Parental Religious Beliefs Influence Kids' Suicide Risk

Pauline Anderson

August 15, 2018

Offspring of parents with strong religious beliefs have a dramatically reduced risk for suicidality, new research shows.

Dr Myrna Weissman

Investigators found an 80% lower risk for suicidal thoughts or attempts for individuals whose parents placed a high value on religion in comparison with their counterparts whose parents placed little emphasis on the importance of religion.

It appears parents' internal beliefs "convey something protective and powerful" to their offspring, study author Myrna M. Weissman, PhD, Diane Goldman Kemper Family Professor of Epidemiology in Psychiatry, Columbia University Mailman School of Public Health and Vagelos College of Physicians and Surgeons, New York City, told Medscape Medical News.

"Physicians should not shy away from exploring the role that a person's religious principles or beliefs has in their lives. They shouldn't be mandated to ask, but if they think it's an area that might be of importance, they should find out about it," Weissman added.

The study was published online August 8 in JAMA Psychiatry.

Three-Generation Study

The authors tapped into an ongoing three-generation study of families that were followed for up to 30 years. The first generation included adults with no history of depression and those who had a history of major depressive disorder.

The current longitudinal observational study included 112 parents (children of the original cohort) and 214 of their offspring, aged 6 to 18 years (mean age, 12.5 years). The all-white sample was drawn from the greater New Haven, Connecticut, area.

Two thirds of the children came from high-risk families. The mean age of the parents was 39.8 years.

The cohort's annual median income was $40,000, and 47% were high school graduates. About 80% were married or remarried.

About 85% of the offspring reported belonging to a Christian religious denomination. Of these, 59% were Catholic, and 26% were Protestant.

Participants were asked about attendance at religious services and were asked to rank the importance of religion in their lives. Together, the importance of religion and the frequency of religious service attendance was termed "religiosity."

Psychologists and psychiatrists were blinded to the participants' clinical status. They carried out intensive interviews of parents and offspring to determine suicidal behavior.

They relied on the Schedule for Affective Disorders and Schizophrenia–Lifetime version for adults, and the child version for offspring.

The authors described the study as "unique" because they were able to examine the association of parent and offspring religiosity separately and simultaneously with offspring suicidal behavior.

After adjusting for age, sex, and familial depression risk status, the results showed that religious importance in offspring was associated with a significantly lower risk for suicidal behavior in girls (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.33 - 0.70; P < .002). This was not the case for boys (OR, 1.15; 95% CI, 0.74 - 1.80).

Higher importance of parental religious belief was associated with an overall lower risk for suicidal behavior in offspring (OR, 0.61; 95% CI, 0.41 - 0.91; P < .05).

Differences by Sex

There was an 80% decrease in risk for suicidal behavior in offspring whose parents reported religious importance at the highest level compared with offspring whose parents reported that religion was unimportant.

Frequency of parental attendance at religious services was not associated with suicidal ideation or attempts in offspring.

Weissman speculated that a parent's "sense of internal strength" helps structure family life, which influences family members.

"There's something about a parent having beliefs and commitment to something outside the family or themselves that is helpful and protective for youth," said Weissman.

She pointed out that it's the commitment that is important, not going to church or attending religious services.

Although it may be helpful to discuss these findings with clergy or others involved in religious practices, "making people go to synagogue or church isn't what's going to make the difference. It's not attendance; it's a person's beliefs," said Weissman.

When offpsring were stratified by sex, parents' religious importance was associated with lower risk for suicidal ideation or attempts in daughters (OR, 0.51; 95% CI, 0.29 - 0.90; P = .02) but not in sons (OR, 0.75; 95% CI, 0.47 - 1.19; P = .22). However, this difference was not statistically significant.

Similarly, frequency of parents' religious attendance was associated with lower risk for suicidal behavior in daughters (OR, 0.71; 95% CI, 0.53 - 0.95; P = .02) but not sons (OR, 0.89; 95% CI, 0.67 - 1.19; P = .44), although this difference, too, was not statistically significant.

The differences between male and female offspring are "a mystery," said Weissman.

"If we were the only ones to find that, we would think it was some kind of fluke, but there have been a number of other studies that have found that girls are much more susceptible to the religious beliefs of their parents."

Strong Family Structure Important

The researchers plan to further explore this and other questions in future research. They want to investigate how often families discuss religion and whether they pray together.

As for whether results for preteens were different than those for older teens or young adults, the researchers did not see any major effect of age, said Weissman. "One caveat is that, fortunately, you don't begin to see suicidal ideation or attempts prepuberty."

When simultaneously considering the importance of religion to parents and to offspring, the investigators found a lower risk associated with parental religious importance (OR, 0.61; 95% CI, 0.39 - 0.96) independent of religious importance to offspring.

Overall, religious importance to both mothers and fathers had a significant association with lower risk for suicidal behavior in their offspring.

The analysis showed that offspring of married and remarried parents were less likely to have suicidal behavior than those whose parents had another marital status. This, said the authors, supports previous research highlighting the importance of a strong family structure.

The researchers didn't see any differences between the participants' various religious denominations, but that could be because of the relatively small sample size for each, said Weissman.

She noted that the associations of parental religiosity on offspring suicidal behavior were independent of parental depression and parental suicide ideation — two of the strongest risk factors for suicidal behavior.

When appropriate, psychiatrists should ask parents of children who display suicidal behavior about their religious beliefs, said Weissman.

"We in the medical profession tend to stay away from these kinds of issues; they're considered personal. But if you think this might be important, you should find out about it; it shouldn't be taboo," she said.

She noted, though, that in some religions, suicide is considered a sin, and so some patients may not want to discuss it.

Significant Contribution

Commenting on the study for Medscape Medical News, child and adolescent psychiatrist David Fassler, MD, clinical professor of psychiatry, University of Vermont College of Medicine, Burlington, said it "represents a helpful and significant contribution to the field."

Fassler agreed that in light of these new findings, clinicians might want to pay more attention to parents' religious beliefs and involvement when assessing suicide risk in children and adolescents.

The study was supported in part by the John Templeton Foundation and the National Institute of Mental Health. Dr Weissman has received funding from the National Institute of Mental Health, the Sackler Foundation, and the Templeton Foundation and receives royalties from the Oxford University Press, Perseus Press, the American Psychiatric Association Press, and MultiHealth Systems. Dr Fassler has disclosed no relevant financial relationships.

JAMA Psychiatry. Published online August 8, 2018. Abstract

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