Relationship of Religion with Suicidal Ideation, Suicide Plan, Suicide Attempt, and Suicide Death: A Meta-analysis

Background: Suicide is a significant public health problem and one of the leading causes of death worldwide. The effect of religion on suicidal behaviors (i.e., ideation, plan, attempt, and death) is an important issue worthy of consideration. Methods: Major electronic databases, including MEDUNE, Web of Science, and Scopus, were searched for the articles published until 26 April 2021. Reference lists were also screened. Observational studies addressing the associations between religion and suicidal behaviors were also examined. Between-study heterogeneity was investigated using the chi(2), tau(2), and l(2) statistics. The probability of publication bias was explored using the Begg and Egger tests, as well as trim-and-fill analysis. The effect size was expressed as odds ratio (OR) with 95% confidence intervals (as) using a random-effects model. Results: Out of 11 389 identified studies, 63 articles were eligible, involving 8,053,697 participants. There was an inverse association between religion and suicidal ideation OR = 0.83 (95% CI: 0.78, 0.88; P<0.001), suicidal plan OR = 0.93 (95% CI: 0.83, 1.04; P = 0.200), suicide attempt OR = 0.84 (95% CI: 0.79, 0.89; P< 0.001), and completed suicide OR = 0.31 (95% CI: 0.14, 0.72; P = 0.006). There was a no evidence of publication bias. Conclusions: The results of this meta-analysis support the notion that religion can play a protective role against suicidal behaviors. Nonetheless, the effect of religion on suicidal behaviors varies across countries with different religions and cultures. Although this association does not necessarily imply causation, an awareness of the relationship between religion and suicide risk can be of great help in suicide prevention policies and programs.