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

•Suicide ideation was correlated to both ultimate-meaning and moral R/S struggles.•Ultimate-meaning struggles both predicted and were predicted by suicide ideation.•Other forms of R/S struggles were not longitudinally associated with suicide risk. 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. 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. Robust evidence supported a positive bidirectional temporal association between suicide ideation and ultimate-meaning R/S struggles, but not other R/S struggle subtypes. We recruited a relatively small sample that was geographically, racially, and socioeconomically homogenous. We also relied solely on self-report data. 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.