The Christian Religion and the Impact on Stigma of SuicideSpecific Aims I have first-hand experience observing the stigma around suicide. When my brother took his life, I read comments on the internet and heard individuals talk specifically about my brother’s suicide or suicide in general. Comments ranged from my brother “choosing to die” to my brother was “weak and the world is better off without him.” Religion is an important part of my life. When my brother died, my family had two pastors visit us, because my family is split regarding religious denominations. My brother’s pastor was Lutheran and my pastor was Assembly of God. The positivity the Lutheran pastor brought to my family was a surprise to me. I attended a Lutheran school and was told that if someone dies by suicide, they would go to hell. Growing up in both traditional and nontraditional denominations, there was little to no conversations around mental health and suicide. Due to my experience and noticing the lack of studies regarding these topics, it would be interesting and valuable to see if suicide viewed as a choice is different based on the religious denominations. In America, about 95% of the population believes in God or a Higher Power of some kind, 90% pray, and about 70% attend church (Tix & Frazier, 2005). Since there are so many individuals that identify with spiritual beliefs, researching the relationship between stigmas around suicide in Christian denominations, and more specifically whether suicide is a choice or not, is important because the support, or the lack of, could have a huge impact on a survivor’s healing. One of the biggest struggles I experienced was wondering what happened to my brother after he died, since the majority of Christian denominations believe that an individual either goes to heaven or hell after death. My experience is influencing this study, as well as the lack of research on the negative impact of religion on mental health. This study would provide information to religious or spiritual leaders and their education or reaction to a surviving family. Since many individuals are religious or spiritual, it is can be detrimental if individuals lack support from their religious leaders and church family. There is a belief that suicide is a choice; however, a google search will indicate there are many websites trying to fight that belief. In my experience, it appears that the stricter a religion is, the more stigmas they have around suicide. Hypotheses: In Christianity, traditional denominations have more stigmas around the topic of suicide than non-traditional denominations. More specifically, individuals that identify with traditional denominations believe more strongly that people choose to kill themselves than individuals that identify with nontraditional denominations.Introduction There are numerous studies on how being involved with religion or spiritual practice can have a positive impact on mental health (Mannheimer & Hill, 2015). However, there are few studies on the negative impact on mental health caused by spiritual or religious shortcomings Religious shortcomings include, but are not limited to, forgetting to pray, not attending church, not going to confession, and having spiritual or religious doubt. Additional studies show patterns of spiritual or religious distress and poorer mental health. Not only does religion have a strong connection with mental health, there appears to be a stronger connection when the person has a deeply personal connection to religion (Tix & Frazier, 2005). Denominations like Conservative Protestant were more intrinsically religious than Catholics. This could be that Catholic is more about the tradition and Conservative Protestant are more about the relationship with God. Another report indicated that elderly subjects who indicated they were religious had higher mental health concerns, while elderly subjects that indicated no religion had less mental health concerns (Ng et al., 2011). In this study, the Christians, Hindus and Muslims were more likely to believe that ‘professionals can do little to help.’ This was also related to a greater likelihood of seeking treatment. This inconsistency may be attributed to the individuals that had a negative experience with seeking treatment and were more like to seek their treatment with the religious community. It was suggested that a collaborative approach between mental health professionals and religious and spiritual communities is beneficial. Stigma can be defined in multiple ways; this research proposal will use the Mental Health Commission of Canada’s definition of Stigma: “beliefs and attitudes about mental health and mental illness that lead to the negative stereotyping of people and to prejudice against them and their families” (2009). The most significant barrier for young people to access school-based mental health programs found in the study by Bowers et al, (2012) was due to stigma. It was found that service provider’s perception of stigma was a barrier for young people to access mental health services, but their perception was less than what the young people reported in the study. Low-income racial and ethnic minorities experience barriers to get health care due to the stigma around mental health (Caplan, 2016). It is common among Latinos to believe that depression is a sign of weakness, to keep personal problems just within the family, and strongly value self-reliance. For Latinos, the