Religion and Spirituality in Psychiatry

Consultation-Liaison Psychiatry 197age, lower education, more depressive symptoms,and poorer cognitive functioning), only two characteristicsindependently predicted passive suicidalideation: depressive symptoms and low religiouscoping. Low life satisfaction and low religious copingwere also the only characteristics that independentlypredicted active suicidal ideation.The inverse relationship between religiousnessand suicidal ideation is also present in patientswith severe medical illness, which brings thistopic into the realm of CL psychiatry. For example,McClain and colleagues examined the relationshipbetween spiritual well-being, depression,and desire for death in 160 terminally ill cancerpatients with less than three months to live.(16)Scales measuring depressive symptoms, hopelessness,attitudes toward a hastened death, andthe FACIT-Spiritual well-being (SWB) scale wereadministered to patients. A single item measuredrecurrent thoughts of death or suicide on a scalefrom absent to “high risk requiring suicide precautions.”SWB was significantly and inverselyrelated to a desire for hastened death, hopelessness,and suicidal thoughts, and of all variables,was the strongest predictor of these three outcomes– even stronger than severity of depression.In fact, while depression was strongly correlatedwith desire for a hastened death in those with lowSWB, no correlation was found between depressionand suicidal yearnings in those with highSWB. This study, published in The Lancet , concludedthat SWB provided substantial protectionagainst end-of-life despair.Examining attitudes toward euthanasia andassisted suicide in an Australian outpatient cancerpopulation, (17) Carter and colleagues studied theimpact of mental health and other characteristicsin predicting attitude toward these suicide-relatedpractices. The sample consisted of 228 patientsattending an oncology clinic in Newcastle, Australia.Possible predictors of suicidal attitude includeddemographic characteristics, disease status, mentalhealth (depression, anxiety, and prior suicideattempts), and quality of life. Results indicated thatthe majority of respondents supported euthanasia(79 percent) and physician-assisted suicide (69percent). Only 2 percent, however, had ever askedtheir physician for either euthanasia or physicianassistedsuicide. Active religious belief was the mostimportant predictor of attitudes toward all threesuicide-related behaviors (euthanasia, assistedsuicide,and personal support for euthanasia orassisted-suicide). Patients with an active religiousbelief were 79 percent less likely to have positiveattitudes toward euthanasia, 65 percent less likely tohave positive attitudes toward assisted suicide, and74 percent less likely to personally support euthanasiaor assisted-suicide (all highly statistically significant).Interestingly, depression, anxiety, recentsuicidal ideation, and history of suicide attemptwere unrelated to any of these three outcomes onceactive religious belief was take into account.5.1. Timely Psychiatric CareReligious beliefs and activities may also affectsuicide rates in other ways besides simply prohibitingsuicide. In particular, religious involvementmay increase the likelihood that personswith suicidal thoughts will obtain timely psychiatriccare. Members of the religious communityoften consider it an obligation to check on thosewho may be depressed or otherwise at risk forsuicidal thoughts. This may be particularly truefor those with medical illness or in other difficultlife situations obvious to members of theirfaith community. First, as noted earlier, the supportfrom members of the congregation may helpto reduce the negative emotions responsible forthe desire to commit suicide. Second, churchmembers may encourage people to seek professionalassistance for their problems before thoseproblems get to a point that suicidal thoughtsdevelop. Third, if suicidal thoughts are alreadypresent, then members of the religious communityare likely to encourage the suicidal personto seek professional help to relieve their distressor discover alternative ways of dealing with theproblem besides suicide.I Want to DieRichard is a 70-year-old retired businessmanwho lost his wife of forty-fiveyears, Ethyl, to cancer two years ago. He