Attendance at Religious Services and Deaths from Despair

On this page, we often discuss topics addressing the influence of neuroscientific advances on the field of psychiatry. However, our attention was recently drawn to an article published in JAMA Psychiatry by Ying Chen and colleagues that examined the association between attendance at religious services and “deaths from despair.” This research group analyzed data from two longitudinal studies: one involving 66,492 female nurses in the Nurses’ Health Study II (NHSII) from 2001 through 2017, and the other involving 43,141 male health professionals in the Health Professionals Follow-up Study (HPFS) from 1988 through 2014.

The authors define “deaths from despair” as deaths from suicide, unintended drug or alcohol poisoning, and chronic liver disease or cirrhosis, which often reflects alcohol or drug use.

In both longitudinal studies, information about demographics, general health, social interactions, and financial situation was obtained through self-report by participants at enrollment. People were assessed every two years. The degree of social involvement was gauged by marital status, number of close friends and relatives, amount of contact with others, and participation in social groups. At the time of enrollment, participants also answered a single question about how often they attended religious services or meetings: never, less than once a week, or at least once a week. About 25-30% of participants responded never; 30% said less than once a week; and 40% indicated they attended at least once a week.

How many deaths from despair occurred in these populations during the study period? After physician review of death certificates and hospital records, 75 nurses in the NHSII were identified as having died as a result of deaths from despair: 43 from suicide, 20 from drug poisoning, and 12 from liver disease. In the HPFS, 306 such deaths were identified: 197 from suicide, 6 from drug poisoning, and 103 from liver disease.

When examining the association between the frequency of attending religious services/meetings and deaths from despair, the investigators controlled for potentially confounding influences, including the degree of social integration. What they found was striking: For female nurses in the NHSII, the risk of death from despair aming those attending religious services weekly was two-thirds lower than for those who never attended services. For the male health professionals in the HPFS, the risk was a third lower.

Does this mean that attending weekly religious services protects an individual from a death from despair? Not necessarily. Even a strong association between factors does not necessarily indicate a causal relationship. Attending services may not directly lower one’s risk; rather, there may be other characteristics about individuals who routinely attend services that correlate with this type of resiliency. However, it is also possible that there is something about attending weekly services that provides support that many find helpful. Is it the social network, the spiritual network, the importance of routine, or a factor unrelated to attendance? It is not possible to answer this question from the data in this report.

Especially in these times of severe stress and social isolation, it seems logical that there may be several avenues that can assist individuals in maintaining a non-despairing mindset. Such ways may include regular exercise, maintaining health routines, and continuing social interactions with friends and family. The Chen et al. article suggests that routinely attending religious services may be helpful for some people. Unfortunately, societal restrictions imposed as a result of COVID-19 have severely limited these options. It will be important to determine the consequences of these restrictions as we recover from the pandemic.

This post was written by Eugene Rubin MD, PhD and Charles Zorumski MD.