religious teachings and their religious communities may be influencing the stigma around mental illness. However, since religion is important among Latinos, the use of religion can also be used as a coping mechanism. Another belief about stigma comes from “fear of the unknown and the challenge and fear of not being able to control mental illness” (Caplan & Cordero, 2015). The lack of knowledge or experience of mental health could be one reason that stigma exists. In one study, it was found that religious leaders lack training on suicide and mental health illnesses (Mason et al., 2016). When studying clergy, those that scored higher in the belief of ‘having a right to die’ were more likely to assess a mental health crisis as low to medium risk, which influenced interventions due to those assessments. In another study, most churches that were involved were not against having mental health services for their members but that they were likely to plead ignorance or feel inadequate in addressing mental health issues (Sullivan et al., 2014). The clergy didn’t have education on identifying mental health concerns and how to make referrals. However, they asked for more training and wanted to know how to make referrals after mental health was further explained. Some obstacles were found when it came to suicide prevention programs in religious organizations which were lack of financial resources, lack of time and lack of training opportunities (Hirono, 2013). When looking at prevention of suicide, the role of clergy is missing but found to be essential and is overlooked by workers. A study that focused on adolescents attending religious and secular education found that the religious group scored higher than the other regarding the view that suicide has a “punishment after death, communicating suicidal problems, and hiding suicidal behavior” (Eskin, 2004). The secular group scored higher on “acceptability of suicide, suicide as a sign of mental illness and open reporting/discussions of suicide factors.” A Reverend discussed mental illness as a “double illness” because the individual with mental illness may not reach out to their spiritual supports (Caplan & Cordero, 2015). She observed church members moving away, stare, or make comments when someone with mental illness would come to church. These responses could prevent someone from seeking support from religious organizations. Other religious entities view mental health symptoms as demonic possession. When it came to suicide, most agreed that it was a sin; however, it was agreed that talking about suicide with the congregation was important. Christian clergy answered yes more frequently to the question if suicide was a sin more than Japanese clergy (Hirono, 2013). Interestingly when looking at denominations of Christianity, denominations of Lutheran and Baptist all answered yes to suicide is a sin, while Roman Catholic denomination answered no, in which the author suggested that further research is needed since Emile Durkheim found the opposite results in 1897. Whether suicide is a sin or not is an important and sensitive issue when working with survivors of suicide. Many websites on suicide contain topics that fight the belief that suicide is a choice. This suggests that view of choice can be included as an aspect of stigmas around suicide. There is very little research on the perception of choice when it comes to suicide, despite the number of websites and advocators on the subject. It would be beneficial to see more studies in this area. Lester (1990) proposed that choice of suicide may be blocked by a filter such as religion, cognitive, ethical, etc. When it comes to suicide the impulse may be allowed if one of the blocking filters were adjusted. This suggests that an individual’s reasons for living can be easily modified such as having children, religion or people will miss them when they start feeling suicidal. What once were protective factors may be adjusted to not mean much to the individual. When journalists write articles on suicide, many words are used to depict “choice” such as commits, take, or self-inflicted (Boudry, 2008). However, words implicating “choice” are not used in articles on the death of other illnesses. Americans also tend to blame individuals for suicide instead of looking at the mental illness. Boudry (2008) states “words used by sources to describe suicide shows a culturally nuanced belief that suicide is a rational choice, versus an irrational choice by a mentally ill person.” Though mental illness is commonly the reason why people complete suicide, Americans seek to understand another reason outside of mental illness. There are many articles that portray suicide due to problems, which takes it away from the context of mental illness. Methods (2-3 pages) The hypothesis of this study is that individuals that identify with traditional denominations believe more strongly that people choose to kill themselves than individuals that identify with nontraditional denominations. To test the hypothesis, the best method would be a questionnaire. The study would offer a questionnaire to several churches of traditional and nontraditional Christian denominations. The question on the questionnaire will be a yes or no response to “Do you believe that suicide is a choice” and in this study, view of choice will define stigma. The questionnaire will also have a line for the denomination that the individual belongs to or identifies