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Bipolar patients who have moral or religious objections to suicide are less likely to attempt to kill themselves, a new retrospective study shows.
"A possible protective role of moral or religious objections to suicide deserves consideration in the assessment and treatment of suicidality in bipolar disorder," Dr Maria A. Oquendo of the New York State Psychiatric Institute, New York City, and colleagues conclude in their study, published online in the Journal of Clinical Psychiatry.
Cross-sectional studies have linked objections to suicide on moral or religious grounds to a lower likelihood of suicidal behaviour in patients with depression or cluster B personality disorder, Dr Oquendo and her team write.
While social support and family networks have important mental health benefits for bipolar patients, they add, to date there's been no research on how religious affiliation influences their suicide risk.
The investigation
To investigate, the researchers looked at records for 149 patients who met DSM-III-R criteria for bipolar disorder, depressed phase. Three-quarters reported religious affiliation, while the rest had no affiliation. About two-thirds had attempted suicide. Over half, about 56%, had past alcohol or substance use disorders, while 39% had cluster B personality disorders.
Among those with religious affiliation, about 63% of the patients, had a history of attempted suicide, compared to 80% of the non-affiliated patients. While the patients with religious affiliations were more likely to have children and had a more strongly family-oriented social network than those without religious affiliation, neither factor influenced the likelihood of attempting suicide.
The researchers also found that the religiously affiliated patients were older at their first suicide attempt (24.5 years vs. 20.4 years), had attempted suicide fewer times (1.6 vs. 2.3), and had fewer first-degree relatives who had killed themselves (3% vs. 14%).
Influential factors
Logistic regression analysis found that patients' score on the moral or religious objections to suicide subsection of the Reasons for Living Inventory was the only independent factor that predicted risk of suicidal behaviour, rather than religious affiliation in and of itself.
Lifetime aggression was the other independent predictor of suicidality. For every five-point increase in a person's score on the Brown-Goodwin Aggression Inventory, their risk of attempting suicide increased 1.6-fold.
"The assessment of moral or religious objections to suicide in clinical settings could help to estimate the orientation toward living, an important part of the assessment of suicidal risk," Dr Oquendo and her colleagues write. "For religiously affiliated individuals, moral or religious objections to suicide may be a powerful tool in coping with suicidal behaviour."
They conclude: "Further studies are needed to investigate the protective role of religious beliefs against suicide under different psychiatric conditions."
(Reuters Health, February 2011)
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