|Year : 2014 | Volume
| Issue : 3 | Page : 138-142
Prevalence and relationship of religiosity level and suicidal ideation in depressed patients
Nagy Fawzy, Nagda Elmasry, Amira A Fouad, Usama M Youssef, Wa-il Abohendy
Department of Psychiatry, Zagazig University, Zagazig, Egypt
|Date of Submission||24-Mar-2014|
|Date of Acceptance||05-May-2014|
|Date of Web Publication||11-Nov-2014|
Department of Psychiatry, Zagazig University, Zagazig
Source of Support: None, Conflict of Interest: None
The aim of this study was to determination the prevalence and relationship of religiosity level and suicidal ideation in depressed patients.
The sample included 100 patients recruited from psychiatric outpatient clinics of Zagazig University Hospitals. The patients included fulfilled the Diagnostic and statistical manual of mental disorders, 4th ed., text revision, criteria for depression, were between 18 and 60 years of age, of both sexes, and were from all socioeconomic and educational classes.
Patients and methods
All participants were subjected to a psychiatric assessment for depressive symptoms using the Arabic version of Beck Depression Scale, suicidal ideation using the Arabic version of the Beck Suicide Ideation Scale, and religiosity using the Scale of Islamic Religiosity Attitude.
The results of the current study showed that the prevalence of suicidal ideations was 18 and 10% in those with low religiosity level among depressed patients. There was a statistically significant difference between religiosity and suicide in depressed patients.
The current study concluded that suicidal ideations are a highly prevalent phenomenon, and suicidal ideation was more prevalent in less religious patients than highly religious patients.
Keywords: depressed patients ideation, prevalence religiosity level, suicidal
|How to cite this article:|
Fawzy N, Elmasry N, Fouad AA, Youssef UM, Abohendy Wi. Prevalence and relationship of religiosity level and suicidal ideation in depressed patients. Egypt J Psychiatr 2014;35:138-42
|How to cite this URL:|
Fawzy N, Elmasry N, Fouad AA, Youssef UM, Abohendy Wi. Prevalence and relationship of religiosity level and suicidal ideation in depressed patients. Egypt J Psychiatr [serial online] 2014 [cited 2023 Sep 21];35:138-42. Available from: https://new.ejpsy.eg.net//text.asp?2014/35/3/138/144333
| Introduction|| |
The growing body of research linking religion and spirituality to health outcomes comes from the west, with empirical evidence in the Arab population in the middle east region (Al-Kandari, 2003). Approximately one million individuals die by suicide every year (WHO, 2001). Suicide is the 10th leading cause of death worldwide (Lopez et al., 2006). Suicide and depression are serious inter-related public health problems accounting for a significant proportion of the global burden of disease (Hawton and Van Heeringen, 2009). One of the nine possible diagnostic criteria of a major depressive episode in Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision, includes recurrent thoughts of death, recurrent suicidal ideation without a specific plane, a suicide attempt or a specific plan for committing suicide (Weissman et al., 1999). Numerous studies have identified depression as a significant risk factor for suicide; this contributes toward mortality rates associated with depression that are ~20 times more than the general population (APA, 2003). Religiosity has been shown to provide protection against the occurrence of depression and to further remission in particular in elderly patients who have few social contacts and little self-confidence (Braam et al., 2000; Koenig, 2001). Although the wish to die is not uncommon among patients with depression in Arab countries, it usually remains at the level of wishing that god would terminate their life and does not progress to the wish to kill themselves (El Islam, 2006). Religious practice appeared to be associated with less depression, both at the individual and at the national level (Braam et al., 2000). Religion may be protective against suicide both at the individual and at the societal level, and this effect is mediated by the degree to which a given religion sanctions suicide (Kumar, 2002). Higher religiosity is associated with lower levels of suicidal ideation among American and Kuwaiti college students (Abdel-Khalek and Lester, 2007). Lower moral and religious objections to suicide are associated with a greater number of lifetime suicide attempts (Kumar, 2002). Suicide is strongly and explicitly prohibited by Islam (Ates, 1975). Lower recorded rates of suicidal behavior are found among Muslims when compared with other religions such as Christianity and Hinduism. However, across religious denominations, a higher degree of religiosity is associated with a decreased risk of suicide (Abdel-Khalek, 2004).
| Patients and methods|| |
This study was carried out in psychiatry outpatient clinics of Zagazig University Hospitals in the period between 1 January 2013 and 1 October 2013. The sample included 100 patients recruited from psychiatric outpatient clinics of Zagazig University Hospitals. To be included in the study, patients had to fulfill the Diagnostic and statistical manual of mental disorders, 4th ed., text revision, criteria for depression and had to be between 18 and 60 years of age. Muslims, both sexes, were included from all socioeconomic and educational classes. The exclusive criteria were patients with other psychiatric or physical disorders, previous suicidal attempts, and substance dependence. An informed written consent was obtained from all participants.
