Suicide to Hope Workshop Review

Introduction

Today I had the opportunity to attend the Suicide to Hope Workshop offered by LivingWorks. This course is a complete overhaul of the suicideCare Workshop that was previously offered by LivingWorks. The seminar takes 8 hours, and includes a participant workshop (like ASIST) and also some handouts that can be used with clients. The purpose of Suicide to Hope is to provide long-term suicide prevention work after the suicide crisis is over and immediate safety is secured.

Pathway to Hope

The key to the Suicide to Hope model is the Pathway to Hope or PaTH. There are three phases (Understanding, Planning and Implementing) and six tasks. These six tasks are:

  1. Explore Stuckness
  2. Describe Issues
  3. Formulate Goals
  4. Develop Plan
  5. Monitor Work
  6. Review Process

The purpose of the workshop involves understanding how to do this, moving through each phase. In contrast to the old suicideCare workshop, Suicide To Hope is much more concrete. The goal is to identify the “stuckness” – the elements that an individual was having trouble moving through in order to reduce their suicidality going forward.

Workshop Structure

Prior to attending the workshop some pre-reading on the theoretical and empirical underpinnings of the worksheet. Once the workshop starts, registration is completed and participants are directed to a Helper Qualities worksheet. This sheet contains 20 values like “Belief in suicide recovery”, “Courage to face the pain” and “Tolerance for risk.” These qualities are looked at throughout the workshop.

Next is a review of the workshop and the five principles of hope creation. These five principles are ways in which a client can experience growth and recovery. They include:

  1. Suicide
  2. Safety First
  3. Respect
  4. Self-Growth
  5. Take Care

Essentially these principles mean that the experience of surviving suicidal thoughts or suicide attempts may represent an opportunity for growth. Ensuring a client’s safety will ensure they’re in the right frame to begin recovery and growth work. Respect for the client is key to building a strong helping relationship with them. Self-growth refers to “walking the talk”, and being able to be true to yourself. The final principle involves being careful to apply the model and not oversimplifying or forgetting client’s uniqueness.

The Three Phases are reviewed, and video illustrations are included throughout. These include some short clips demonstrating individuals who are safe but still suicidal, followed by clips of their recovery and a 25 minute single-take demo to really cement the learning.

A short roleplay experience in a triad helps individuals become more comfortable with the variety of tools that are provided (such as the questions to ask and the worksheets that are available.)

The ABCs of Safety

One of the really useful elements is a sheet titled “The ABCs of Safety”, which is an excerpt from the Suicide to Hope Planning Tool provided to workshop participants. This includes some checkboxes under the headings “I am ready to start R&G work”, “I know how to keep myself safe while doing R&G work” and “I know how we will work together.” These elements ensure that clients entering into recovery work have a safety plan and understand informed consent elements related to the treatment or service provision they will be receiving.

Conclusion

I found the Suicide to Hope workshop a vast improvement over the old version. The materials would be extremely useful for case managers, counsellors, psychologists, social workers, therapists and other professionals that are providing support to individuals struggling with suicide.

To learn more about Suicide to Hope you can read about it on LivingWorks’ website or find available training opportunities here.

Cite this article as: MacDonald, D.K., (2017), "Suicide to Hope Workshop Review," retrieved on November 17, 2017 from http://dustinkmacdonald.com/suicide-hope-workshop-review/.
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Suicide Facts and Figures for Presentations

Introduction

For those of you who don’t use it, the website Quora is an absolute goldmine for information on a wide variety of topics. It allows you to ask and answer questions by individuals who all use their real names, and who have to identify their area of expertise (their reason for knowing the answer.)

One of the questions asked was “What are some striking facts or figures about suicide?” My answer is the basis for this post. I identify a number of suicide facts and figures with citations. These may make useful additions to presentations that you do in the future.

Suicide Attempts

We know that in the United States, about 50% of suicide deaths are by firearm (CDC, 2016). This accounts for the startling statistic that 60% of people who attempt suicide will die on their first attempt (Bostwick, et. al., 2016)

Of those that survive, 70% of those who live will never go on to have a second attempt, hopefully because they get the help that they need. About 23% will go on to attempt again (sometimes repeatedly) and live, while 7% will die on a future attempt. (Owens, Horrocks & House, 2002)

Gun owners in particular at much higher risk of suicide. We know that gun owners are 57 times more likely to die by suicide within 7 days of their purchase (likely because they purchased it specifically intent on suicide), and 7 times more likely within the first year as non-gun-owners. (Wintermule, et. al., 1999)

Depending on the type of gun and other variables, 85-98% of firearm suicide attempts will end in death, while only about 2% of overdoses will end in death. (Elnour & Harrison, 2008).

