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Rahman M, Kabir MHMI, Sultana S, Shimu AT, Griffiths MD. Suicidal behaviours and associated factors among medical students in Bangladesh: a protocol for systematic review and meta-analysis (2000-2024). BMJ Open 2024; 14:e083720. [PMID: 38964798 PMCID: PMC11227789 DOI: 10.1136/bmjopen-2023-083720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 06/11/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Suicidal behaviour is common among medical students, and the prevalence rates might vary across various regions. Even though various systematic reviews have been conducted to assess suicidal behaviours among medical students in general, no review has ever assessed or carried out a sub-analysis to show the burden of suicidal behaviours among Bangladeshi medical students. METHODS AND ANALYSIS The research team will search the PubMed (Medline), Scopus, PsycINFO and Google Scholar databases for papers published between January 2000 and May 2024 using truncated and phrase-searched keywords and relevant subject headings. Cross-sectional studies, case series, case reports and cohort studies published in English will be included in the review. Review papers, commentaries, preprints, meeting abstracts, protocols and letters will be excluded. Two reviewers will screen the retrieved papers independently. Disagreements between two reviewers will be resolved by a third reviewer. Exposure will be different factors that initiate suicidal behaviours among medical students. The prevalence of suicidal behaviours (suicidal ideation, suicide plans and suicide attempts) in addition to the factors responsible, and types of suicide method will be extracted. Narrative synthesis and meta-analysis will be conducted and the findings will be summarised. For enhanced visualisation of the included studies, forest plots will be constructed. Heterogeneity among the studies will be assessed and sensitivity analysis will be conducted based on study quality. Included studies will be critically appraised using Joanna Briggs's Institutional critical appraisal tools developed for different study designs. ETHICS AND DISSEMINATION The study will synthesise evidence extracted from published studies. As the review does not involve the collection of primary data, ethical approval will not be required. Findings will be disseminated orally (eg, conferences, webinars) and in writing (ie, journal paper). PROSPERO REGISTRATION NUMBER CDR 42023493595.
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Affiliation(s)
- Mantaka Rahman
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
- MSc Student, Applied Statistics and Data Science, East West University, Dhaka, Bangladesh
| | - M H M Imrul Kabir
- Department of Mathematical and Physical Science (MPS), East West University, Dhaka, Bangladesh
| | - Sharmin Sultana
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | | | - Mark D Griffiths
- Department of Psychology, Nottingham Trent University, Nottingham, UK
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Mateen A, Kumar V, Singh AK, Yadav B, Mahto M, Mahato S. Suicide and Suicidal Ideation in Medical Students: A Systematic Review. Cureus 2024; 16:e65246. [PMID: 39184700 PMCID: PMC11343338 DOI: 10.7759/cureus.65246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 08/27/2024] Open
Abstract
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.
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Affiliation(s)
- Azfar Mateen
- Forensic Medicine, Mahamaya Rajkiya Allopathic Medical College (MRAMC), Ambedkarnagar, IND
| | - Visesh Kumar
- Biochemistry, Mahamaya Rajkiya Allopathic Medical College (MRAMC), Ambedkarnagar, IND
| | - Ajay K Singh
- Biochemistry, Mahamaya Rajkiya Allopathic Medical College (MRAMC), Ambedkarnagar, IND
| | - Berendra Yadav
- Physiology, Mahamaya Rajkiya Allopathic Medical College (MRAMC), Ambedkarnagar, IND
| | - Mala Mahto
- Biochemistry, All India Institute of Medical Sciences (AIIMS), Patna, IND
| | - Sumit Mahato
- Pharmacology, All India Institute of Medical Sciences (AIIMS), Deoghar, IND
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Varshney K, Patel H, Panhwar MA. Risks and Warning Signs for Medical Student Suicide Mortality: A Systematic Review. Arch Suicide Res 2024:1-19. [PMID: 38334169 DOI: 10.1080/13811118.2024.2310553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Medical students have been known to face numerous mental health issues at disproportionately high rates. Of pertinence, medical students have been shown to have high rates of suicidal thoughts and behavior. However, little is known about the risks and warning signs for death by suicide in this group. We therefore conducted a systematic review regarding the factors associated with medical student suicide mortality. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted searches in six different databases. Studies with stratified data on at least one suicide death by a medical student were eligible for inclusion. RESULTS Searches produced a total of 1744 articles, and of those, 13 articles were eligible for inclusion. There was a pooled total of 362 suicide deaths of medical students across five different countries. 67.6% of deaths occurred among male students, primarily in their early twenties. Students in their later years of medical school were shown to be more likely to die by suicide, as were those with a history of psychiatric issues such as depression. Motivations for suicide were academic stress/failure, harassment/bullying, and relationship issues. Warning signs for suicide among medical students were recent changes in mood/behavior and leaving a suicide note. DISCUSSION Numerous risks and warning signs of suicide have been described in our review. Medical schools may have an important role in lowering suicide deaths by medical students; impactful change can occur through better support, changes in curriculum, and appropriate data collection.
