O papel da religiosidade/espiritualidade no comportamento suicida: um estudo transversal multicêntrico

Abstract

Introduction: Suicide is one of the main public health challenges. Despite research advances, the role of religiosity and spirituality (R/S) in the prevention and risk of suicidal behavior (SB) remains scarcely explored in Brazil. Objective: To evaluate whether multiple R/S dimensions are independently associated with lifetime suicide attempt, suicidal ideation and suicide planning in the past month among adults receiving outpatient or inpatient psychiatric care. Methods: Observational, cross- sectional, multicenter study with 240 adults (≥18 years) hospitalized or under outpatient follow-up in psychiatric services of six Brazilian cities. R/S dimensions were assessed with the Duke Religion Index (DUREL); religious coping with the 14- item Religious Coping Scale (CRE-Breve-14); and moral objections to suicide with the corresponding subscale of the Reasons for Living Inventory. SB outcomes were lifetime suicide attempt, and suicidal ideation and planning in the past month. Analyses used descriptive statistics, chi-square tests and multivariable logistic regression adjusted for sociodemographic variables. Results: The sample was predominantly female (68.2%) and White (50.8%); 73.3% reported a religion – mainly Catholic (39.1%) and Evangelical/Protestant (33.9%). Prevalence of lifetime suicide attempts was 69.2% (N= 240), past-month suicidal ideation 64.7% (N= 119), and thinking about means of suicide 57.1% (N= 119). Intrinsic religiosity was associated with 16% lower odds of lifetime attempt (OR= 0.84; 95% CI 0.75-0.93; p= 0.001). Moral objections to suicide – especially “only God can take a life” – were linked to up to 69% lower odds of attempt (OR = 0.31; 95 % CI 0.15–0.68; p = 0.003). Positive religious coping (“seeing how God could strengthen me”) showed a 54% protective association (OR= 0.46; 95% CI 0.23-0.95; p= 0.035). Negative religious coping (“I felt punished by God”) increased the odds of past-month ideation about seven-fold (OR = 6.92; 95% CI 1.57-30.45) and of planning (OR= 6.55; 95% CI 1.41-30.45); feeling abandoned by the religious community also raised ideation (OR= 9.04; 95% CI 1.17- 69.87). Past-month planning was most strongly associated with the objection “I am afraid of going to hell or a place of spiritual suffering” (OR= 8.20; 95% CI 1.81-37.24). Evangelical/Protestant participants showed higher odds of planning than Catholics (OR= 6.36; 95% CI 1.01-40.13). Conclusion: Several R/S dimensions are linked to reduced SB risk, whereas negative religious-coping strategies increase vulnerability. Routine assessment of R/S in mental-health practice is recommended to enhance preventive strategies.