Suicidal ideation among students of a medical college in Western Nepal: a cross-sectional study

Prevalence of Suicidal Behavior Among Students in South-East Asia: A Systematic Review and Meta-Analysis

OBJECTIVES

Estimation of rates of suicidal behaviors (ideation, plan, and attempt) would help to understand the burden and prioritize prevention strategies. However, no attempt to assess suicidal behavior among students was identified in South-East Asia (SEA). We aimed to assess the prevalence of suicidal behavior (ideation, plan, and attempt) among students in SEA.

METHODS

We followed PRISMA 2020 guidelines and registered the protocol in PROSPERO (CRD42022353438). We searched in Medline, Embase, and PsycINFO and performed meta-analyses to pool the lifetime, 1-year, and point prevalence rates for suicidal ideation, plans, and attempts. We considered the duration of a month for point prevalence.

RESULTS

The search identified 40 separate populations from which 46 were included in the analyses, as some studies included samples from multiple countries. The pooled prevalence of suicidal ideation was 17.4% (confidence interval [95% CI], 12.4%-23.9%) for lifetime, 9.33% (95% CI, 7.2%-12%) for the past year, and 4.8% (95% CI, 3.6%-6.4%) for the present time. The pooled prevalence of suicide plans was 9% (95% CI, 6.2%-12.9%) for lifetime, 7.3% (95% CI, 5.1%-10.3%) for the past year, and 2.3% (95% CI, 0.8%-6.7%) for the present time. The pooled prevalence of suicide attempts was 5.2% (95% CI, 3.5%-7.8%) for lifetime and 4.5% (95% CI, 3.4%-5.8%) for the past year. Higher rates of suicide attempts in the lifetime were noted in Nepal (10%) and Bangladesh (9%), while lower rates were reported in India (4%) and Indonesia (5%).

CONCLUSIONS

Suicidal behaviors are a common phenomenon among students in the SEA region. These findings call for integrated, multisectoral efforts to prevent suicidal behaviors in this group.

The role of spirituality and religiosity on the suicidal ideation of medical students

BACKGROUND

There is solid evidence that spirituality and religiousness may reduce the suicidal ideation of individuals. However, studies are scarce on medical students.

AIMS

To investigate the relationship between spirituality, religiousness, and suicidal ideation among Brazilian medical students.

METHODS

This is a cross-sectional study including Brazilian medical students. Sociodemographic and health variables, suicidal ideation (item 9 of the Beck Depression Inventory - BDI), spiritual and religious Coping (Brief SRC), religiousness (Duke Religion Index), spiritual well-being - Meaning, Peace and Faith (FACIT SP-12), and depressive (PHQ-9) and anxiety (GAD-7) symptoms were assessed.

RESULTS

A total of 353 medical students were included, 62.0% presented significant depressive symptoms, 44.2% presented significant anxiety symptoms, and 14.2% presented suicidal ideation. In the adjusted Logistic Regression models, meaning (OR = 0.90, p = .035) and faith (OR = 0.91, p = .042) were associated with lower suicidal ideation, while negative spiritual and religious coping was associated with greater suicidal ideation (OR = 1.08; p = .006).

CONCLUSION

There was a high prevalence of suicidal ideation among Brazilian medical students. Spirituality and religiousness were associated with suicidal ideation in two different directions. These findings could help educators and health professionals to understand suicidal ideation among medical students, helping in the development of preventive strategies to mitigate such problem.

Behavioral and psychosocial factors related to mental distress among medical students

Introduction

Physicians die by suicide at rates higher than the general population, with the increased risk beginning in medical school. To better understand why, this study examined the prevalence of mental distress (e.g., depressive symptoms and suicide risk) and behavioral and psychosocial risk factors for distress, as well as the associations between mental distress and risk factors among a sample of medical students in a pre-COVID-19-era.

Methods

Students enrolled in a large California medical school in 2018-2019 (N = 134; 52% female) completed questionnaires assessing sociodemographic characteristics, depression and suicide family history, health behaviors, and psychosocial wellbeing. Assessment scores indexing mental distress (e.g., depressive symptoms, thoughts of suicide in the past 12 months, suicide risk, and history of suicidality) and risk factors (e.g., stress, subjective sleep quality, alcohol use, impostor feelings, and bill payment difficulty) were compared across biological sex using chi-squared tests, and associations between mental distress and risk factors were determined through logistic regression.

Results

Elevated mental distress indicators were observed relative to the general public (e.g., 16% positive depression screen, 17% thought about suicide in previous 12 months, 10% positive suicide risk screen, and 34% history of suicidality), as well as elevated risk factors [e.g., 55% moderate or high stress, 95% at least moderate impostor feelings, 59% poor sleep quality, 50% screened positive for hazardous drinking (more likely in females), and 25% difficulty paying bills]. A positive depression screen was associated with higher stress, higher impostor feelings, poorer sleep quality, and difficulty paying bills. Suicidal ideation in the previous 12 months, suicide risk, and a history of suicidality were independently associated with higher levels of impostor feelings.

Discussion

Higher scores on assessments of depressive symptoms and suicidal thoughts and behaviors were related to several individual-level and potentially modifiable risk factors (e.g., stress, impostor feelings, sleep quality, and bill payment difficulties). Future research is needed to inform customized screening and resources for the wellbeing of the medical community. However, it is likely that the modification of individual-level risk factors is limited by the larger medical culture and systems, suggesting that successful interventions mitigate suicide risk for medical providers need to address multiple socio-ecological levels.

Suicidal behaviours among Ugandan university students: a cross-sectional study

BACKGROUND

Suicide remains the leading cause of death among university students often resulting from multiple physical and psychological challenges. Moreover, suicidal behaviours among students appear to have increased due to the COVID-19 pandemic according to some studies.

OBJECTIVE

To explore the prevalence and associated factors for suicidal ideation, suicide plans, and suicide attempts among university students in Uganda.

METHODS

Cross-sectional study data were collected from May to September 2021 from 540 undergraduate university students in south-western Uganda (363 males, mean age 23.3 years). Questions from the General Health Questionnaire (GHQ-28) were used to assess suicidal ideation, while other bespoke questions were used to assess suicide plans and attempts. The survey also investigated the suicide attempt/plan method, location of the suicidal activity, and reason for not enacting the suicide plan. Three independent regression analyses were used to determine the factors associated with different forms of suicidal behaviours.

