Abstract:
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Methods for mediation, interaction, and sensitivity analysis for unmeasured confounding were used in longitudinal analyses of the Nurses' Health Study data (N=89,708) to assess associations between religious service attendance and suicide. Attending religious services once per week or more was associated with an approximately five-fold lower rate of suicide, compared with never attending services (Hazard Ratio [HR]=0.16, 95% confidence interval: 0.06-0.46). Service attendance once or more per week, versus less often, was associated with a HR=0.05 (0.006-0.45) for Catholics, but only HR=0.34 (0.10-1.10) for Protestants (p-value for heterogeneity=0.05). Results were robust in sensitivity analysis and to exclusions of persons who were previously depressed or had a history of cancer or cardiovascular disease. There was evidence that social integration, depressive symptoms, and alcohol consumption partially mediated the relationship among those occasionally attending services, but not for those regularly attending.
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