with. For the purpose of this study, strictness of religion will be defined as Traditional Christian denominations of Catholics, Lutherans, and Methodists. Less strict or Non-Traditional denominations will be defined by Assembly of God, United Church of Christ, and Free Evangelical. A church will be defined as a membership of at least 15 members. The questionnaire will be sent to 15 random Wisconsin churches in each denomination (Catholic, Lutheran, Methodist, Assembly of God, United Church of Christ and Free Evangelical). By randomizing the sample, the results will come from different size churches, different locations such as rural, city, or urban, and different ages. This should be a close representation of the state of Wisconsin. It will be random by utilizing computers and programs to find churches throughout the state of Wisconsin. A third-party organization will be responsible for going to the churches and giving out the questionnaires to the church-goers. The questionnaire will be anonymous. There will be an informed consent on the questionnaire that participants will be asked to initial and date. By involving the third-party organization, it will help make the study double blinded. To guarantee anonymity, the participants will be able to give the questionnaire back to the representative in a sealed envelope or mail it back to the three-party organization that will compile the data and sends the information back to the research team. After the information has been compiled and the study finished, the questionnaires will be destroyed after six months. The data and relationships will be measured by chi-square. This study will have 1 degree of freedom and will use alpha=0.05. If this study shows a strong relationship between suicide viewed as a choice and traditional versus non-traditional denominations, it would provide ample reasons to continue research regarding stigma of suicide and its relation to religion. There are concerns for individuals that don’t speak English. It would be impossible to foresee every language that might need translation. However, since Spanish and Hmong are found to be common in Wisconsin, the questionnaire could include translations in those languages as well as English.Data Analysis Plan (1 paragraph) The data will be presented by a table and a chi-square. The table will include the raw numbers specific to the denomination it came from. On the top of the Table, it will have the following categories: Catholic, Methodist, Lutheran, Assembly of God, United Church of Christ, and Free Evangelical. Under each category, it will list the number of individuals that answered yes and how many answered no. The information will also be presented in a Chi-Square, with categories being Traditional and Non-Traditional on the top, and yes and no on the right side. The Data Analysis Plan will include p-values and the alpha level. To reject the null hypothesis, the alpha level=0.05. Limitations Section (1/2 page) Since this hypothesis hasn’t been tested in previous studies, the test was conducted on a small scale. If the results showed strong confidence levels, additional studies should be pursued. Another limitation was that study was conducted in one state. It would be beneficial to conduct this study on a national level and eventually on a world level. The larger and wider the sample, the better chances the study would represent the population. Another aspect to keep in consideration is the possibility that only the individuals with strong or extreme opinions responded to the survey. Individuals that feel strongly about this subject are more likely to respond than those that don’t feel as strongly. There are some weaknesses in the study, as it would benefit to know how much value the individual puts on religion as well as including those that don’t identify with a specific religion or aren’t religious at all. In future studies, a random sample of the population could be utilized as a control group to identify a baseline, and taking that information and comparing it to results looking at religion. Though it likely the case in other religions, this study focused on one opinion or aspect of stigma. There are multiple facets of stigma beside the view of suicide. This study chose religious denominations based on a common view, but there isn’t known research on the chosen denominations and strictness of their beliefs. Also, there is a lot of differences of views and opinions that are congregation specific. An example, there are Lutheran congregations that can be viewed as more liberal than typical Lutheran congregations. I chose to define stigma as suicide viewed as a choice based on personal experience. There are weaknesses in both internal and external validity. One weakness of external validity that it is unknown that even if the study shows to be strong and confident that it would produce similar results in different states or on a broader scale. It may appear to have a confident relationship between suicide viewed as choice and denomination. However, instead of denomination, the variable could be the belief system of the geographical area. This would eventually be answered as more studies are conducted. An example of internal validity weakness is that individuals may have answered yes on the questionnaire as they are viewing suicide choice in aspects of physician-assisted suicide, which may skew the results. 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