RESULTS

The prevalence of past-year suicidal behaviours was 31.85% for suicidal ideation, 8.15% for suicide plans, and 6.11% for suicide attempts. Having a chronic physical medical condition increased the likelihood of having all forms of suicidal behaviours. Suicidal ideation was associated with having difficulty paying university tuition fees. However, being in the fifth year of university education, and feeling satisfied with current academic grades reduced the likelihood of suicidal ideation. Individuals feeling satisfied with academic performance appeared to be a protective factor against having suicide plans. Suicide attempts were associated with having a history of sexual abuse and having difficulty paying university tuition fees. The most common method used for attempted suicide was a drug overdose, and the most common location for attempted suicide was their homes.

CONCLUSION

University students have prevalent suicide behaviours especially among students with a chronic physical medical condition, a history of sexual abuse, and problems paying university tuition fees. Based on the present study, for students at risk, universities should provide appropriate interventions such as life skills education and suicide prevention techniques.

Proposal for a Model of Suicidal Ideation in Medical Students in Colombia: A Simulation Study

Suicidal behaviour is a global public health problem, and one population group with high prevalence rates is medical students, especially in the ideation component. Various models have tried to explain it, but there are few inferential studies in the Colombian population. The structural equation models used in controlled social sciences to explain this problem and their analytical power allow generalisations to be made with a certain degree of precision. These analyses require a large amount of data for robust estimation, which limits their usability when there are restrictions to access the data, as is the case today due to Covid-19, and a question that stands out in these models is the evaluation of the fit. Through a set of 1,200 simulated data, an appropriate model fit was found (x₅₂₄² = 1.732,300, p < 0,001, CFI = 0.97, GFI = 0.97, TLI = 0.97, RMSEA = 0.04[0.042-o.046], SRMR = 0.06) for the predictors of depression and perceived burdensomeness, which were analysed using the JASP program. The role of thwarted belongingness is discussed, as well as the appropriateness of the assessment instrument used to evaluate it an considerations regarding suicidal ideation monitoring, evaluation and intervention in medical students.

Risk factors for suicidal ideation and suicide attempt among medical students: A meta-analysis

Background

Medical training poses significant challenge to medical student wellbeing. With the alarming trend of trainee burnout, mental illness, and suicide, previous studies have reported potential risk factors associated with suicidal behaviours among medical students. The objective of this study is to provide a systematic overview of risk factors for suicidal ideation (SI) and suicide attempt (SA) among medical students and summarize the overall risk associated with each risk factor using a meta-analytic approach.

Methods

Systemic search of six electronic databases including MEDLINE, Embase, Education Source, Scopus, PsycInfo, and CINAHL was performed from database inception to March 19, 2021. Studies reporting original quantitative or epidemiological data on risk factors associated with SI and SA among undergraduate medical students were included. When two or more studies reported outcome on the same risk factor, a random-effects inverse variance meta-analysis was performed to estimate the overall effect size.

Results

Of 4,053 articles identified, 25 studies were included. Twenty-two studies reported outcomes on SI risk factors only, and three studies on both SI and SA risk factors. Meta-analysis was performed on 25 SI risk factors and 4 SA risk factors. Poor mental health outcomes including depression (OR 6.87; 95% CI [4.80–9.82] for SI; OR 9.34 [4.18–20.90] for SA), burnout (OR 6.29 [2.05–19.30] for SI), comorbid mental illness (OR 5.08 [2.81–9.18] for SI), and stress (OR 3.72 [1.39–9.94] for SI) presented the strongest risk for SI and SA among medical students. Conversely, smoking cigarette (OR 1.92 [0.94–3.92]), family history of mental illness (OR 1.79 [0.86–3.74]) and suicidal behaviour (OR 1.38 [0.80–2.39]) were not significant risk factors for SI, while stress (OR 3.25 [0.59–17.90]), female (OR 3.20 [0.95–10.81]), and alcohol use (OR 1.41 [0.64–3.09]) were not significant risk factors for SA among medical students.

Conclusions

Medical students face a number of personal, environmental, and academic challenges that may put them at risk for SI and SA. Additional research on individual risk factors is needed to construct effective suicide prevention programs in medical school.

Prevalence of suicidal behavior in young university students: A systematic review with meta-analysis

OBJECTIVE

to identify the prevalence of suicidal behavior in young university students.

METHOD

a systematic review with meta-analysis of cross-sectional studies based on the Joanna Briggs Institute proposal, and carried out in the PubMed, Web of Science, Scopus, PsycINFO and LILACS databases and in the Brazilian Digital Library of Theses and Dissertations, with no language or year restrictions. A total of 2,942 publications were identified. Selection, data extraction and methodological evaluation of the studies were performed by two independent researchers. The meta-analysis was performed considering the random effects model.

RESULTS

eleven articles were included in this review. The prevalence variation for suicidal ideation was from 9.7% to 58.3% and, for attempted suicide, it was from 0.7% to 14.7%. The meta-analysis showed a 27.1% prevalence for suicidal ideation in life, 14.1% for ideation in the last year, and 3.1% for attempted suicide in life.

CONCLUSION

the high prevalence of suicidal behavior, even with the considerable heterogeneity of the studies, raises the need to implement interventions aimed at preventing suicide and promoting mental health, especially in the academic environment.

Parents parenting styles differences were associated with lifetime suicidal ideation: Evidences from the Chinese medical college students

This study aims to explore the association between parents parenting styles differences and lifetime suicidal ideation (LSI). The sample included 2598 Chinese medical students. Results showed that 10.5% of students reported LSI. Moreover, total differences in parenting styles (OR = 1.04, 95% CI = 1.02, 1.06), parental nurture rejects differences (OR = 1.11, 95% CI = 1.04, 1.18), parental emotional warmth differences (OR = 1.08, 95% CI = 1.03, 1.14), and parental overprotective differences (OR = 1.11, 95% CI = 1.06, 1.16), obtain a scholarship, physical disease and mental health were associated with LSI. The major finding reminds us of the importance of consistent parenting style for suicide prevention.

Study on prevalence of suicidal ideation and risk factors of suicide among patients visiting psychiatric OPD at Shree Birendra Hospital, Kathmandu Nepal

INTRODUCTION

Suicide is a global public health issue. Several environmental, psychosocial, behavioral factors along with physical, sexual, and emotional abuse have been associated with suicidal ideation and attempts. Childhood physical, sexual abuse, and health risk behaviors are also associated with suicidal attempts. The suicidal ideation prevalence varied from 1 to 20% and it varied with study population, geography, age group, gender, and other factors. The Beck suicidal ideation scale is an effective tool for assessing the major suicidal ideation with a six cut-off score.

MATERIALS AND METHOD

160 patients who met the inclusion criteria were enrolled into this cross-sectional study after random sampling among the patients visiting the Psychiatric OPD of Shree Birendra Hospital, Kathmandu, Nepal. The Semi-Structured Interview Schedule (SSIS), Beck Scale for Suicide Ideation (BSS), and Kuppuswamy's Scale were used to collect the data from the patients enrolled in the study. The Chi-square test and binary logistic regression analyses were used to identify and differentiate the factors associated with high suicidal risk.

