Prevalence and Protective Factors of Suicidal ideation among Medical Students in Karachi: The impact of Religious beliefs and Social support

Background: Suicidal ideation and attempts are major public health concerns among young adults, particularly those in demanding academic settings. Medical students exhibit disproportionately high rates compared to peers in the general population and other fields of study, highlighting the urgent need to understand and address mental health challenges in medical education. Objective: This scoping review summarizes evidence from systematic reviews and meta-analyses on the prevalence and risk factors of suicidal ideation and suicide attempts among medical students worldwide. Methods: Following PRISMA-ScR guidelines, six databases were searched for peer-reviewed reviews published in the last ten years. Studies focused exclusively on medical students and reporting prevalence or risk factors of suicidal ideation or attempts were included. Data were charted on prevalence, risk factors, study characteristics, and recommendations. Results: Twelve reviews comprising 378,081 medical students were included. Lifetime prevalence of suicidal ideation ranged from 2.9% to 53.6% among the systematic reviews, with pooled estimates from meta-analyses ranging from 11% and 25%. Attempted suicide pooled prevalences ranged from 1.64% to 8%. Depression was frequently reported as the most significant risk factor for both suicidal ideation and attempts. Other significant risk factors for suicidal ideation included anxiety, burnout, female gender, financial strain, and academic stress. Suicidal ideation was higher during the COVID-19 pandemic and among clinical-phase students. Gender differences in suicide attempts were inconsistent. Medical students’ rates of suicidal behavior exceeded those of other university students. Conclusion: Suicidal behavior remains a critical mental health issue for medical students globally. Despite known risk factors, targeted interventions are limited. Future research should emphasize longitudinal studies, post-pandemic effects, regional gaps, and intervention development. Implications are discussed.

BackgroundThe pursuit of medical and dental education is challenging and can affect the overall quality of life of medical students. Assessing the quality of life of medical students is the first step in the preparation of efficient future health care professionals. This study used the World Health Organization Quality of Life Brief Version (WHOQOL-BREF) to evaluate the quality of life of medical and dental students in Karachi, Pakistan.ObjectivesThe study objectives include: assessing the QoL of medical and dental students and their general health satisfaction and self-satisfaction.Materials and methodsThis cross-sectional study was conducted among 344 medical and dental students from different medical and dental schools in Karachi, Pakistan. The World Health Organization Quality of Life Brief Version (WHOQOL-BREF) questionnaire was used to assess QOL, which included 26 items covering four domains: physical, psychological, social, and environmental. All scores for the domains ranged from 4 to 20. Scoring was done according to the WHOQOL-BREF procedure manual. The questionnaire was disseminated to medical students using Google Forms. SPSS software was used to analyze the data. Cronbach’s alpha and the Kaiser-Meyer-Olkin (KMO) test were used to evaluate the reliability and sampling adequacy of the data for factor analysis. Descriptive statistics were computed for each variable and QoL domain, including frequencies, percentages, averages, and standard deviations. Domain scores were compared using a t-test and one-way ANOVA, with p-values less than 0.05, indicating statistical significance.ResultsAmong the 344 medical students, 56.7% (n = 195) were female and 43.3% (n = 149) were male. The WHOQOL-BREF demonstrated excellent reliability, with a Cronbach’s alpha of 0.918. Most medical students rated their overall QOL (62.2%) and health satisfaction (46.8%) as good, and were able to get around well (71.3%). No significant sex differences were found across the various QOL domains. Marital status significantly affected QOL scores (p < 0.005). Single students had significantly higher QOL scores than married/separated/divorced students did. Overall, the environmental domain had the highest mean score (26.81 ± 6.17), while social relationships had the lowest mean score (9.68 ± 2.93).ConclusionThe findings of this study provide valuable insights into the QoL of medical and dental students. Most participants reported moderate satisfaction with their physical health and lower satisfaction with the psychological, social, and environmental components of QoL. Marital status was found to significantly impact the QoL as compared to single students with greater QoL. These findings can help form targeted interventions to enhance medical students’ quality of life and prepare efficient future healthcare professionals.