Suicide Prevalence

Women attempt suicide about 3 times as frequently as men do (Vijayakumar, 2015) but tend to die 3 times more frequently (Varnik, 2012) chiefly because of their use of more lethal methods like firearm and hanging, when compared to women who more commonly use overdose.

Suicide is most common in the middle ages, accounting for 54% of suicides in Canada (Statistics Canada, 2013) and 51% of suicides in the United States (CDC, 2011).

Suicide Antecedents

It’s been suggested that up to 90% of those who die by suicide have a diagnosable mental illness (Bertole & Fleischmann, 2002). Although this figure has been challenged because it is based on psychiatric autopsies (reviews with those left behind) that might be vulnerable to bias, it is common enough to be valuable.

Conclusion

Did I miss any suicide facts and figures that you’d like to see? Let me know and I’ll update the article. Thanks all!

References

Bertolote, J.M. & Fleischmann, A. (2002) Suicide and psychiatric diagnosis: a worldwide perspective. World Psychiatry. 1(3): 181-185.

Bostwick, J. M., Pabbati, C., Geske, J. R., & McKean, A. J. (2016). Suicide attempt as a risk factor for completed suicide: Even more lethal than we knew. American Journal of Psychiatry, 173(11), 1094–1100.

Centers for Disease Control and Prevention (CDC). Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2013, 2011) National Center for Injury Prevention and Control, CDC (producer). Available from http://www.cdc.gov/injury/wisqars/index.html

Centers for Disease Control and Prevention. (2016) National Vital Statistics Report. 65(4). Retrieved on September 19, 2017 from https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_04.pdf

Elnour, A.A. & Harrison, J. (2008) Lethality of suicide methods. Journal of Injury Prevention. 14(1). 39-45. doi: 10.1136/ip.2007.016246.

Vijayakumar, L. (2015) Suicide in women. Indian Journal of Psychiatry. 57(Supp. 2). S233-S238. doi: 10.4103/0019-5545.161484.

Owens, D., Horrocks, J. & House, A. (2002) Fatal and non-fatal repetition of self-harm: systematic review. British Journal of Psychiatry. 181. 193-199.

Statistics Canada. (2013) CANSIM, table 102-0551 and Catalogue no. 84F0209X. Retrieved from http://www5.statcan.gc.ca/cansim/a26?id=1020551&

Varnik, P. (2012) Suicide in the World. International Journal of Environmental Research and Public Health. 9(3). 760-771. doi:  10.3390/ijerph9030760

Wintemute, G.J., Parham, C.A., Beaumont, J.J., Wright, M., & Drake, C. (1999) Mortality among recent purchasers of handguns. New England Journal of Medicine. 341(21):1583-9

Cite this article as: MacDonald, D.K., (2017), "Suicide Facts and Figures for Presentations," retrieved on November 17, 2017 from http://dustinkmacdonald.com/suicide-facts-figures-presentations/.
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Biopsychosocial Model of Suicidal Behaviour

Introduction

There are a variety of models of suicidal behaviour. These models attempt to map suicidal behaviour or put it into boxes so that a helping professional can better understand how suicidal behaviour forms and how it can be treated and resolved. This Biopsychosocial Model comes from Kumar, U. & Mandal, M.K. (2010).

The model is first presented in textual format, followed by an image, and then an explanation.

Biopsychosocial Model

Biological, Environmental and Event factors feed into a Psychological Process. This psychological process leads to the development or exacerbation of a mental health issue and to suicidal behaviour. On a cognitive level, this affects how the individual thinks and feels about the past, present and future.

 

 

 

 

 

 

 

 

 

 

 

 

 

Biological Influences in Suicide

There are a number of biological factors that can increase the risk of suicide which have been reviewed by Pandey (2013). These include genetic predisposition of suicidal behaviour (Turecki, 2001) which may be related to increased prevalence of impulsiveness and aggressiveness.

5HT receptors are receptors in the brain that are activated by the neurotransmitter serotonin. Serotonin plays an important role in mood (Yohn, Guerges & Samuels, 2017), appetite and eating (Sharma & Sharma, 2012), sleep, memory and sexual function. Improperly functioning 5HT receptors may play a role both in depression and in suicidal behavior.