RESULTS

Out of total 160 patients, 65% (n = 104) were female, 92.5% (n = 148) were married, 61.9% (n = 99) were residing in urban area, 93.1% (n = 148) were Hindus, 74.4% (n = 119) patients were living in the nuclear family, 5% (n = 8) patients had family history of psychiatric illness and 10.6% (n = 17) patients were using the substance of abuse. In the Beck scale for suicidal ideation questionnaire, 87.5% (n = 140) patients had moderate to strong wish to live, 89.4% (n = 143) patients responded as they would take precautions to save a life, 88.8% (n = 142) patients had such ideation/wish for brief, 96.3% (n = 154) had not considered for specificity/planning of contemplated suicidal attempt, 91.9% (n = 147) patients stated that they would not attempt active suicide because of a deterrent example from family, religion, irreversibility of the act and 98.1% (n = 157) patients had revealed ideas of deception/concealment of contemplated suicide openly. 16.9% (n = 27) of participants were categorized as high risk for suicide while 83.1% (n = 133) patients were as a low-risk category for suicide based on the Beck scale for suicidal ideation scoring.

CONCLUSION

In conclusion, this study found that most of the suicidal attempts were done as an act of impulse and it is higher among female and married individuals residing in the urban areas. This study did not establish any statistically significant association or differences among independent variables with the higher risk scoring in the Beck suicidal ideation scale.

Prevalence of mistreatment among physiotherapy interns in Nigeria: a preliminary study

Background

Healthcare professionals with the least experience, such as students and interns, are likely to face some form of mistreatments in the world of health professionals. Mistreatment has a negative impact on the victim’s well-being as it results in psychological distress such as burn out, lack of motivation and reduced performance. This study aims to explore mistreatment among physiotherapy interns in Nigeria with a view to protecting the future of the profession.

Result

Most of the participant were male (57.5%) and doing their internship in the northwestern part of the country (42.5%). Forty interns participated in the study, and 2/3 of them had experience of mistreatment. The most common type of mistreatment was yelling or shouting (60%), followed by someone taking credit for what an intern did (55%), humiliation or belittlement (50%), and threat of an extension beyond the 12 months (27.5%). Eighty-seven percent reported that the mistreatment changes their relationship with the perpetrator. Mistreatment led to stress in 70% of the respondent, affected the self-confidence of 62.5%, and led to decreased clinical output in 45% of the participants. Forty percent of the participants acquired depression due to the mistreatment.

Conclusion

Most physiotherapy interns experience mistreatment during the 1-year mandatory clinical internship. Verbal abuse is the most prevalent form of mistreatment, while the least is physical abuse. This study found that mistreatment has adverse effects on the health and work output of physiotherapy interns.

Risk factors of suicidality among married adults: A cross-sectional survey in Rajshahi City, Bangladesh

Background

Suicide is a serious public health concern all over the world including Bangladesh. About 9% of the patients admitted with suicidal ideation (SI) or suicide attempt (SA) later complete suicide. To understand and prevent suicide, the study of SI and SA is necessary but research in this area is scanty in Bangladesh. Therefore, we studied suicidality (SI and SA) among married adults in Rajshahi City, Bangladesh.

Methods

This was a household cross-sectional study. A total of 708 married adults were selected for this study using a multi-stage random sampling. Suicidality was measured based on two factors: (i) suicidal ideation, and (ii) suicide attempt. Frequency distribution, Chi-square test and multiple binary logistic regression model were used in this study according to our objectives.

Results

The prevalence of suicidal ideation, suicide attempt, and suicidality was 5.8%, 3.4%, and 8.3% respectively among married adults. A multiple binary logistic regression model provided the following risk factors of suicidality: (i) joint family (AOR = 0.310, p<0.01), (ii) ≥26 years of age at the first marriage (AOR = 0.379, p<0.05), (iii) twice or more marriage (AOR = 0.214, p<0.01), (iv) conjugal life of ≥16 years (AOR = 0.410, p<0.05), (v) having no child (AOR = 6.343, p<0.01) and (vi) having 1–2 children (AOR = 6.190, p<0.01), (vii) medical comorbidity (AOR = 0.421, p<0.01), (viii) mental comorbidity (AOR = 0.253, p<0.01), (ix) stress-anxiety (AOR = 0.311, p<0.01), (x) family history of mental disorders (AOR = 0.059, p<0.01), (xi) family history of suicide/suicide attempt (AOR = 0.009, p<0.01), (xii) substance abuse (AOR = 0.065, p<0.01), (xiii) poor relationship with spouse (AOR = 0.209, p<0.01), and (xiv) poor relationship with other family members (AOR = 0.347, p<0.05).

Conclusion

The prevalence of suicidality is remarkable in Rajshahi city, Bangladesh. The government and non-government agencies can use the findings of this study to identify the vulnerable groups and undertake measures for preventing and reducing suicidality.

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

Background

Looking at the background vulnerability and increasing incidence of suicides among medical students, more information on its burden and causes is needed.

Methods

A cross-sectional study was conducted at a medical college to assess prevalence of suicide ideation and associated factors among medical students. Data were collected through a web-based survey questionnaire using Patient Health Questionnaire-9 and items on suicide cognitions, suicide attempt history and risk factors. Bivariate and multivariate analyses were performed in SPSS.

Results

A total of 506 students (69.2%) responded to the survey questionnaire. The 2-week prevalence of depression and suicide ideation was 14% (73/506) and 9% (44/506). Proportion of participants reporting suicidal cognitions in preceding 1 month: life not worth living-13%; death wish-6%; suicidal ideas-4%; and suicide plan-1%. The significant predictors of suicide ideation were female gender (adjusted odds ratio [AOR] = 3.2, 95% confidence interval [CI] 1.6-49.1), alcohol use (AOR = 3.2, 95% CI 1.1-9.7), history of facing any type of abuse (AOR = 3.9, 95% CI 1.2-11.9), academic stress (AOR = 3.3, 95% CI 1-10.9), family-related stress (AOR = 5.6, 95% CI 1.8-17) and relationship-related stress (AOR = 3.5, 95% CI 1.1-10.8). Half of the students reported presence of academic stress as important life stressor. Three-fourth students preferred friends as their source of help in times of need. Web-based survey method for screening was acceptable to students.

Conclusion

The prevalence of suicide ideation is alarmingly high among medical students. Academic stress, previous experience of abuse, stress originating from family expectations and strained relationship with friends and peers were found to be risk factors or predictors for suicidal ideation.

