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Correspondence |
Princess Marina Hospital, Upton, Northampton NN5 6UH, UK.
Correspondence: E-mail: mamdouh.eladl{at}nht.northants.nhs.uk
Gunnell et al’s (2004) interesting study came with useful learning points. However, while known as important factors that influence development and amelioration of suicidal thoughts, ethnicity and religion were not included in the study. As the world has become a small, or big, village, and as we live in a multi-ethnic and multi-religious society, I feel this should be considered as an additional limitation to the study. The relationship between religion and suicide became famous through Durkheim’s study in the 19th century.
In European countries, evidence suggests that the prevalence of suicide continues to vary in accordance with international differences in traditions, customs and religious practices (Cavanagh & Masterton, 1998). Cavanagh & Masterton suggested that the strength of these differences is decreasing because of homogenisation among countries. In my opinion, it is unlikely that this influence will completely disappear. In a modern secularised society, religion is still a meaningful and protective factor for many individuals in a suicidal crisis (Lonnqvist, 2000).
Makinen & Wassermann (2001) believe that much of the difference in suicidal behaviour between national groups can be connected with differences in cultural outlook, and state that ‘traditionally religion has been considered to be the matrix of culture’.
Various factors that influence development and amelioration of suicidal thoughts do not function separately. I wonder, had ethnicity and religion been included, how would this have affected the outcome?
REFERENCES
Cavanagh, J. T. O. & Masterton, G. (1998) Suicide and deliberate self-harm. In Companion to Psychiatric Studies (6th edn) (eds E. Johnstone, C. Freeman & A. Zealley), pp. 751–783. Edinburgh: Churchill Livingstone.
Gunnell, D., Harbord, R., Singleton, N., et al
(2004) Factors influencing the development and amelioration
of suicidal thoughts in the general population. Cohort study.
British Journal of Psychiatry,
185, 385
–393.
Lonnqvist, J. K. (2000) Suicide: epidemiology and causes of suicide. In New Oxford Textbook of Psychiatry, vol. 1 (eds M. G. Gelder, J.J. López-Ibor pez-Ibor & N. Andreasen), pp. 1033 –1039. Oxford: Oxford University Press.
Makinen, I. H. & Wasserman, D. (2001) Some social dimensions of suicide. In Suicide: An Unnecessary Death (ed. D. Wasserman), pp. 101 –108. London: Martin Dunitz.
Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK.
Social Survey Division, Office for National Statistics, London, UK
WHO Collaborating Centre, Institute of Psychiatry, London, UK
Division of Psychiatry, Cotham House, University of Bristol, Bristol, UK
Correspondence: E-mail: D.J.Gunnell{at}bristol.ac.uk
We agree with Dr El-Adl’s comment that both ethnicity and religion may influence the incidence of, and recovery from, suicidal thoughts. Data on ethnicity were collected in the Office for National Statistics Survey that formed the basis of our paper (Singleton et al, 2001). Because of the relatively small sample size, only 122 (5.1%) of the individuals who reported ethnicity were from a Black or minority ethnic group and only seven of these experienced incident suicidal thoughts. Thus, specific investigation of the impact of belonging to a particular ethnic group was not possible. If the Black and minority groups are combined to give a single group, the odds ratio for incident suicidal thoughts in this group compared with the White group in analyses adjusted for age, gender and score on the Clinical Interview Schedule – Revised is 0.77 (95% CI 0.27–2.17). The breadth of the confidence interval indicates that the data are compatible with either a threefold reduction or a doubling in risk. Data on religion were not collected in the Office for National Statistics Survey of Psychiatric Morbidity.
REFERENCES
Singleton, N., Bumpstead, R., O’Brien, M., et al (2001) Psychiatric Morbidity among Adults Living in Private Households, 2000. London: Stationery Office.
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