Religious attendance link to lower risk of 'deaths of despair' for health workers

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People who attended religious services at least once a week were significantly less likely to die from "deaths of despair," including deaths related to suicide, drug overdose, and alcohol poisoning, according to new research led by Harvard TH Chan School of Public Health. The study showed that the association between service attendance and lower risk of deaths from despair was somewhat stronger for women in the study than for men. It was based on an analysis of data from the Nurses' Health Study II on 66,492 women as well as data from the Health Professionals Follow-Up Study on 43,141 men.

"Despair is something that can confront anyone dealing with severe difficulties or loss. While the term 'deaths of despair' was originally coined in the context of working-class Americans struggling with unemployment, it is a phenomenon that is relevant more broadly, such as to the health care professionals in our study who may be struggling with excessive demands and burnout, or to anyone facing loss. As such, we need to look for important community resources that can protect against it," said Tyler VanderWeele, John L Loeb and Frances Lehman Loeb professor of epidemiology at Harvard Chan School. VanderWeele is also director of the Human Flourishing Programme and co-director of the Initiative on Health, Religion and Spirituality at Harvard University.

Religion may be a social determinant of health, and previous research has shown that attending religious services may be associated with a lower risk of various factors related to despair, including heavy drinking, substance misuse, and suicidality.

For this study, researchers analysed data from the Nurses' Health Study II on 66,492 women as well as data from the Health Professionals Follow-Up Study on 43,141 men. Among the women, there were 75 deaths from despair: 43 suicides, 20 deaths from poisoning, and 12 deaths from liver disease and cirrhosis. Among the men there were 306 deaths from despair: 197 suicides, 6 deaths from poisoning, and 103 deaths from liver diseases and cirrhosis.

After adjusting for numerous variables, the study showed that women who attended services at least once per week had a 68% lower risk of death from despair compared to those never attending services. Men who attended services at least once per week had 33% lower risk of death from despair.

The study authors noted that religious participation may serve as an important antidote to despair and an asset for sustaining a sense of hope and meaning. They also wrote that religion may be associated with strengthened psychosocial resilience by fostering a sense of peace and positive outlook, and promoting social connectedness.

"These results are perhaps especially striking amidst the present COVID-19 pandemic," said Ying Chen, research associate and data scientist at the Human Flourishing Programme at Harvard's Institute for Quantitative Social Science, and first author of the paper. "They are striking in part because clinicians are facing such extreme work demands and difficult conditions, and in part because many religious services have been suspended. We need to think what might be done to extend help to those at risk for despair."

Other authors from Harvard Chan School include Howard Koh and Ichiro Kawachi. Michael Botticelli of the Grayken Centre for Addiction at Boston Medical Centre was also a co-author.

Importance: The increase in deaths related to drugs, alcohol, and suicide (referred to as deaths from despair) has been identified as a public health crisis. The antecedents associated with these deaths have, however, seldom been investigated empirically.
Objective: To prospectively examine the association between religious service attendance and deaths from despair.

Design, Setting, and Participants: This population-based cohort study used data extracted from self-reported questionnaires and medical records of 66 492 female registered nurses who participated in the Nurses’ Health Study II (NHSII) from 2001 through 2017 and 43 141 male health care professionals (eg, dentist, pharmacist, optometrist, osteopath, podiatrist, and veterinarian) who participated in the Health Professionals Follow-up Study (HPFS) from 1988 through 2014. Data on causes of death were obtained from death certificates and medical records. Data analysis was conducted from September 2, 2018, to July 14, 2019.
Exposure: Religious service attendance was self-reported at study baseline in response to the question, “How often do you go to religious meetings or services?”

Main Outcomes and Measures: Deaths from despair, defined specifically as deaths from suicide, unintentional poisoning by alcohol or drug overdose, and chronic liver diseases and cirrhosis. Cox proportional hazards regression models were used to estimate the hazard ratio (HR) of deaths from despair by religious service attendance at study baseline, with adjustment for baseline sociodemographic characteristics, lifestyle factors, psychological distress, medical history, and other aspects of social integration.
Results: Among the 66 492 female participants in NHSII (mean [SD] age, 46.33 [4.66] years), 75 incident deaths from despair were identified (during 1 039 465 person-years of follow-up). Among the 43 141 male participants in HPFS (mean [SD] age, 55.12 [9.53] years), there were 306 incident deaths from despair (during 973 736 person-years of follow-up). In the fully adjusted models, compared with those who never attended religious services, participants who attended services at least once per week had a 68% lower hazard (HR, 0.32; 95% CI, 0.16-0.62) of death from despair in NHSII and a 33% lower hazard (HR, 0.67; 95% CI, 0.48-0.94) of death from despair in HPFS.
Conclusions and Relevance: The findings suggest that religious service attendance is associated with a lower risk of death from despair among health care professionals. These results may be important in understanding trends in deaths from despair in the general population.

Ying Chen, Howard K Koh, Ichiro Kawachi, Michael Botticelli, Tyler J VanderWeele

Harvard TH Chan School of Public Health material

JAMA Psychiatry abstract

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