Proposal for a Model of Suicidal Ideation in Medical Students in Colombia: A Simulation Study

Suicidal behaviour is a global public health problem, and one population group with high prevalence rates is medical students, especially in the ideation component. Various models have tried to explain it, but there are few inferential studies in the Colombian population. The structural equation models used in controlled social sciences to explain this problem and their analytical power allow generalisations to be made with a certain degree of precision. These analyses require a large amount of data for robust estimation, which limits their usability when there are restrictions to access the data, as is the case today due to Covid-19, and a question that stands out in these models is the evaluation of the fit. Through a set of 1,200 simulated data, an appropriate model fit was found (x5242=1.732,300;p<0,001, CFI = 0.97, GFI = 0.97, TLI = 0.97, RMSEA = 0.04[0.042-0.046], SRMR = 0.06) for the predictors of depression and perceived burdensomeness, which were analysed using the JASP program. The role of thwarted belongingness is discussed, as well as the appropriateness of the assessment instrument used to evaluate it an considerations regarding suicidal ideation monitoring, evaluation and intervention in medical students.

Suicidal Ideation Among Medical Students in Dammam, Saudi Arabia

Background: Medical students are at high risk of suicidal ideation. Aim: We aimed to obtain information on suicidal ideation among medical students in Dammam located in the Eastern Province of Saudi Arabia. Method: This cross-sectional study was conducted at the College of Medicine affiliated with Imam Abdulrahman Bin Faisal University in the Eastern Province of Saudi Arabia. Suicidal ideation in the past 12 months was assessed based on responses to four questions in the depression subscale of the General Health Questionnaire 28 (GHQ-28). In addition, data were collected to examine the association of suicidal ideation with various factors. Results: We found that 1 in 3 medical students in the study had suicidal ideation in the past 12 months, while around 40% had lifetime suicidal ideation. Suicidal ideation was associated with feelings of parental neglect, history of physical abuse, and dissatisfaction with academic performance. Limitations: The cross-sectional nature of this study limits its ability to determine causality regarding suicidal ideation. Conclusion: These rates are considerably high when compared with rates from studies in other countries around the world. This study provides a reference in the field of suicidology for this region of Saudi Arabia.

Prevalence and associated factors of suicidal ideation and attempt among undergraduate medical students of Haramaya University, Ethiopia. A cross sectional study

INTRODUCTION

Suicide is a disastrous act which has a significant effect on the global burden of disease, contributing yearly to 1.4% of the total burden with the foremost role played by a people aged between 15 and 35 years. Medical students are one of the high-risk groups for suicide. This increased risk may begin during medical school and leads to premature death. But, there is a paucity of epidemiologically reliable data on the issue. Therefore, the current study was aimed to assess the prevalence and associated factors of suicidal ideations and attempt among undergraduate medical students of Haramaya University.

METHOD

An institutional based cross-sectional study was conducted from May 13 to June 12, 2019 at College of Health and Medical Science, Haramaya University. Stratified sampling technique was used and a total of 757 participants were selected by using simple random sampling technique. Data were collected using a self-administered questionnaire. Suicidal ideation and attempt were assessed by using suicidal module of world mental health survey initiative version of the World Health Organization, composite international diagnostic interview. Data were analyzed using Statistical Package for Social Science Version 20. Descriptive results were presented by tables and graphs. Bivariate and multivariate logistic regression analyses were done to identify factors associated with suicidal ideation and attempt. P-values less than 0.05 were considered statistically significant and the strength of association was presented by an adjusted odds ratio with 95% confidence interval.

RESULT

The study showed that the prevalence of suicidal ideation and attempt were 23.7% (95%CI, 20.5-26.8) and 3.9% (95%CI, 2.6-5.5), respectively. Cumulative grade point average (AOR = 0.30, 95% CI: 0.18-0.49), current alcohol use (AOR = 2.26, 95%CI: 1.45-3.55), depression (AOR = 3.58, 95%CI: 2.23-5.76), anxiety (AOR = 3, 95%CI: 1.88-4.77), and poor social support (AOR = 2.57, 95%CI: 1.41-4.68) were the factors statistically associated with the suicidal ideation. Depression (AOR = 5.4, 95%CI: 1.45-20.14) and anxiety (AOR = 3.19, 95%CI: 1.01-10.18) were associated with the suicidal attempts.

CONCLUSION

This study showed that the high prevalence of suicidal ideation and attempt as compared to the prevalence of suicidal behavior among other university students who were studying in other fields. Cumulative Grade Point Average, current alcohol use, depression, anxiety and poor social support were the factors statistically associated with the suicidal ideation. Depression and anxiety were the ones associated with the suicidal attempt. Early screening, detection and management of suicidal behavior and associated mental health problems were recommended for undergraduate medical students.

Depression, anxiety, and burnout among medical students and residents of a medical school in Nepal: a cross-sectional study

BACKGROUND

Medical students and residents were found to have suffered from depression, anxiety, and burnout in various studies. However, these entities have not been adequately explored in the context of Nepal. We proposed to determine the prevalence of depression, anxiety, burnout, their associated factors, and identify their predictors in a sample of medical students and residents in a Nepalese medical school.

METHODS

It was a cross-sectional study with 651 medical students and residents chosen at random between December 2018 and February 2019. The validated Nepali version of Hospital Anxiety and Depression Scale, the Copenhagen Burnout Inventory, and Medical Students' Stressor Questionnaire were used to assess depression, anxiety, burnout, and stressors respectively. We used univariate and multivariable logistic regression analyses to identify the correlation of predictor variables with depression, anxiety, and burnout.

RESULTS

The overall prevalence of burnout (48.8%; 95% CI 44.9-52.7) and anxiety (45.3%; 95% CI 41.4-49.2) was more than that of depression (31%; 95% CI 27.5-34.7). Burnout and depression were more prevalent in residents than in medical students (burnout: 64.5% vs 37.6%, P-value < 0.0001; depression: 33.7% vs 29.1%, P-value 0.21). Whereas, medical students were found more anxious than residents (46.3% versus 43.96%, P-value 0.55). Academic related stressors caused high-grade stress to participants. Multivariable model for depression significantly showed anxiety, personal burnout, and work-related burnout as risk enhancing correlates; satisfaction with academic performance as a protective correlate. Similarly, the multivariate model for anxiety significantly identified female gender, depression, personal burnout, teaching and learning related stressors, and past history of mental illness as risk enhancing correlates; being satisfied with academic performance, getting adequate sleep, and being a second-year resident as protective correlates. The logistic model for burnout significantly showed being a first-year resident, depression, anxiety, and drive and desire related stressors as positive predictors. None of the variables were identified as significant negative predictors of burnout.