Detection of depressive symptoms was performed using the Arabic version of the 21-item Beck Depression Scale-II, which consists of 21 items; each item is composed of four options scored on a four-point scale ranging from 0 to 3. Scores can range from 0 to 63, where 0-13 indicates the lowest level of depression, 14-19 indicates mild depression, 20-28 indicates moderate depression, and 29-63 indicates severe depression (Beck et al., 1996).
Detection of suicidal ideation was performed using the Arabic version of Beck Suicide Ideation Scale, which consists of 19 items. There are five screening items (three items assess the wish to live or the wish to die and two items assess the desire to attempt suicide). Fourteen additional items were administered. Each item includes three options of grading according to the intensity of the suicidality and is rated on a three-point scale ranging from 0 to 2. These ratings are then summed to yield a total score, which ranges from 0 to 38 (Beck et al., 1979).
Detection of religiosity level was performed using the Scale of Islamic Religiosity Attitude (SIRA, 40-item). It is an objective measure of the religiosity attitude of Muslims. It consists of 40 items (included in three groups); each item is composed of five options scored on a five-point scale ranging from 1 to 5. Scores can range from 0 to 200, where scores of 0-50 indicate a very low level of religiosity, scores of 51-100 indicate a low level of religiosity, scores of 101-150 indicate a moderate level of religiosity, and scores of 151-200 indicate a high level of religiosity (Khaldoun Marwa, 2010).
Chi-square analysis was used to compare the sociodemographic characteristics of the study between groups.
Where O is the observed value and E is the expected value.
Correlation between depression and suicidal ideation, and other correlations were assessed and analyzed by a personal computer using the statistical software program SPSS (version 13) (SPSS, 2002).
| Results|| |
The results of the current study are as follows: the prevalence of suicidal ideations in depressed patients was 18%, but only 2% (1% men and 1% women) had failed suicidal attempts [Table 1]. There were no suicidal cases; these rates are very low and statistically not significant. [Table 2] shows that religiosity was more prevalent in male than female patients, and the difference was statistically not significant. [Table 3] shows that religiosity was more prevalent in older than younger patients, and the difference was statistically highly significant. [Table 4] shows that religiosity was more prevalent in married than unmarried patients, and the difference was statistically nonsignificant. [Table 5] shows that religiosity was more prevalent in more educated than less educated patients, and the difference was highly significant. [Table 6] shows that suicidal ideation was more prevalent in severely depressed patients than those with other less degrees of depression, and the difference was statistically insignificant. [Table 7] shows that suicidal ideation was more prevalent in less religious patients than highly religious patients and vice versa, and the difference was statistically significant. [Table 8] shows that religiosity level was higher in older, less depressed patients and in patients who did not have suicidal ideation, and the correlation was statistically highly significant, as P value less than 0.05 indicates significance and P value less than 0.01 indicates high significance.