It has been well-documented that teens and adolescents are more impulsive than adults as their brains continue to develop up to age 25 (Kasen, Cohen & Chen, 2011) and this can increase their risk of suicide and homicide. (Glick, 2015) Witt et. al. (2008) examines this through the lens of the Interpersonal Theory of Suicide – suggesting that impulsive individuals are more likely to have acquired capability (through being exposed to pain), which is one of the 3 key elements of that Theory of Suicide.

Environmental Influences in Suicide

Environmental influences on suicidal behaviour include literal environmental factors like sunlight exposure and situational factors like presence of abuse, history of suicide attempts and other items that are commonly known as suicide risk factors.

Souêtre et. al. (1990) found that decreased sunlight exposure and lowered temperature was linked to increased risk of suicide. This may explain the high rate of suicide in Nordic and Scandinavian countries that lack many of the other risk factors for suicide. Lam et. al. (1999) found that light therapy decreased suicidal ideation in a population of women who struggled with Seasonal Affective Disorder (SAD).

Evans, Owens & Marsh (2005) found that an external locus of control (believing that life “happens to one” rather than one having control over their life) was associated with an increased risk of suicide in adolescents. This likely holds true in adults as well.

Other risk factors for suicide include the American Association of Suicidology’s IS PATH WARM mnemonic:

  • Ideation (thoughts of suicide)
  • Substance Abuse
  • Purposelessness
  • Anxiety
  • Trapped (a feeling of being trapped)
  • Hopelessness
  • Withdrawal (from others)
  • Anger
  • Recklessness
  • Mood Changes

Event Influences in Suicide

Sometimes an event occurs in someone’s life that is so devastating that it may lead to suicide. For instance, relational changes and other interpersonal issues (such as a loss of a relationship or fights with a friend) commonly precede a suicide attempt (Yen et. al., 2005; Bagge, Glenn & Lee, 2013; Conner, et. al., 2012)

In addition to interpersonal events as described above, events that may lead to suicidal behaviour include being arrested, charged or sentenced with a crime (Cooper, Appleby & Amos, 2002). Zhang & Ma (2012) also found this in a Chinese sample of suicide attempters, with the most common stressful life events preceding suicide involving family/home, hospital/health and marriage/love.

Conclusion

It’s clear that the biopsychosocial model of suicide has a fair amount of support for its component parts. It may be difficult to apply the Biopsychosocial Model directly in a clinical or therapeutic context. For that reason, other models may be preferred for intervention purposes.

References

Bagge, C. L., Glenn, C. R., & Lee, H. (2013). Quantifying the impact of recent negative life events on suicide attempts. Journal Of Abnormal Psychology122(2), 359-368. doi:10.1037/a0030371

Conner, K. R., Houston, R. J., Swogger, M. T., Conwell, Y., You, S., He, H., & … Duberstein, P. R. (2012). Stressful life events and suicidal behavior in adults with alcohol use disorders: Role of event severity, timing, and type. Drug & Alcohol Dependence120(1-3), 155-161. doi:10.1016/j.drugalcdep.2011.07.013

Cooper, J., Appleby, L., & Amos, T. (2002). Life events preceding suicide by young people. Social Psychiatry & Psychiatric Epidemiology37(6), 271.

Evans, W. P., Owens, P., & Marsh, S. C. (2005). Environmental Factors, Locus of Control, and Adolescent Suicide Risk. Child & Adolescent Social Work Journal22(3/4), 301-319. doi:10.1007/s10560-005-0013-x

Glick, A. R. (2015). The role of serotonin in impulsive aggression, suicide, and homicide in adolescents and adults: a literature review. International Journal Of Adolescent Medicine And Health, (2), 143. doi:10.1515/ijamh-2015-5005

Kasen, S., Cohen, P., & Chen, H. (2011). Developmental course of impulsivity and capability from age 10 to age 25 as related to trajectory of suicide attempt in a community cohort. Suicide And Life-Threatening Behavior, (2), 180.

Kumar, U & Mandal, M.K. (2010). Suicidal Behavior: Assessment of People-at-Risk. New Delhi, India: SAGE Publications.

Lam, R. W., Carter, D., Misri, S., Kuan, A. J., Yatham, L. N., & Zis, A. P. (1999). A controlled study of light therapy in women with late luteal phase dysphoric disorder. Psychiatry Research86185-192. doi:10.1016/S0165-1781(99)00043-8

Pandey, G. N. (2013). Biological basis of suicide and suicidal behavior. Bipolar Disorders15(5), 524-541. doi:10.1111/bdi.12089

Sharma, S., & Sharma, J. (2012). Regulation of Appetite: Role of Serotonin and Hypothalamus. Iranian Journal Of Pharmacology & Therapeutics11(2), 73-79.

