Reasons for Living, Spirituality, and Suicidal Ideation among Adults in a Spiritually Integrated Inpatient Program

Joseph M. Currier, University of South Alabama
Joshua D. Foster, University of South Alabama
Charlotte vanOyen-Witvliet, Belmont University
Alexis D. Abernethy, Graduate School of Psychology, Fuller Theological Seminary
Karl VanHarn, Pine Rest Christian Mental Health Services
Lindsey L. RootLuna, Hope College
Sarah A. Schnitker, Baylor University

Key Practitioner Message

• Psychiatric patients who are experiencing severe psychological suffering often have reasons for living and spiritual beliefs, practices, and relationships that mitigate risk for suicide.
• Moral objections to suicide and survival and coping beliefs were moderately to strongly positively linked with patients deriving a sense of transcendence and accountability from their spirituality and better mental health (lower depression symptoms and suicide ideation) at start of their inpatient treatment.
• Moral objections to suicide might serve as a mechanism for the protective role of spirituality in reducing suicide risk; namely, patients in our sample with higher spiritual transcendence and transcendent accountability, on average, had stronger moral objections to ending their lives, which also contributed to less risk for depression symptoms and suicidal ideation at the start of inpatient treatment.
• Clinicians working in psychiatric settings will ideally inquire about patients’ spirituality and reasons for living in routine assessment and intervention procedures.

Abstract

Parallel lines of research suggest reasons for living (RFL) and spirituality often reduce risk for suicide in psychiatric patients. However, research has not examined the links and probable interplay between RFL and core aspects of patients’ spirituality that might buffer suicidal ideation in times of severe psychological suffering. In total, 242 adults entering an inpatient treatment program in a spiritually integrated behavioral health center (40% Cisgender male; 57% Cisgender female; 3.0% non-binary) completed validated measures of RFL (fear of social disapproval, moral objections of suicide, survival/coping beliefs, responsibility to the family, fear of suicide), spirituality (spirituality transcendence, transcendent accountability), suicidal ideation and other mental health symptoms (anxiety, depression). Of the factors in Linehan et al.’s (1983) seminal framework, moral objections to suicide and survival and coping beliefs were moderately to strongly linked with deriving a sense of transcendence and accountability from their spirituality and better mental health (lower depression symptoms and suicide ideation). Of the RFL factors, multivariate findings suggested survival and coping beliefs mitigate suicidal ideation independently from spirituality factors whereas moral objections to suicide might serve as a vital mechanism for the protective role of spirituality in reducing suicide risk in high-risk groups. In combination, these findings highlight the need for longitudinal research to ascertain the temporal sequence of these apparent pathways to suicidal ideation along with the value of inquiring about patients’ spirituality and RFL in routine assessment and intervention procedures in psychiatric settings.