More than a year has passed since World Health Organization (WHO) declared COVID-19 as a pandemic, and during this period over 237 million cases and more than 4.8 million deaths have occurred worldwide due to COVID-19.1 This unprecedented pandemic not only has burdened health systems but it also constitutes a major stressful event both due to the threat of illness and death that it poses, and to the drastic impact on human relations, financial activity, access to health services, etc. Additional factors that may contribute to stress include the protection measures against COVID-19, social distancing, and mobility restrictions. The impact of the pandemic on suicidal behavior, especially on the Greek population, is of critical importance, due to the increase in suicidality during the recent financial crisis in the country.2 The impressive decline in the GDP during the first months of the COVID-19 pandemic (-9% of GDP),3 unemployment, isolation, reduced social contacts, problems in accessing mental health services, and also the limitations in terms of psychological support may increase the risk of suicidal behavior.4 With a view to investigating the psychosocial effects of the COVID-19 pandemic, an online questionnaire was developed in March 2020 by the Second Department of Psychiatry of the National and Kapodistrian University of Athens (NKUA) and the Postgraduate Program "Liaison Psychiatry: Integrated Care of Physical and Mental Health" of NKUA. This questionnaire included items regarding demographic characteristics, physical and mental health data, and issues related to the pandemic and the imposed restriction measures, such as perceived changes in participants' biorhythms, habits, and relationships with their colleagues, friends, and family. In addition, participants were asked to complete psychometric scales with regard to anxiety, depression and suicidal ideation, family functioning, anger and resilience. During the first national lockdown in Greece (April 7 to May 3) a total of 5,748 adults from the community participated in the survey by anonymously completing the aforementioned questionnaire on a secure website of NKUA. A considerable effort was devoted to make the sample as representative as possible and to include members of the community who do not usually participate in such surveys, as individuals of older age or individuals with health conditions. The 5.20% two-week prevalence of suicidal ideation found in our study is an intermediate rate with respect to the 2.4% one-month prevalence in 2008, the 6.7% in 2011 and the 2.6% prevalence in 2013.5 Among the respondents, 14.1% were potential cases of anxiety, while 26.5% of depression. Independent risk factors for suicidal ideation included anxiety, depression, impaired family functioning, being unmarried or divorced, having a mental health history, as well as a poor perceived quality of physical health. In contrast, higher resilience, positive feelings with regard to the lockdown measures, relationship with friends, and faith in a Supreme Being emerged as protective factors for suicidal ideation.6 Investigating the risk and protective factors for suicidal ideation is especially important during this difficult period of the pandemic. There was an additional significant finding in this study: individuals who completed the questionnaire during the last two weeks of the first lockdown reported statistically significantly higher suicidal ideation, depression, and anxiety than those who completed it in the previous two weeks, while a similar finding was revealed in a study from USA.7 Therefore, we were looking forward to the results of our survey conducted during the second lockdown.8 From the 5,116 individuals who had fully completed our questionnaire with respect to suicidal ideation during the first lockdown, 811 fully completed it for the second time from November 22 to December 21, 2020. Suicidal ideation was not found significantly different compared to the first lockdown. Independent risk factors for suicidal ideation during the second lockdown were depression, anxiety, living with a person with frail health and vulnerable for COVID-19 and suicidal ideation during the first lockdown. It is noted that during the second lockdown the rates of potential depression cases remained unchanged, whereas anxiety rates increased. Greater accessibility to health services, state financial support and increased mobility might have contributed to the stability of suicidal ideation despite the greater severity of the second wave of the COVID-19 pandemic. The aforementioned studies determined the prevalence of suicidal ideation and its association with various demographic, clinical, social, familial, and psychopathological factors in a cohort context at different stages of the COVID-19 pandemic, with the relevant literature being rather poor. We consider that the provision of such data is critical for the plans of health system in pandemic conditions, while this longitudinal study is in progress during the subsequent waves of the pandemic.

Suicidal ideation: Prevalence and risk factors during pregnancy

Background: This study aimed to compare the prevalence and risk factors of suicidal ideation by age groups among the elderly in Korea. Methods: This cross-sectional study used Fifth Korean National Health and Nutrition Examination Survey (V-3, 2012). The participants were divided into two age groups: the young-old (n=1,016, 65-74 years), old-old (n=579, 75 years or greater) groups. Multiple logistic regression was used for data analysis. Results: The prevalence of suicidal ideation was 19.6% of young-old and 22.7% of old-old, respectively. There was no difference on prevalence of suicidal ideation by age groups. Risk factors of suicidal ideation differ by age groups. In the young-old group, higher suicidal ideation showed significant correlation with a higher level of depression, perceived stress and a lower level of education, self-rated health. In the old-old group, higher suicidal ideation showed significant correlation with a higher level of depression, perceived stress, restriction of activity, and pain/discomfort. Conclusions: Age group-specific nursing strategies may be required for prevention of suicidal ideation in elderly. Korean J Health Promot 2015;15(2):54-62

The incidence of suicide and its ideation among medical students is increasingly recognized as a significant issue, influenced by the demanding nature of medical education and the various associated psychological stressors. This systematic review aims to elucidate the risk factors and prevalence of suicide and suicidal ideation within this group, with a focus on the implications for mental health interventions. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this review analyzed 11 studies selected from major databases such as Scopus-Elsevier, Google Scholar, PubMed, and others, focusing on publications between 2015 and 2023. Studies were predominantly observational and cross-sectional, examining suicide rates and suicidal ideation among medical students. The review found that medical students experience higher rates of suicide and suicidal ideation compared to the general population, with significant stressors including academic pressure, personal relationship challenges, and professional expectations. Notably, female respondents displayed a higher prevalence of suicidal ideation than males. Key warning signs identified include changes in mood or behavior and previous attempts of suicide. Despite varying findings regarding the role of medical training duration on suicidal ideation, all studies highlight the critical need for targeted mental health support. The findings underscore the urgent need for integrated mental health services and the incorporation of mental health education within the medical curriculum. A multidimensional approach involving enhancements to both curricular and support structures is crucial for mitigating the risk of suicide among medical students. Future research should focus on developing and evaluating interventions to reduce educational stress and promote psychological well-being in medical educational settings.