Souêtre, E., Wehr, T.A., Douillet, P. & Darcourt, G. (1990) Influence of environmental factors on suicidal behavior. Psychiatry Research. 32(3):253-63.

Turecki, G. (2001). Suicidal behavior: is there a genetic predisposition?. Bipolar Disorders3(6), 335-349.

Witte, T. K., Merrill, K. A., Stellrecht, N. E., Bernert, R. A., Hollar, D. L., Schatschneider, C., & Joiner, J. E. (2008). Research report: “Impulsive” youth suicide attempters are not necessarily all that impulsive. Journal Of Affective Disorders107107-116. doi:10.1016/j.jad.2007.08.010

Yen, S., Pagano, M. E., Shea, M. T., Grilo, C. M., Gunderson, J. G., Skodol, A. E., & … Zanarini, M. C. (2005). Recent Life Events Preceding Suicide Attempts in a Personality Disorder Sample: Findings From the Collaborative Longitudinal Personality Disorders Study. Journal Of Consulting And Clinical Psychology73(1), 99-105. doi:10.1037/0022-006X.73.1.99

Yohn, C. N., Gergues, M. M., & Samuels, B. A. (2017). The role of 5-HT receptors in depression. Molecular Brain101-12. doi:10.1186/s13041-017-0306-y

Zhang, J., & Ma, Z. (2012). Research report: Patterns of life events preceding the suicide in rural young Chinese: A case control study. Journal Of Affective Disorders140161-167. doi:10.1016/j.jad.2012.01.010

Cite this article as: MacDonald, D.K., (2017), "Biopsychosocial Model of Suicidal Behaviour," retrieved on November 17, 2017 from http://dustinkmacdonald.com/biopsychosocial-model-suicidal-behaviour/.
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SIMPLE STEPS Model for Suicide Risk Assessment

Introduction

The SIMPLE STEPS Model (McGlothlin, 2008) for suicide risk assessment provides a simple mnemonic similar to others like SADPERSONS (Patterson, et. al., 1983) or IS PATH WARM (from the American Association of Suicidology). Each of these is correlated with increasing suicide lethality and so this can be a useful short-hand to remember these items.

Suicide risk assessment on the crisis line is mostly concerned with imminent risk, and many suicide screeners designed for lay people may miss important variables in a goal to be simplistic; the SIMPLE STEPS model appears to avoid both of these traps, by providing an assessment tool simple enough to be used in the crisis line environment but comprehensive enough to be used by counsellors or therapists for ongoing monitoring of suicide risk.

Items in the SIMPLE STEPS Model

  • Suicidal – Is the individual expressing suicidal ideation?
  • Ideation – What is their suicidal intent?
  • Method – How detailed and accessible is their suicidal method?
  • Perturbation – How strong is their emotional pain
  • Loss – Have they experienced actual or perceived losses? (Relationships, material objects)
  • Earlier Attempts – What previous attempts has the individual experienced, what happened after those attempts?
  • Substance Use – Is the individual abusing drugs, alcohol, or other substances?
  • (Lack of) Troubleshooting Skills – Are they able to see alternatives or options other than suicide?
  • Emotions / Diagnosis – “Assessment of emotional attributes (hopelessness, helplessness, worthlessness, loneliness, agitation, depression, and impulsivity) and diagnoses commonly associated with completed suicide (e.g., substance abuse, mood disorders, personality disorders, etc.)” (McGlothlin, et. al., 2016)
  • (Lack of) Protective Factors – What is keeping this person safe from suicide? Who are their supports (internal such as personal values and external like people), resources and agencies
  • Stressors and Life Events – What has happened in their life to lead them to suicide?

Sharp readers will identify that these elements map very neatly onto the DCIB Model of Suicide Risk Assessment, but perhaps provide a better mnemonic in order to make sure that clinicians who do not have the DCIB in front of them are able to perform that assessment.

Validation of the SIMPLE STEPS Model

McGlothlin, et. al. (2016) used 13,000 calls over six years to a crisis line and correlated the SIMPLE STEPS items with the lethality risk present in that call. One limitation of this study is that it used self-reported (by the helpline worker taking the call) lethality rather than using another evidence-based risk assessment in order to compare with. I am satisfied that McGlothlin addressed this in his limitations section, where he noted the difficulty with using data collected in this manner.