CONCLUSIONS

A high prevalence of depression, anxiety, and burnout was seen among medical students and residents. Most of them were stressed with academic-related factors. A strong correlation between teaching and learning-related stressors with depression and anxiety may be a call for an efficient and more student-friendly curriculum.

Cigarette smoking dose-response and suicidal ideation among young people in Nepal: a cross-sectional study

BACKGROUND

Worldwide, tobacco smoking is a major risk factor for morbidity and early mortality among adult population. The present study aimed to find out the association between current smoking and suicidal ideation among young people in Nepal.

MATERIALS AND METHODS

A cross-sectional questionnaire-based survey was carried out among 452 youths from Pokhara, Nepal. The present study included both genders (age 18-24 years) who were smokers as well as non-smokers.

RESULTS

Across the study period, 452 participants were identified after matching for age, and sex (226 in the smoking group and 226 in the non-smoking group). The mean age of participants was 21.6±1.2 years and 58.8% were males. The overall rate of suicidal ideation in our cohort was 8.9%. Smokers were slightly more likely to report suicidal ideation than non-smokers (aOR 1.12). The risk of developing suicidal ideation was 3.56 (95% CI 1.26-10.09) times more in individuals who smoked greater than 3.5 cigarettes per week (p=0.01).

CONCLUSION

The rate of suicidal ideation was slightly higher among smokers and a dose-response relationship was identified with the number of cigarettes smoked per week. Being aware of the link between smoking and suicidal ideation may help health care professionals working with young people to address more effectively the issues of mental well-being and thoughts about suicide.

Suicide ideation, attempt, and determinants among medical students Northwest Ethiopia: an institution-based cross-sectional study

BACKGROUND

Suicide ideation and attempt are more highly prevalent among medical students compared to the general population. Suicidal thought negatively impacts the quality of life, physical, and mental well-being of the students. However, research into suicide ideation and attempt among medical students in low- and middle-income countries is limited. Therefore, this study aimed to explore suicide ideation and attempt and their determinants among medical students in Ethiopia have a crucial role for further intervention.

METHODS

An institution-based cross-sectional study was conducted on 393 medical students from March to June 2019 at the University of Gondar (UoG) in Ethiopia. Simple random sampling technique was used to select study participants. Suicide ideation and attempt were assessed using the World Health Organization Composite International Diagnostic Interview (CIDI) to assess lifetime suicide ideation and attempts during medical school. Data were collected using a self-administered questionnaire. Binary logistic regression analyses were used to identify factors associated with suicide ideation and attempt. An odds ratio (OR) with a 95% confidence interval (CI) was computed to assess the strength of the association.

RESULTS

A total of 393 participants took part with a response rate of 92.9%. The prevalence of suicide ideation and attempt among study participants was found to be 14% and 7.4%, respectively, with 95% CI (10.9-18.1) and (5.1-10.2). Being female (AOR: 5.21, 95% CI 3.42-7.20), co-morbid depression symptoms (AOR: 10.12, 95% CI 6.80-15.52), current khat chewing (AOR: 4.46, 95% CI 3.32-10.02), and poor social support (AOR: 4.46, 95% CI 3.43-9.87) were factors significantly associated with suicide ideation; whereas, female sex (AOR: 8.08, 95% CI 6.04-12.39), depression (AOR: 10.66, 95% CI 8.01-19.01) and history of mental illness (AOR: 5.53, 95% CI 5.20-15.50) were factors significantly associated with suicide attempt.

CONCLUSIONS

In the current study, the prevalence of suicide ideation among medical students was low compared to other studies, but the suicide attempt was high. Ministry of Health should develop a guideline on how to screen and manage suicide ideation and attempt among medical students.

Factors associated with suicidal ideation and suicidal attempts among adolescent students in Nepal: Findings from Global School-based Students Health Survey

INTRODUCTION

Suicide has been recognized as a major public health problem with high burden in low and middle income countries. Suicide has long lasting psychological trauma on friends and relatives in addition to loss of economic productivity. Although the need of high quality evidence is essential for designing suicide prevention program, Nepal lacks reliable evidence from nationally representative data. This study aimed to estimate the prevalence of suicidal ideation and attempt among adolescent students and identify the factors associated with them.

MATERIALS AND METHODS

Total of 6,531 students of grade 7 to 11 from 74 schools representing all three ecological belts and five development regions participated in this cross sectional study. To select the representative sample from study population, two stage cluster sampling method was used. Standardized self-administered questionnaire were completed by participants. Multivariable logistic regression was done to identify the factors associated with suicidal ideation and attempt.

RESULTS

Nearly 13.59% of the participants had considered suicide while 10.33% had attempted it. Food insecurity (OR = 2.32, CI = 1.62-3.32), anxiety (OR = 2.54, CI = 1.49-4.30), loneliness (OR = 2.51, CI = 1.44-4.36) and gender (OR = 1.39, CI = 1.03-1.89) were identified as risk factors of suicidal ideation. Anxiety (OR = 3.02, CI = 1.18-7.74), loneliness (OR = 2.19, CI = 1.28-3.73) truancy (OR = 1.99, CI = 1.40-2.82), cigarette use (OR = 3.13, CI = 1.36-7.23) and gender (OR = 1.60, CI = 1.07-2.39) were identified as risk factors of suicidal attempt. Having 3 or more close friends was found to have protective effect (OR = 0.35, CI = 0.16-0.75) against suicidal attempt.

CONCLUSION

Study reveals relatively high prevalence of suicidal ideation and suicidal attempt among school-going adolescents in Nepal. Appropriate coping strategies for factors like anxiety, loneliness seem could be useful for preventing both suicidal ideation and attempt.

Factors associated with suicidal ideation and suicidal attempts among adolescent students in Nepal: Findings from Global School-based Students Health Survey

INTRODUCTION

Suicide has been recognized as a major public health problem with high burden in low and middle income countries. Suicide has long lasting psychological trauma on friends and relatives in addition to loss of economic productivity. Although the need of high quality evidence is essential for designing suicide prevention program, Nepal lacks reliable evidence from nationally representative data. This study aimed to estimate the prevalence of suicidal ideation and attempt among adolescent students and identify the factors associated with them.

MATERIALS AND METHODS

Total of 6,531 students of grade 7 to 11 from 74 schools representing all three ecological belts and five development regions participated in this cross sectional study. To select the representative sample from study population, two stage cluster sampling method was used. Standardized self-administered questionnaire were completed by participants. Multivariable logistic regression was done to identify the factors associated with suicidal ideation and attempt.