The objective of this study was to investigate the prevalence and predictors of suicide ideation among primary, middle and high school students. We used multilevel modelling to investigate suicide ideation among 12,733 Chinese children and adolescents aged 9-18 years from wide range of areas across China. Approximately, 32.09% of children and adolescents reported suicide ideation, with females were more likely to report suicide ideation than males (38.09% vs. 29.95%). Our results showed that the risk factors in primary school students were different from middle and high school student groups, whereas significant risk factors for middle and high school students were similar. The city's standard of living as indicated by the Engel coefficient and the city's divorce rate were positively associated with the prevalence of suicide ideation; in contrast, the school's pupil-to-teacher ratio was negatively correlated with elevated suicide ideation. Significant risk factors for suicide ideation included study anxiety, self-accusation tendency, impulsive tendency, terror tendency and physical symptoms. These results have important implications for the prevention of suicide, suggesting that both contextual (city-level) and compositional (individual-level) factors could be important targets for prevention and intervention for children and adolescents at risk of suicide ideation.

Prevalence and predictors of suicide ideation among undergraduate medical students from a medical college of Western India

BackgroundSexual and gender minority populations experience elevated risks for suicidality. This study aimed to assess prevalence and disparities in non-fatal suicidality and potential protective factors related to social support and health care access among sexual and gender minority youth and adults and their heterosexual and cisgender counterparts in Canada. The second objective was to examine changes in the prevalence of suicidal ideation and protective factors during the COVID-19 pandemic.MethodsPooled data from the 2015, 2016 and 2019 Canadian Community Health Surveys were used to estimate pre-pandemic prevalence of suicidal ideation, plans and attempts, and protective factors. The study also estimated changes in the prevalence of recent suicidal ideation and protective factors in fall 2020, compared with the same period pre-pandemic.ResultsThe prevalence of suicidality was higher among the sexual minority populations compared with the heterosexual population, and the prevalence was highest among the bisexual population, regardless of sex or age group. The pre-pandemic prevalence of recent suicidal ideation was 14.0% for the bisexual population, 5.2% for the gay/lesbian population, and 2.4% for the heterosexual population. The prevalence of lifetime suicide attempts was 16.6%, 8.6%, and 2.8% respectively. More than 40% of sexual minority populations aged 15–44 years had lifetime suicidal ideation; 64.3% and 36.5% of the gender minority population had lifetime suicidal ideation and suicide attempts. Sexual and gender minority populations had a lower prevalence of protective factors related to social support and health care access. The prevalence of recent suicidal ideation among sexual and gender minority populations increased in fall 2020, and they tended to experience longer wait times for immediate care needed.ConclusionsSexual and gender minority populations had a higher prevalence of suicidality and less social support and health care access compared to the heterosexual and cisgender populations. The pandemic was associated with increased suicidal ideation and limited access to care for these groups. Public health interventions that target modifiable protective factors may help decrease suicidality and reduce health disparities.

This research investigates prevalence and side effects of caffeinated drinks intake, sleep biological rhythms and increase BMI among medical students in Karachi. The primary objective was to assess the prevalence of caffeinated drinks intake among undergraduate medical students on weekly and daily basis. Secondary objectives were to determine the associated potential side effects, the way excessive consumption influences the sleep patterns and BMI. Thirdly objective were to determine the relationship between demographic variables and caffeinated drink intake, assess mean differences in Sleep schedule and BMI between students’ groups and, report the predictors of caffeinated drinks consumption. A cross-sectional study was conducted for 6 months (February – July 2024) among currently enrolled undergraduate medical students studying in medical colleges and universities in Karachi, Pakistan. The study used the self-reported questionnaire that included four sections: Sec (1). Demographic characteristics; Sec (2). Caffeinated drinks consumption; Sec (3). Side effects of caffeinated drink intake; Sec (4). Body Mass Index (BMI) and collected data through Convenient sampling. Data was analyzed through SPSS version 23.0. Pearson Correlation analysis was conducted to reveal the relationship between caffeinated drink consumption, Potential side effects and impact on sleep biological rhythms and altered BMI. This study examines the demographics, consumption patterns, and impacts of caffeinated drink intake among 309 students aged 20-25 from medical and non-medical fields. The sample included 66.9% females and 33.1% males, with 68.5% from medical fields. Regular caffeine consumption was reported by 98% of participants, primarily for taste (24.4%), staying awake (56.2%), and social reasons (33.1%). Common side effects included insomnia (66.9%), nervousness (33.1%), and palpitations (24.4%). Sleep patterns showed 66.9% maintained a regular schedule, but caffeine significantly disrupted sleep. BMI analysis revealed a mean of 22.45 kg/m² (SD=6.07), with significant correlations between caffeine intake and BMI changes (12.3%). Awareness of caffeine’s impact on weight was reported by 50.3%, with 16.6% seeking medical advice. Significant associations were found between awareness of side effects and impacts on BMI (p=0.006), medical advice (p=0.004), and sleep (p=0.000). Caffeinated drink consumption is prevalent among medical and non-medical students, primarily driven by academic pressures and social habits. While providing temporary cognitive benefits, it is associated with several side effects, including sleep disturbances and increased BMI. This study underscores the importance of promoting health education and informed consumption practices to safeguard students' health and well-being.