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Affiliation(s)
- Karan Varshney
- School of Medicine, Deakin University, Waurn Ponds, Australia
| | - Hinal Patel
- School of Medicine, Deakin University, Waurn Ponds, Australia
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Ebrahim OS, Sayed HA, Rabei S, Hegazy N. Perceived stress and anxiety among medical students at Helwan University: A cross-sectional study. J Public Health Res 2024; 13:22799036241227891. [PMID: 38313630 PMCID: PMC10838489 DOI: 10.1177/22799036241227891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
Background Medical students are prone to high levels of perceived stress and anxiety, which can negatively impact their academic performance, as well as their physical and mental health. This study aimed to assess the main stressors, levels of perceived stress and anxiety, and their predictors among medical students. Design and methods A structured questionnaire was used to collect data from 1696 medical students at Helwan University. A cross-sectional study was designed to evaluate their perceived stress, stressors, and anxiety using the Perceived Stress Scale, Medical Students Stressor Questionnaire, and Beck Anxiety Inventory, respectively. Results Approximately 93% of medical students experienced moderate to high levels of stress, while 54.9% of medical students experienced moderate to concerning levels of anxiety. The main stressors were academic, teaching, social, intrapersonal, group activity, and desire-related stressors. Risk factors associated with higher perceived stress included being female, young age, living away from the family, obtaining lower academic percentages, having psychiatric, neurological, or other chronic medical illnesses, and experiencing higher levels of academic, intrapersonal, drive, and group activities-related stressors. Risk factors for higher anxiety included being female, residing in rural areas, having psychiatric, neurological, or other chronic medical illnesses, perceiving a high level of stress, and experiencing higher levels of academic, intrapersonal, and social-related stressors. Conclusions The findings indicate that a significant proportion of medical students experience various levels of stress and anxiety. These results underscore the urgent need for a stress management program, to help medical students to cope with different stressors.
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Affiliation(s)
- Omnya S Ebrahim
- Department of Community, Occupational and Environmental Medicine, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Hanan Ali Sayed
- Department of Community, Occupational and Environmental Medicine, Faculty of Medicine, Helwan University, Cairo, Egypt
- Department of Public Health, Theodor Bilharz Research Institute, Giza, Egypt
| | - Samah Rabei
- Department of Neuropsychiatry, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Nelly Hegazy
- Department of Community, Occupational and Environmental Medicine, Faculty of Medicine, Helwan University, Cairo, Egypt
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Shipley JH. Finding Relief: Loan Forgiveness for Unmatched Medical Graduates Can Save Lives. Curr Probl Diagn Radiol 2023; 52:586-587. [PMID: 37684187 DOI: 10.1067/j.cpradiol.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023]
Affiliation(s)
- Jonathan H Shipley
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA..
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Balsarkar G. Physician Heal Thyself: 'Mental Health is a Universal Human Right'. J Obstet Gynaecol India 2023; 73:371-373. [PMID: 37916047 PMCID: PMC10616046 DOI: 10.1007/s13224-023-01858-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023] Open
Affiliation(s)
- Geetha Balsarkar
- Seth GS Medical College and Nowrosjee Wadia Maternity Hospital, Mumbai, India
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Khalil MT, Rathore FA, Dy R. Wellness in residency: Addressing the neglected need in lower middle-income countries. J Pediatr Rehabil Med 2023; 16:457-462. [PMID: 37694319 PMCID: PMC10578206 DOI: 10.3233/prm-230031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/15/2023] [Indexed: 09/12/2023] Open
Abstract
The concept of wellness incorporates many domains, including mental, physical, social, and integrated well-being. However, it is not well understood in most lower middle-income countries (LMIC). The significance of practicing wellness during residency, focusing on the context of LMIC, is described here. Based on the authors' experiences of working in LMIC, the challenges faced during residency and the importance of prioritizing self-care and well-being is highlighted. Physician burnout is a global concern having a negative impact on patient care quality, patient satisfaction, and professionalism. Interventions to address wellness can be individual and organization-based. Individual interventions include mindfulness training, behavioral interventions, self-care practices, and support networks. Organizational interventions involve the establishment of wellness committees, introduction of wellness curricula, optimization of workflows, and creation of shared social spaces. There is a need for implementing wellness practices within residency programs in LMIC. By focusing on wellness, physicians can mitigate burnout, enhance their well-being, and improve patient care outcomes.