References

McGlothlin, J. (2008). Developing clinical skills in suicide assessment, prevention and treatment.
Alexandria, VA: American Counseling Association

McGlothlin, J., Page, B., & Jager, K. (2016). Validation of the SIMPLE STEPS Model of Suicide Assessment. Journal Of Mental Health Counseling, 38(4), 298-307. doi:10.17744/mehc.38.4.02

Patterson, W.M., Dohn, H.H., Patterson, J. & Patterson, G.A. (1983). “Evaluation of suicidal patients: the SAD PERSONS scale.” Psychosomatics 24(4): 343–5, 348–9. doi:10.1016/S0033-3182(83)73213-5. PMID 6867245

Cite this article as: MacDonald, D.K., (2017), "SIMPLE STEPS Model for Suicide Risk Assessment," retrieved on November 17, 2017 from http://dustinkmacdonald.com/simple-steps-model-suicide-risk-assessment/.

 

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Suicide and Religion

Introduction

Studies on the connection between religion and suicide have led to mixed results. Some studies indicated higher levels of suicidality, no relation or reduced risk. Many of the studies that indicated a relationship (either positive or negative), had mediators attached – such as that individuals who were more religious were less likely to attempt suicide as long as they lacked other social supports.

Religiosity and Suicide

Meta-reviews, large scale analyses of suicide risk have helped shed some evidence on the connection between religion and suicide.

Lawrence, Oquendo & Stanley (2016) noted that suicide and religion are both complex dimensions (e.g. suicide ideation versus attempts versus death, religious affiliation versus attendance.) Being part of a majority religious community was found to be a greater protective factor against suicide than a minority community, but that attending religious services was not as important as having social supports (whether religious or not.)

Norko et. al. (2017) noted that all major faith communities (including Islam, Hinduism, Judaism, Buddhism, and Christianity) have strong objections to suicide.

In Lawrence et. al. (2016) a sample of clinically depressed patients in a hospital setting were found to have a higher rate of suicidality if they identified a religious affiliation, the more they attended religious services, and the more they indicated religion was important.

Finally, Wu, Wang & Jia (2015), analyzing over 5000 participants across several large studies identified the three elements that are responsible for the protective factor of suicide: being of a western culture, being older, and living in a area with religious homogeneity.

Spirituality and Suicide

Spirituality can be examined through a lens different from organized religion. While religion may entail specific doctrine, spirituality instead examines one’s relationship with “self, others and ‘God’” (Mandhoui, et. al., 2016), in whatever form that takes.

Mandhoui et. al. (2016) surveyed individuals who were in hospital for suicide attempts. Those individuals lower in spirituality were more likely to attempt suicide at 18 months, with “value of life” tending to reduce the chance that someone re-attempts.

Amato, et. al. (2016) noted that spirituality can be integrated into suicide prevention programs such as case management, therapy and suicide assessment to determine the impact for that individual. They summarize the impact of spirituality by noting that “some individuals at high risk of suicide may find fellowship in an affirming community of faith; others may be helped by rituals that confer atonement or a state of exaltation; still others may learn, through mindfulness meditation, to suspend their inclination to judge themselves harshly.”

Specific Religions / Denominations and Suicide

Buddhism and Suicide

Buddhism has received some exploration in the scientific literature, especially in light of Buddhist monks who have self-immolated for political reasons, the most famous of whom was Thích Quảng Đức in 1963, but research on the exact suicide rate, especially when considered with other religions is lacking.

Lizardi & Gearing (2010) noted several elements that may decrease suicide in Buddhist individuals, including that the largest communities of Buddhists (Asian Americans and Pacific Islanders) have lower suicide rates than whites (who tend to belong to different religious communities) and a strong aversion to killing. In contrast, a belief in reincarnation and life-after-death may contribute to an increase in the suicide rate among specific individuals who adhere strongly to Buddhist traditions.

Catholicism / Protestantism and Suicide

Emile Durkheim in his 1897 work Suicide examined the suicide rates among Catholics and Protestants. He found that Catholics had much lower rates of suicide than Protestants and theorized that it was the result of social support provided in the Catholic community. Additional support was confirmed by Torgler & Schaltegger (2014) and Siegrist (1996) in a modern sample, who also found that church attendance reduced suicide.