RESULTS

Nearly 13.59% of the participants had considered suicide while 10.33% had attempted it. Food insecurity (OR = 2.32, CI = 1.62-3.32), anxiety (OR = 2.54, CI = 1.49-4.30), loneliness (OR = 2.51, CI = 1.44-4.36) and gender (OR = 1.39, CI = 1.03-1.89) were identified as risk factors of suicidal ideation. Anxiety (OR = 3.02, CI = 1.18-7.74), loneliness (OR = 2.19, CI = 1.28-3.73) truancy (OR = 1.99, CI = 1.40-2.82), cigarette use (OR = 3.13, CI = 1.36-7.23) and gender (OR = 1.60, CI = 1.07-2.39) were identified as risk factors of suicidal attempt. Having 3 or more close friends was found to have protective effect (OR = 0.35, CI = 0.16-0.75) against suicidal attempt.

CONCLUSION

Study reveals relatively high prevalence of suicidal ideation and suicidal attempt among school-going adolescents in Nepal. Appropriate coping strategies for factors like anxiety, loneliness seem could be useful for preventing both suicidal ideation and attempt.

Prevalence and correlates of suicidal ideation among college students: A mental health survey in Jilin Province, China

BACKGROUND

The prevention of suicidal ideation plays a key role in reducing suicide rates. This study aimed to determine the prevalence of suicidal ideation among college students in Jilin Province, China, and to analyse the risk factors associated with suicidal ideation.

METHODS

A total of 6284 valid data collection sheets were collected using the stratified cluster sampling method. The data collected were divided into four sections, namely, socio-demographic information, family and social interactions, daily habits, and mental health self-rating scales.

RESULTS

The prevalence of suicidal ideation in the past 12 months was 9.2%. A multivariate logistic regression analysis showed that being a senior (OR = 1.769, 95%CI:1.225-2.555), general family relationships (OR = 1.641, 95%CI:1.172-2.298), frequent parental quarrels (OR = 1.398, 95%CI:1.027-1.902)/parental separation (OR = 2.497, 95%CI:1.414-4.408), the level of satisfaction with motherly love (OR = 2.261, 95%CI:1.454-3.515), having only one or two friend(s) (OR = 1.530, 95%CI:1.038-2.254), frequent excursions to bars/ karaoke halls/ song and dance halls (OR = 1.673, 95%CI:1.257-2.229) or billiard halls with friends (OR = 1.865, 95%CI:1.270-2.740), smoking (OR = 2.175, 95%CI:1.603-2.951), moderate sleep quality (OR = 1.636, 95%CI:1.115-2.402), and depressive symptoms (OR = 2.078, 95%CI: 1.710-2.525) were risk factors for suicidal ideation. Family factors had the most influence on suicidal ideation, whereas depression symptoms were identified to be a mediating factor between family, social interactions, or daily habits and suicidal ideation, and it only exerted direct effects.

LIMITATIONS

This cross-sectional study cannot provide causal interpretations.

CONCLUSION

Our findings showed the prevalence of suicidal ideation among college students in Jilin province. Among all the risk factors associated with suicidal ideation, family factors should be the main concern in the prevention of suicidal ideation, and interventions that target depression symptoms are key to reducing suicidal ideation.

Psychological distress among college students of coastal district of Karnataka: A community-based cross-sectional survey

BACKGROUND

Common Mental Disorders (CMDs) are frequent among adolescents and early adults. National Mental Health Survey of India 2015-2016 shows alarming results, especially for depression. This study explored the prevalence of psychological distress among college students. Additionally, the relationship between gender, living arrangement with psychological distress in various educational streams were explored.

MATERIALS AND METHODS

Through a cross-sectional community-based survey a total of 4839 college going students of various educational streams in Mangalore, Karnataka were assessed for psychological distress with Self-Reporting Questionnaire (SRQ-20).

RESULTS

Participants had median age of 19 (range = 9) years and the majority (59.5%) were females. The median SRQ score was 4 (range 20) and about 28.5% of students were found to be psychologically stressed. The suicidal ideation was reported by 13.6% of the students. Engineering and Arts/science/commerce students had significantly higher psychological distress scores as compared to health and allied sciences (k = 47.7; p < 0.001) and those who were staying with families (U = 2,687,648.5; p = 0.004) reported higher levels of psychological distress in comparison to those who were staying away from their families.

CONCLUSION

Prevalence of psychological distress was high among students, especially non-medical students, students who were staying with their families, and those who were younger in age. A significant proportion of students had suicidal ideation, which needs early mental health interventions at the college level.

Violence Exposure and Mental Health of College Students in the United States

Background: Despite the well-established link between exposure to violence and mental health problems, less is known about this association among college students. The current study aimed to investigate the association between history of exposure to violence and mental health of American college students. Methods: Healthy Mind Study (HMS, 2016⁻2017) is a national online survey of 41,898 adult college students. The independent variable was lifetime history of exposure to violence (psychological, physical, and sexual). The dependent variables were anxiety, depression, and suicidality. Race, age, gender, sexual orientation, parental education, financial stress, transfer status, enrollment status, and graduate status were covariates. Linear and logistic regression models were used for data analysis. Results: History of exposure to violence was associated with all three aspects of poor mental health, namely general anxiety, depression, and suicidality. These associations were independent of covariates and type of abuse. Conclusions: There is a need to address various mental health needs of college students who have experienced various forms of violence. College students who screen positive for history of violence exposure should be evaluated for anxiety, depression, and suicidal behaviors.

Substance use and suicidal ideation and behaviour in low- and middle-income countries: a systematic review

Background

Understanding relationships between substance use and suicidal ideation and behaviour (SIB) has important public health implications for suicide prevention in low- and middle-income countries (LMICs), where 75% of suicides occur. This systematic review explored the associations between substance use and SIB in LMICs.

Methods

We searched five databases using a combination of keywords for substance use, SIB and LMICs to identify English-written quantitative studies published between January 2006 and February 2016. Data were extracted to provide an overview of what is known about the topic, highlight gaps in the literature, and explore the implications of current knowledge for suicide prevention. Studies included in the review were assessed for methodological quality using the Scottish Intercollegiate Guidelines Network checklist.

Results

Analysis of included studies (N = 108) demonstrated a consistent positive association between substance use and SIB across all substances (i.e. alcohol, tobacco, cannabis, illicit drugs, non-medical use of prescription drugs), all substance use dimensions (i.e. intoxication, use, and pathological use) and all SIB dimensions (i.e. suicidal ideation, non-fatal suicidal behaviour, and suicide). Most of the available research evidence comes from upper-middle-income countries, only 22% comes from lower-middle-income and low-income countries. Most studies focused on alcohol and tobacco, while neglecting substances such as cannabis, opioids, sedatives, stimulants, misuse of prescription medication, inhalants, and hallucinogens. Most of the studies employed a cross-sectional design, were conducted within a risk-factor paradigm, and provided little information about the potential interaction between variables.

