The relationship between religion and suicide was first established in Emile Durkheim’s 19th-century seminal treatise. This has since been corroborated in different countries,most recently by Swiss researchers who used a year 2000 census-based cohort study to show that such risk patterns still persisted, with risk highest for those with no religious affiliation, lowest for Roman Catholics and intermediate for Protestants. Why religion should exhibit this protective effect is less clear: Durkheim attributed it to the sense of community that arises from active church membership, with attendance the most commonly cited attribute. Others, however, emphasise the moral and religious objections to suicide,although Durkheim was at pains to rule this out as an explanation. Perhaps a more pertinent question is why, given increasing societal secularisation, does the relationship between religion and suicide still seem to persist? Increasing secularization is also evident in Switzerland, where by the end of the 1990s nonpractising Christians made up almost half the population, and a further 11% cited no religious affiliation. This has led many social researchers, including some in Switzerland, to conclude that affiliation bears little correspondence to religious belief or practice but is more likely to reflect a diverse set of traditions or social convenience.

So begins a new paper from the British Journal of Psychiatry looking at what seems to be a very old and established relationship: religion and suicide. This is heavily treed ground, as the above quotation suggests, with work going back to Durkheim’s 1897 book.

Emile Durkheim

I remember medical school and residency conversations on this topic of religion and suicide, referencing Durkheim. Though people debated the reasons, this much seemed to be taken for granted: religion bestows a protective quality on its followers. For Durkheim, the thinking was that church attendance – highest among the Catholics – provided the advantage.

In “Religion and the risk of suicide: longitudinal study of over 1 million people,” Dermot O’Reilly and Michael Rosato focus on Northern Ireland, drawing on census data.

Dr. Dermot O’Reilly

It’s a short, clever study. It also raises a simple question: is Durkheim’s thinking dated?

O’Reilly and Rosato look at Northern Ireland. If Durkheim is relevant, then Catholics – with their high church attendance – should have the lowest risk.

Here’s what they did:

· The study used the Northern Ireland Mortality Study, derived from the 2001 census, and including registered deaths to 2009. There were a total of 1,106,146 people, ages 16-74, used in the study.

· Religious affiliation was based on two census questions. The first asked if people regarded themselves as belonging to any religion; the second asked them to specify the religion. The groups were Catholics, Protestants (the main denominations), conservative Christians (Free Presbyterians, Baptists, and Brethren), and other faiths – who were excluded from the survey.

Here’s what they found:

· Not surprisingly, Protestants composed the largest group (41.6%) in the study. Other religious groups: Roman Catholics (39.5%), conservative Christians (6.3%). 12.6% had no religious affiliation.

· During the study period (8.7 years), there were 52,617 deaths; 1,119 were by suicide or of undetermined intent. Suicides were largely men (74.4%) and young (64.8% were under 45 years old).

· “The risk for those with no religious affiliation was the same as that for Catholics and this was not significantly altered by adjustment for other sociodemographic factors.” (!)

· Conservative Christians had the lowest risk of suicide – about 30% less likely to complete suicide.

· The authors looked at age grouping, and did find differences. For example, “at younger ages suicide risk is highest for Catholics; for Protestants and conservative Christians it is about 25% lower. The risk for those without a religious affiliation is a little lower than that for Catholics but not significantly so.”

They conclude:

In this study suicide risk was generally the same for those with and without a professed religious affiliation.

Looking to the age breakdown, they add:

Within the denomination groups tested, the risk for younger Catholics was about 20% higher than for mainstream Protestant denominations, and only those belonging to the more conservative Christian groups recorded lower relative risks (at least up to age 55 years).

What to make of the small group of conservative Christians and their low suicide risk?

The results of our study would argue against Durkheim’s mechanism of church attendance, as contemporaneous social surveys suggest that church attendance is generally higher among those who are Catholics. However, it is possible that other church-related activities or the less organisational aspects of religion are important. It is also possible that the effects of religion might be more indirect and operate through reduction of other social and behavioural factors that are known to increase the risk of suicide.

Drawing on the work of McCullough and Willoughby – who emphasize religion’s influence on self-control – they note:

It is recognised that religion can influence lifestyle through endorsement of health-promoting behaviours and disapproval of excess risk-taking, and religious involvement is associated with less delinquency, alcohol misuse and drug-taking. Religious youths demonstrate greater commitment to studies and higher educational attainment, and married religious people record higher levels of marital satisfaction and lower levels of divorce.

The reasoning is sound and draws from a thoughtful literature. But it’s also difficult not to find the commentary somewhat jarring – after dismissing Durkheim, they seem to tap their inner-Durkheim. All the arguments they put forward should hold for Catholics and Protestants, not just conservative Christians.

Perhaps it’s too clever by half and the simplest conclusion is that cultural factors beyond crude religious affiliation are at play.

A few thoughts:

This is a good study. It’s well constructed, covering a reasonable time period, and with a significant number of people involved.

This study raises good questions. Is this result reproducible in other areas? Consider that these results are quite different than the Swiss data. And would similar results be found in places that were less Christian and with greater representation of other religions?

This study sheds new light on old thinking. One thing I really like about this study: it goes back to an “old truth” and discovers more complexity than we may have previously appreciated.

Reading of the Week. Every week I pick a reading — often an article or a paper — from the world of Psychiatry.