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Original Investigation |

Association Between Religious Service Attendance and Lower Suicide Rates Among US Women

Tyler J. VanderWeele, PhD1,2,3; Shanshan Li, ScD1; Alexander C. Tsai, MD4,5,6; Ichiro Kawachi, PhD7
[+] Author Affiliations
1Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
2Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
3Program on Integrative Knowledge and Human Flourishing, Institute of Quantitative Social Science, Harvard University, Cambridge, Massachusetts
4Center for Global Health, Massachusetts General Hospital, Boston
5Harvard Center for Population and Development Studies, Cambridge, Massachusetts
6Mbarara University of Science and Technology, Mbarara, Uganda
7Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
JAMA Psychiatry. 2016;73(8):845-851. doi:10.1001/jamapsychiatry.2016.1243.
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Importance  Previous studies have linked suicide risk with religious participation, but the majority have used ecologic, cross-sectional, or case-control data.

Objective  To examine the longitudinal association between religious service attendance and suicide and the joint associations of suicide with service attendance and religious affiliation.

Design, Setting, and Participants  We evaluated associations between religious service attendance and suicide from 1996 through June 2010 in a large, long-term prospective cohort, the Nurses’ Health Study, in an analysis that included 89 708 women. Religious service attendance was self-reported in 1992 and 1996. Data analysis was conducted from 1996 through 2010.

Main Outcomes and Measures  Cox proportional hazards regression models were used to examine the association between religious service attendance and suicide, adjusting for demographic covariates, lifestyle factors, medical history, depressive symptoms, and social integration measures. We performed sensitivity analyses to examine the influence of unmeasured confounding.

Results  Among 89 708 women aged 30 to 55 years who participated in the Nurses’ Health Study, attendance at religious services once per week or more was associated with an approximately 5-fold lower rate of suicide compared with never attending religious services (hazard ratio, 0.16; 95% CI, 0.06-0.46). Service attendance once or more per week vs less frequent attendance was associated with a hazard ratio of 0.05 (95% CI, 0.006-0.48) for Catholics but only 0.34 (95% CI, 0.10-1.10) for Protestants (P = .05 for heterogeneity). Results were robust in sensitivity analysis and to exclusions of persons who were previously depressed or had a history of cancer or cardiovascular disease. There was evidence that social integration, depressive symptoms, and alcohol consumption partially mediated the association among those occasionally attending services, but not for those attending frequently.

Conclusions and Relevance  In this cohort of US women, frequent religious service attendance was associated with a significantly lower rate of suicide.

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Figure.
Suicide Incidence From 1996 to 2010 by Frequency of Religious Service Attendance in 1996

Patterns of suicide incidence per 100 000 person-years by religious service attendance for Protestants, Catholics, and overall.

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