Conclusions

Public health suicide prevention policy and research in LMICs should take account of the fact that: substance use is a potentially modifiable risk factor; assessment and management of substance use is integral to the care of at-risk patients; reducing consumption and hazardous use of substances in LMICs is important for suicide prevention; and research needs to be expanded to include more theory driven research that focuses on all substance use dimensions and SIB dimensions, while employing more sophisticated statistical methods.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5425-6) contains supplementary material, which is available to authorized users.

Suicidal Ideation Among Medical Students: Prevalence and Predictors

Suicide is one of the leading causes of death among medical students, second to car accidents. We investigated the prevalence and predictors of suicidal ideation (SI) among medical students in Brazil. This is a cross-sectional study with 475 medical students of a public university. The research protocol included data on sociodemographics and academic life, and structured instruments to assess social support and psychopathological symptoms, including the Beck Depression Inventory (BDI). The outcome was evaluated using the BDI suicide item. Bivariate analyses were followed by logistic regression. SI was present in 34 participants (7.2%). In the logistic regression, SI remained associated with living alone, thoughts of abandoning the course, moderate or severe depressive symptoms, and probable obsessive-compulsive disorder. SI is frequent among medical students and can be identified with a simple screening question. Special attention should be given to students living alone, with thoughts of abandoning the course, and relevant depressive or obsessive-compulsive symptoms.

Suicide and self harm in Nepal: A scoping review

BACKGROUND

Suicide and self harm behavior has become a major public health issue in recent years in Nepal. This small south Asian country was ranked 7th by suicide rate globally by the 2014 World Health Organization report with an estimated 6,840 suicides annually, or 24.9 suicides per 100,000 people. We decided to explore the epidemiology of suicidal behaviour and self harm, modes of attempt, associated risk factors and trends in specific population.

METHODOLOGY

Two researchers independently reviewed 47 studies published in the US National Library of Medicine's PubMed electronic Database and Google Scholar till December 2016. Finally, twenty articles meeting the objective were included. This article summarizes findings on epidemiology of suicidal behavior, associated patterns, risk factors and trend in specific population in Nepal.

RESULTS

Most of the data available till date are hospital based and either cross-sectional or retrospective. Some of the studies have relied on mortality statistics whereas few have done community based screening. Some of the key findings include higher rate among women and younger age group, a rising trend among specific groups such as marginalized, migrant workers and disaster affected population. The studies also show role of mental illness, predominantly mood disorders and psycho-social factors such as interpersonal or marital conflicts and socio-economic issues in triggering suicide and self harm behavior.

CONCLUSION

Overall, the studies provide satisfactory information about the burden of suicide in Nepal. Some of the limitations include discrepancy in suicide reporting, lack of longitudinal follow up and qualitative studies and absence of studies on preventive aspects. Further, more research is warranted in this area not only at the assessment level but also at an intervention level. Several challenges such as poor distribution of mental health resources, social attitude towards mental illness and suicide in particular need to be addressed.

Prevalence of poor mental health among medical students in Nepal: a cross-sectional study

BACKGROUND

Poor mental health among medical students is widely acknowledged. Studies on mental health among medical students of Nepal are lacking. Therefore, we conducted a study to determine the prevalence of mental disorders.

METHODS

A cross-sectional study was conducted among medical students at KIST Medical College and Teaching Hospital, Nepal from December 2016 to February 2017. Our survey instrument consisted of the Patient Health Questionnaire (PHQ) and questions about socio-demographic factors, smoking, marijuana use, suicidal ideation and thoughts of dropping out of medical school.

RESULTS

The prevalence rates were 29.2% (95% CI, 24.4% - 34.3%) depression, 22.4% (95% CI, 18.0% - 26.9%) medium to highly severe somatic symptoms, 4.1% (95% CI, 2.0% - 6.2%) panic syndrome, 5.8% (95% CI, 3.4% - 8.3%) other anxiety syndrome, 5% (95% CI, 2.7% - 7.3%) binge eating disorder and 1.2% (95% CI, 0.0% - 2.3%) bulimia nervosa. Sixteen students [4.7% (95% CI, 2.4% - 6.9%)] seriously considered committing suicide while in medical school. Thirty-four students [9.9% (95% CI, 6.8% - 13.1%)] considered dropping out of medical school within the past month. About 15% (95% CI, 11.1% - 18.6%) of the students reported use of marijuana during medical school.

CONCLUSIONS

We found high prevalence of poor mental health among medical students of Nepal. Future studies are required to identify the factors associated with poor mental health.

Psychological strain and suicidal ideation: A comparison between Chinese and US college students

OBJECTIVE

This study was to explore the relation between psychological strains and suicidal ideation among Chinese and American college students. Another secondary purpose of the study was to examine the reliability of the psychological strains scales (PPS: Ref) one more time in China and the United States in college populations.

METHOD

Samples of college students were randomly recruited from China and United States. All of 529 college students (aged 17-27, 68.9% female) completed self-report assessments of psychological strains (Psychological Strain Scale), suicidal ideation (Beck Scale for Suicide Ideation), and indicators of psychological well-being (e.g., depression, anxiety, and stress).

RESULTS

Empirical results show that Psychological Strain Scales (PSS) has a good reliability. Chinese college students reported higher suicide ideation scores than American students whereas there was no statistical difference in psychological strains. Psychological strains and, depression, anxiety, and stress, were positively related to suicidal ideation in both countries. Stepwise multiple regression analysis indicated that psychological strain can significantly predict suicidal ideation.

CONCLUSIONS

These findings provide support for the Strain Theory of Suicide for both Chinese and American college students and some measures can be taken to reduce psychological strains in students. However, future work could extend these findings by utilizing a longitudinal design to determine whether psychological strains are in fact antecedents, and not simply correlates, of suicide ideation.

Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis

IMPORTANCE

Medical students are at high risk for depression and suicidal ideation. However, the prevalence estimates of these disorders vary between studies.

OBJECTIVE

To estimate the prevalence of depression, depressive symptoms, and suicidal ideation in medical students.

DATA SOURCES AND STUDY SELECTION

Systematic search of EMBASE, ERIC, MEDLINE, psycARTICLES, and psycINFO without language restriction for studies on the prevalence of depression, depressive symptoms, or suicidal ideation in medical students published before September 17, 2016. Studies that were published in the peer-reviewed literature and used validated assessment methods were included.

DATA EXTRACTION AND SYNTHESIS

Information on study characteristics; prevalence of depression or depressive symptoms and suicidal ideation; and whether students who screened positive for depression sought treatment was extracted independently by 3 investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression.

MAIN OUTCOMES AND MEASURES

Point or period prevalence of depression, depressive symptoms, or suicidal ideation as assessed by validated questionnaire or structured interview.