This study aimed to assess the knowledge regarding female fertility, infertility treatments and the attitudes regarding parenthood of medical students in Pakistan. Delayed childbirth among medical trainees due to extended years of medical education and training puts this population at a higher risk for involuntary childlessness later in life due to age-related decline in female fertility. A knowledge, attitude and practice study was carried out among medical students in Karachi in July 2021 using the English version of the Swedish Fertility Awareness questionnaire, which has been used in similar studies. Most participants wished to have children at some point in the future. However, a majority of students did not have sufficient knowledge regarding age-related decline in female fertility and overestimated the efficacy of infertility treatments. The results of this study indicate that despite planning to have children and placing great importance on parenthood, medical students severely overestimate female fertility and plan to start having children at an age at which female fecundity has begun to decline. These findings highlight a need for better provisions regarding fertility knowledge in the curriculum for medical students, as they are an at-risk group for involuntary childlessness due to age-related fertility decline.

Knowledge-attitude-practice toward swine flu

Objective. To determine the prevalence of suicidal ideation among Métis men and women (20–59 years) and identify its associated risk and protective factors using data from the nationally representative Aboriginal Peoples Survey (2006).Study design. Secondary analysis of previously collected data from a nationally representative cross-sectional survey.Results. Across Canada, lifetime suicidal ideation was reported by an estimated 13.3% (or an estimated 34,517 individuals) of the total population of 20-to-59-year-old Métis. Of those who ideated, 46.2% reported a lifetime suicide attempt and 6.0% indicated that they had attempted suicide in the previous 12 months. Prevalence of suicidal ideation was higher among Métis men than in men who did not report Aboriginal identity in examined jurisdictions. Métis women were more likely to report suicidal ideation compared with Métis men (14.9% vs. 11.5%, respectively). Métis women and men had some common associated risk and protective factors such as major depressive episode, history of self-injury, perceived Aboriginal-specific community issues, divorced status, high mobility, self-rated thriving health, high self-esteem and positive coping ability. However, in Métis women alone, heavy frequent drinking, history of foster care experience and lower levels of social support were significant associated risk factors of suicidal ideation. Furthermore, a significant interaction was observed between social support and major depressive episode. Among Métis men, history of ever smoking was the sole unique associated risk factor.Conclusion. The higher prevalence of suicidal ideation among Métis women compared with Métis men and the observed gender differences in associations with some associated risk and protective factors suggest the need for gender-responsive programming to address suicidal ideation.

In China, suicide accounts for twenty-six percent of all suicides worldwide; however, researches on the suicidal ideation among older people living alone in the rural region are few. We performed a cross-sectional study to explore the prevalence and influence factors of suicidal ideation, and provide a theoretical basis for suicide prevention among older people living alone in rural region.695 older people living alone in rural region were selected by using stratified cluster sampling. Chi-square for categorical variables, T-test for continuous variables, and path analysis were conducted to statistical analysis.The prevalence of suicidal ideation among the elderly living alone in rural China was 23.6%. Path analyses showed that depression had the most substantial influence on suicidal ideation among the elderly living alone, it was also as a mediator between physical, economic status, social support, anxiety, and suicidal ideation; anxiety and social support had both direct and indirect influence on suicidal ideation; physical status and economic status had indirection impact.The incidence of suicidal ideation among the elderly living alone was high in Dangtu county. Psychological disorders (anxiety and depression) had the strongest impact on suicidal ideation. Strategies and measures targeting these relevant factors (economic status, physical status, and social support) should be taken to reduce the burdens of suicidal ideation among the elderly living alone in China.

Prevalence and incidence of suicide, suicidal ideation and self-harm in caregivers of cancer patients: A systematic review and meta-analysis