|Table 8 Pearson's correlation coeffi cient between religiosity score and other variables|
Click here to view
| Discussion|| |
Suicide is not only a personal tragedy but also a serious international public health problem; few authors have investigated the influence of religion on suicide from a medical and suicidological perspective (Okash, 2008). The growing body of research linking religion and spirituality to health outcomes comes from the west, with little empirical evidence in Arab populations in the middle east region (Al-Kandari, 2003). In the current study, the results showed that suicidal ideations were more prevalent in depressed patients, and the difference was statistically highly significant as 18% of the depressed patients had suicidal ideations, and only 2% of patients (1% men and 1% women) had attempted suicide. These results are generally low (perhaps because of the religious factor), but in agreement with the authors of the Oxford textbook of suicidology and suicide prevention Wasserman and Wasserman, 2009), who consider depression as a precursor to suicide, and also in agreement with other studies that have identified depression as a significant risk factor for suicide; this contributes toward mortality rates associated with depression that are ~20 times more than the general population (Weissman et al., 1999). This finding is in agreement with that of Kamath et al. (2007) as they found depression to be associated with suicidal ideation (as well as hopelessness and a history of suicide attempts); these results has been confirmed by several psychological autopsy studies that showed that the majority of suicidal victims had a mood disorder (usually untreated major depression with a comorbidity of substance use and anxiety disorder) (Rihmer et al., 1995). In a review of the literature (Diekstra, 1993), as for the relation between suicidal ideation and depression in this study, suicidal ideation was more prevalent in severely depressed than in those with other less degrees of depression, and the difference was statistically significant; these results are in agreement with the findings of Balci and Sevincok (2009) as they found that severity of depression was more likely to be higher in patients with suicidal ideation than patients without suicidal ideation. In terms of the relation between religiosity and depression, religiosity was more prevalent in less depressed than in severely depressed patients, and the difference was statistically highly significant; this result is in agreement with APA (2003), who found that religious practices appear to be associated with less depression both at the individual and at the national level. In terms of the relation between religiosity and suicidal ideation, religiosity was more prevalent in patients without suicidal ideation than in patients with suicidal ideation, and the difference was statistically highly significant; suicidal ideation was more prevalent in less religious patients than highly religious patients and vice versa, and the difference was statistically significant, Also, the mean suicidal ideation was more in less religious patients and vice versa, and the difference was highly significant. These results are in agreement with those of Dervic et al. (2004) as they found that across religious denominations, a higher degree of religiosity is associated with a decreased risk of suicide. Colucci and Martin (2008) cite numerous studies that have found religious factors to be associated with lower rates of suicidal behaviors well as more negative attitudes toward such behaviors. Lizardi and Gearing (2010) found that lower moral and religious objections to suicide are associated with a greater number of lifetime suicide attempts. Kumar (2002) found that higher religiosity is associated with lower levels of suicidal ideations among American and Kuwaiti college students. In contrast to the results of the current study, Leff (1986) found that religion seems to suppress the suicidal actions but not suicidal thoughts; this observation may be supported by the findings that suicidal thoughts were elicited in 58% of depressive patients in Kuwait and only 11% had attempted suicide. Similarly, a comparison of Egyptian, Indian, and British depressive patients showed that Egyptians have significantly increased suicidal tendencies, but not in the actual suicide or attempted suicide (Okash, 2000). In terms of the relation between religiosity and education, religiosity was more prevalent in more educated than less educated patients, and the difference was highly significant. In terms of the relation between religiosity and age, religiosity was more prevalent in the older than in the younger patients, and the difference was statistically highly significant. In the relation between religiosity and sex, religiosity was more prevalent in male than female patients, and the difference was statistically nonsignificant. The lower rate of suicide in Egypt could be attributed to the Islamic law or doctrine in which suicide is condemned and is considered to be a criminal act in itself (the Holy Quran, Surah An-Nisa, 4:29 and the Holy Quran, Surah Al-Baqarah, 2:195). We believe that this might have a role in preventing many vulnerable individuals from committing these acts. The relatively low average suicide rate was also found in another Islamic country, Saudi Arabia, and was 1.1/100 000 population per annum according to a study in 2005 (Nock et al., 2006). In another study in Dammam, the second largest city in Saudi Arabia, there was a marked decrease in suicide rate in this city from 2.55/100 000 population in 2003 to 1.15/100 000 population in 2007 (Uzun et al., 2007).
| Conclusion|| |
The current study concluded that suicidal behavior is not a highly prevalent phenomenon in depressed patients with a high level of religiosity, and it is strongly inter-related with sociodemographic characteristics.
More attention should be paid to depressed patients as depression is a significant risk factor for suicide and one of the most prevalent mental problems in individuals who die by committing suicide. More attention should be paid to religiosity and morals as religion is considered a protective factor from mental illness, and obtain the maximal benefit from religion in psychiatry. Further researches are needed to study the role of religiosity in patients with other mental disorders.
| Acknowledgements|| |
| References|| |
Abdel-Khalek AM (2004). Neither altruistic suicide, nor terrorism but martyrdom: A Muslim perspective. Archives of Suicide Research, 8:99-113.
Abdel-Khalek AM, Lester D (2007). Religiosity, health and psychopathology in two cultures: Kuwait and USA. Mental Health Religion Culture 10:547-550.