Hinduism / Islam and Suicide

Ineichen (1998) examined a number of studies on Hinduism and Islam and consistently found that Muslims had much lower suicide rates than Hindus, focused on a variety of South Asian diaspora (such as individuals in the United Kingdom from other countries.)

Following up on this research, Thimmaiah et. al. (2016) explored a population of Muslims and Hindus in India and found that , while Muslims indicated more negative attitudes towards suicide which may help explain why they are less likely to attempt suicide.

Judaism and Suicide

Examining Jewish Israelis, Eliezer & Daniel (2012) found a rate of suicide lower in Jewish individuals than those who are Catholic or Protestant. Significantly, those with other risk factors for suicide (like veterans, immigrants or those who have experienced trauma) are at elevated at risk of suicide despite their religiosity.

Conclusion

After a review of the literature, it emerges that religious denominations and other factors can have an influence on suicide. Some religions have higher rates of suicide, and some have lower rates, which may be explained by the value system of those religions or the social support of those religions.

The suicide risk by religion, from highest to lowest is below:

  1. Protestant Christian
  2. Catholic Christian
  3. Jewish

Other religions with less well established data sets can be compared to each other, but not necessarily to other religions: Islam has a lower level of suicide than Hinduism, while Buddhism has a lower level of suicide than Native American spirituality.

References

Amato, J. J., Kayman, D. J., Lombardo, M., & Goldstein, M. F. (2016). Spirituality and religion: Neglected factors in preventing veteran suicide?. Pastoral Psychology, doi:10.1007/s11089-016-0747-8

Dyson, J., Cobb, M., Forman, D. (1997) The meaning of spirituality: a literature review. Journal of Advanced Nursing. 26(6). Retrieved on March 3, 2017 from http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2648.1997.00446.x/abstract doi: 10.1046/j.1365-2648.1997.00446.x

Durkheim, E. (1897). Le suicide: étude de sociologie. F. Alcan: Chicago, IL.

Eliezer, W., & Daniel, S. (2012). Suicide in Judaism with a Special Emphasis on Modern Israel. Religions, Vol 3, Iss 3, Pp 725-738 (2012), (3), 725. doi:10.3390/rel3030725

Ineichen, B. (1998). The influence of religion on the suicide rate: Islam and Hinduism compared. Mental Health, Religion & Culture, 1(1), 31.

Lawrence, R. E., Brent, D., Mann, J. J., Burke, A. K., Grunebaum, M. F., Galfalvy, H. C., & Oquendo, M. A. (2016). Religion as a risk factor for suicide attempt and suicide ideation among depressed patients. Journal Of Nervous And Mental Disease, 204(11), 845-850. doi:10.1097/NMD.0000000000000484

Lawrence, R. E., Oquendo, M. A., & Stanley, B. (2016). Religion and suicide risk: A systematic review. Archives Of Suicide Research, 20(1), 1-21. doi:10.1080/13811118.2015.1004494

Mandhouj, O., Perroud, N., Hasler, R., Younes, N., & Huguelet, P. (2016). Characteristics of spirituality and religion among suicide attempters. Journal Of Nervous And Mental Disease, 204(11), 861-867. doi:10.1097/NMD.0000000000000497

Norko, M. A., Freeman, D., Phillips, J., Hunter, W., Lewis, R., & Viswanathan, R. (2017). Can Religion Protect Against Suicide?. Journal Of Nervous & Mental Disease, 205(1), 9-14. doi:10.1097/NMD.0000000000000615

Siegrist, M. (1996). Church Attendance, Denomination, and Suicide Ideology. Journal Of Social Psychology, 136(5), 559-566.

Thimmaiah, R., Poreddi, V., Ramu, R., Selvi, S., & Math, S. (2016). Influence of Religion on Attitude Towards Suicide: An Indian Perspective. Journal Of Religion & Health, 55(6), 2039-2052. doi:10.1007/s10943-016-0213-z

Torgler, B., & Schaltegger, C. (2014). Suicide and Religion: New Evidence on the Differences Between Protestantism and Catholicism. Journal For The Scientific Study Of Religion, 53(2), 316-340. doi:10.1111/jssr.12117

Wu, A., Wang, J., & Jia, C. (2015). Religion and Completed Suicide: a Meta-Analysis. Plos ONE, 10(6), 1-14. doi:10.1371/journal.pone.0131715

Cite this article as: MacDonald, D.K., (2017), "Suicide and Religion," retrieved on November 17, 2017 from http://dustinkmacdonald.com/suicide-and-religion/.

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