RESULTS

Depression or depressive symptom prevalence data were extracted from 167 cross-sectional studies (n = 116 628) and 16 longitudinal studies (n = 5728) from 43 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of depression or depressive symptoms was 27.2% (37 933/122 356 individuals; 95% CI, 24.7% to 29.9%, I2 = 98.9%). Summary prevalence estimates ranged across assessment modalities from 9.3% to 55.9%. Depressive symptom prevalence remained relatively constant over the period studied (baseline survey year range of 1982-2015; slope, 0.2% increase per year [95% CI, -0.2% to 0.7%]). In the 9 longitudinal studies that assessed depressive symptoms before and during medical school (n = 2432), the median absolute increase in symptoms was 13.5% (range, 0.6% to 35.3%). Prevalence estimates did not significantly differ between studies of only preclinical students and studies of only clinical students (23.7% [95% CI, 19.5% to 28.5%] vs 22.4% [95% CI, 17.6% to 28.2%]; P = .72). The percentage of medical students screening positive for depression who sought psychiatric treatment was 15.7% (110/954 individuals; 95% CI, 10.2% to 23.4%, I2 = 70.1%). Suicidal ideation prevalence data were extracted from 24 cross-sectional studies (n = 21 002) from 15 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of suicidal ideation was 11.1% (2043/21 002 individuals; 95% CI, 9.0% to 13.7%, I2 = 95.8%). Summary prevalence estimates ranged across assessment modalities from 7.4% to 24.2%.

CONCLUSIONS AND RELEVANCE

In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among medical students was 27.2% and that of suicidal ideation was 11.1%. Further research is needed to identify strategies for preventing and treating these disorders in this population.

Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis

Importance

Medical students are at high risk for depression and suicidal ideation. However, the prevalence estimates of these disorders vary between studies.

Objective

To estimate the prevalence of depression, depressive symptoms, and suicidal ideation in medical students.

Data Sources and Study Selection

Systematic search of EMBASE, ERIC, MEDLINE, psycARTICLES, and psycINFO without language restriction for studies on the prevalence of depression, depressive symptoms, or suicidal ideation in medical students published before September 17, 2016. Studies that were published in the peer-reviewed literature and used validated assessment methods were included.

Data Extraction and Synthesis

Information on study characteristics; prevalence of depression or depressive symptoms and suicidal ideation; and whether students who screened positive for depression sought treatment was extracted independently by 3 investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression.

Main Outcomes and Measures

Point or period prevalence of depression, depressive symptoms, or suicidal ideation as assessed by validated questionnaire or structured interview.

Results

Depression or depressive symptom prevalence data were extracted from 167 cross-sectional studies (n = 116 628) and 16 longitudinal studies (n = 5728) from 43 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of depression or depressive symptoms was 27.2% (37 933/122 356 individuals; 95% CI, 24.7% to 29.9%, I2 = 98.9%). Summary prevalence estimates ranged across assessment modalities from 9.3% to 55.9%. Depressive symptom prevalence remained relatively constant over the period studied (baseline survey year range of 1982-2015; slope, 0.2% increase per year [95% CI, -0.2% to 0.7%]). In the 9 longitudinal studies that assessed depressive symptoms before and during medical school (n = 2432), the median absolute increase in symptoms was 13.5% (range, 0.6% to 35.3%). Prevalence estimates did not significantly differ between studies of only preclinical students and studies of only clinical students (23.7% [95% CI, 19.5% to 28.5%] vs 22.4% [95% CI, 17.6% to 28.2%]; P = .72). The percentage of medical students screening positive for depression who sought psychiatric treatment was 15.7% (110/954 individuals; 95% CI, 10.2% to 23.4%, I2 = 70.1%). Suicidal ideation prevalence data were extracted from 24 cross-sectional studies (n = 21 002) from 15 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of suicidal ideation was 11.1% (2043/21 002 individuals; 95% CI, 9.0% to 13.7%, I2 = 95.8%). Summary prevalence estimates ranged across assessment modalities from 7.4% to 24.2%.

Conclusions and Relevance

In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among medical students was 27.2% and that of suicidal ideation was 11.1%. Further research is needed to identify strategies for preventing and treating these disorders in this population.

Forensic analysis of suicidal ideation among medical students of Egypt: A crosssectional study

Suicide is one of the major causes of death in the world. In this study a total of 612 students from two public universities in Cairo were assessed using an online survey that included 19 items from the self administered version of Beck's Suicidal Ideation scale in addition to three questions to assist in forensic analysis of the suicide. 12.75% of respondents scored above 24 in the 19 items from the suicidal ideation scale. Females showed a slightly higher score of suicidal ideation (Mean 18.1, SD 12.22) and year 1 students tended to score higher than pre-clinical and clinical phase students (Mean 15.1, SD 10.1, P value 0.042). Most of the suicide plans were to be executed at home with the use of available medications for overdose. This study shed light on the importance of support systems for medical students with a high stress on family support.

Suicidal ideation among medical students of Pakistan: a cross-sectional study

Few studies have investigated suicidal ideation among medical students in the developing world. We found only one report on suicidal ideation among medical students in Pakistan published in the year 2005. The present cross-sectional survey on suicidal ideation conducted in July 2013 involved 331 medical students of Dow University of Health Sciences, Karachi, Pakistan. In the past one year, suicidal ideation was found in 118 (35.6%) students. Forty-six (13.9%) of all the students had made a plan in their life time to commit suicide while 16 (4.8%) of the 331 students tried to commit suicide at some point of time in their life. More females than males pondered suicide while first year medical students formed the majority of those with suicidal ideation. The single greatest risk factor predisposing to suicidal ideation was substance abuse. This was followed jointly by parental neglect and previous psychiatric disorder. Campaigns against substance abuse and counseling of vulnerable students will help in eradicating suicidal intent.

Prevalence and correlates of depression among college nursing students in China

This study aims to assess the prevalence of depression and examine potential risk factors correlated to depression among nursing college students in China. Between September and November 2012, a total of 763 college nursing students were randomly selected to participate in a survey, which included the Center for Epidemiologic Studies Depression Scale (CES-D). The result showed that 22.9% (95% CI: 20.0%-25.9%) of participants reported high score on the CES-D (16 or above). Risk factors significantly associated with depression in the univariate analysis were academic performance, academic stress, interest in majors, occupational future, interpersonal relationship, frequency of exercise, self-reported health status, social support, educational level of father, relationship with parents and making decisions without interference by parents. Backward multivariate logistic regression analysis revealed that lower academic stress, and better occupational future were strongly related to lower risk of depression, followed by active use of social support, full making decision power, better relationship with father and higher self-reported health status. The findings suggested that in order to prevent depression among college nursing students, school- and family-based strategies should be developed and implemented.