Al-Kandari YY (2003). Religiosity and its relation to blood pressure among selected Kuwaitis. J Biosoc Sci 35:463-472.
American Psychiatric Association (APA) (2003) practice guidelines provide evidence-based recommendations for the assessment and treatment of psychiatric disorders. http://psychiatryonline.org/content.aspx?bookid=28§ionid=1673332.
Ates Y. (1975). The effects of religious versus secular education on suicide ideation and suicidal attitudes in adolescents in Turkey. Social Psychiatry and Psychiatric Epidemiology 39:536-542.
Balci V, Sevincok L (2009). Suicidal ideation in patients with obsessive-compulsive disorder. Psychiatry Res 175:104-108.
Beck AT, Kovacs M, Weissman A (1979). Assessment of suicidal intention: the Scale for Suicide Ideation. J Consult Clin Psychol 47:343-352.
Beck AT, Steer RA, Ball R, Ranieri W (1996). Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients. J Pers Assess 67:588-597.
Braam AW, Sonnenberg CM, Beekman ATF, Deeg DJH, Tilburg WV (2000). Religious denominations as a symptom formation factor of depression in older Dutch citizens. Int J Geriatr Psychiatry 15:458-466.
Colucci E, Martin G (2008). Religion and spirituality along the suicidal path. Suicide Life Threat Behav 38(2):229-244.
Dervic K, et al.
(2004). Religious affiliation and suicide attempts. Am J Psychiatry 161:2303-2308.
Diekstra RF (1993). The epidemiology of suicide and parasuicide. Acta Psychiatr Scand 371(Suppl):9-20.
El Islam F (2006). Social psychiatry and impact of religion. In images in psychiatry: An Arab Perspective.
Hawton K, Van Heeringen K (2009). Suicide. Lancet 373(9672):1372-1381.
Kamath P, Reddy J, Kandavel T (2007). Suicidal behaviour in obsessive - compulsive disorder. J Clin Psychiatry 68:1741-1750.
Khaldoun Marwa M (2010). Measuring Islamic religiosity: concepts and applications of the Scale of Islamic Religiosity Attitude [SIRA]. Riyadh: King Fahad National Library Cataloguing-in publication data.
Koenig HG (2001). Handbook of religion and health. A century of research reviewed
New York: Oxford University Press.
Kumar V (2002). Religion a protective factor in suicide. Suicidology 2:9-12.
Leff JP. The epidemiology of mental illness across cultures. In: Cox JL, editor. Transcultural psychiatry
. 1986;London: Croom Helm; 22-39.
Lizardi D, Gearing RE (2010). Religion and suicide: Buddhism, native American and African religions, atheism, and agnosticism. J Relig Health 49:377-384.
Lopez AD, et al.
(2006). Global burden of disease and risk factors
. Washington, DC: Oxford University Press and the World Bank.
Nock MK, Joiner TEJr, Gordon KH, et al.
(2006). Non-suicidal self injury among adolescents: diagnostic correlates and relation to suicide attempts. Psychiatry Res 144:65-72.
Okash A (2000). Global burden of depression. Presented at the meeting on globalization of psychiatry; International prospective; Cairo.
Okash A (2008). Epidemiology and psychiatric morbidity in suicide attempters at the poison control center. Curr Psychiatry 15:231-238.
Rihmer Z, Rutz W, Pihlgren H (1995). Depression and suicide on Gotland: an intensive study of all suicides before and after a depression-training programme for general practitioners. J Affect Disord 35:147-152.
SPSS (2002). Statistical package for the social sciences, version 13.0
. Cary, NC, USA: SAS Institute.
Uzun I, Buyuk Y, B Gurpinar (2007). Suicidal hanging: fatalities in Istanbul retrospective analysis of 761 autopsy cases. J Forensic Leg Med 14:406-409.
Wasserman D, Wasserman C (2009). Oxford textbook of suicidology and suicide prevention
; a global perspective, Oxford: Oxford University Press (pp 381-388).
Weissman MM, Bland RC, Canino GJ, et al
. (1999). Prevalence of suicide ideation and suicide attempts in nine countries. Psychol Med 29:9-17.
WHO (2001). The World Health Organization report 2001. Mental health, new understanding, new hope
. Geneva: WHO.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]