013; Kleiman and Liu 2018; Stack and Laubepin 2018; for reviews see Colucci and Martin 2008; Lester 2000; Stack 2000; citealpB32-religions-277188). Religious measures are used to predict the rates of suicide for such aggregates as cities, countries, states and nations (Lester 2000; Stack 2000). This work is marked by the ecological fallacy problem. It is unclear to what extent the persons who die by suicide are disproportionately the ones who are presumably low in measures of religion. Work on the concrete level of individuals is needed to address this issue. A third, recurrent limitation of the literature is that there is little gender specific analysis. Generally, even individual level analyses of religion and suicide mortality are not gender specific but lump males and females together (e.g., Foster et al. 1999; Hilton et al. 2002; Kleiman and Liu 2014, 2018; Nisbet et al. 2000; Phillips and Luth 2018; Stack and Scourfield 2015). To the extent that females are higher in measures of religion than males, it may be that the association between religion and suicide is gendered. Stack (2000) concludes in his review of the literature on suicide completions, work which is based, however, at the ecological level, that the weight of the evidence points to religion having more of a protective effect on females than males. More recently, in an analysis of the fifty states spanning 1976–2000 Phill (...truncated)