Religious/Spiritual Struggles and Suicide Ideation Among Adult Psychiatric Outpatients: A 12-Month Longitudinal Study

Austin W. Lemke, Edward B. Davis, Vitaliy L. Voytenko, Richard G. Cowden, Zhou Job Chen, John M. McConnell, Kenneth I. Pargament, Kenneth P. Phillips, Robert Marseilles, Richard P. Wolff

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Initial empirical evidence links religious/spiritual (R/S) struggles to suicide ideation. However, few longitudinal studies have examined the temporal associations of R/S struggles and suicide ideation, and none have focused on treatment-seeking individuals. This study addresses these gaps. Methods: We assessed suicide ideation and six subtypes of R/S struggles in a sample of adult psychiatric outpatients (N = 120) at their initial psychiatry appointment (T1), 6-month follow-up (T2), and 12-month follow-up (T3). Following the analytic template for outcome-wide longitudinal designs, separate linear regression models tested the association of (a) T2 R/S struggle subtypes with T3 suicide ideation and (b) T2 suicide ideation with T3 R/S struggle subtypes. All models adjusted for salient demographics, organizational and nonorganizational religiousness, depression symptoms, T1 suicide ideation, and prior values of all six R/S struggle subtypes. Results: Robust evidence supported a positive bidirectional temporal association between suicide ideation and ultimate-meaning R/S struggles, but not other R/S struggle subtypes. Limitations: We recruited a relatively small sample that was geographically, racially, and socioeconomically homogenous. We also relied solely on self-report data. Conclusions: Findings highlight the importance both of assessing ultimate-meaning R/S struggles as part of suicide risk assessment and of using clinical interventions that nurture adult psychiatric patients’ sense of ultimate meaning.

Original languageEnglish (US)
Article number100640
JournalJournal of Affective Disorders Reports
StatePublished - Dec 2023
Externally publishedYes


  • meaning
  • religion
  • religious/spiritual struggles
  • spirituality
  • suicide

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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