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Affiliation(s)
| | | | - Rochelle Dy
- Baylor College of Medicine/Texas Children’s Hospital, Houston, TX, USA
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Goel A, Sethi Y, Moinuddin A, Deepak D, Gupta P. Competency-based medical education (CBME) curriculum and its effect on prevalence of anxiety, depression and stress amongst medical undergraduates. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:380. [PMID: 36618479 PMCID: PMC9818703 DOI: 10.4103/jehp.jehp_564_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/13/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND A growing body of literature now identifies higher levels of anxiety, depression, and stress among medical students as a distinct mental health domain. The competency-based medical education (CBME) curriculum was introduced to revamp the existing curriculum with an aim to garner constructive impact on the mental health of undergraduate medical students. As such, we sought to draw comparisons between the mental health of medical students, studying the old (2018 batch) and the new (2019 batch) medical education systems in India. MATERIALS AND METHODS We designed a survey that contained structured questions pertained to anxiety (HAM-A, GAD-7), depression (HAM-D, BDI), and stress (PSS) amongst medical undergraduate students of 2018 and 2019 batches at the Government Doon Medical College (GDMC), Dehradun, India. RESULTS Contrasting the 2018 and 2019 batches, the introduction of CBME resulted in a significant two-fold decrease in moderate anxiety, as exhibited by both HAM-A (6.0 vs 3.0, P = 0.016) and GAD-7 (3.5 vs 1.0, P = 0.037) scales, although no significant change in mild and severe anxiety, and overall depression (BDI: P = 0.05, HAM-D: P = 0.05) or stress (PSS: P = 0.86) was found. CONCLUSION The CBME system has made a significant impact on the mental health of undergraduate medical students for anxiety, albeit its effect on depression and stress remains equivocal. Future studies are warranted to compare the effect of CBME in other undergraduate and postgraduate courses across the country to help predict the psychological impact of the newfangled CBME education system.
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Affiliation(s)
- Ashish Goel
- Department of Physiology, Government Doon Medical College, Dehradun, Uttarakhand, India
| | - Yashendra Sethi
- Department of Physiology, Government Doon Medical College, Dehradun, Uttarakhand, India
| | - Arsalan Moinuddin
- Vascular Health Researcher, Department of Sports and Exercise Physiology, School of Sport and Exercise, University of Gloucestershire, UK
| | - Desh Deepak
- Department of Physiology, Government Doon Medical College, Dehradun, Uttarakhand, India
| | - Priyanka Gupta
- Department of Physiology, Government Doon Medical College, Dehradun, Uttarakhand, India
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Mamun MA, Griffiths MD. Using media reports about suicide as data: Response to Etchells et al. (2021). Perspect Psychiatr Care 2022; 58:3106-3112. [PMID: 34897690 DOI: 10.1111/ppc.12991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Mohammed A Mamun
- CHINTA Research Bangladesh, Dhaka, Bangladesh.,Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Bangladesh
| | - Mark D Griffiths
- Psychology Department, Nottingham Trent University, Nottingham, UK
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Singh OP. Increasing suicides in trainee doctors: Time to stem the tide! Indian J Psychiatry 2022; 64:223-224. [PMID: 35859556 PMCID: PMC9290410 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_355_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Om Prakash Singh
- Department of Psychiatry, WBMES, Kolkata, West Bengal, India.,AMRI Hospitals, Kolkata, West Bengal, India
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Tatia P, Shehnaz SI. Do Indian physicians heal themselves? An online cross-sectional survey of health access behaviour of doctors at a tertiary-care hospital in South India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Das N, Khar P, Karia S, Shah N. Suicide among Health Care Professionals—An Indian Perspective. Healthcare (Basel) 2022; 10:healthcare10020354. [PMID: 35206967 PMCID: PMC8871638 DOI: 10.3390/healthcare10020354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 11/18/2022] Open
Abstract
Suicide is a global phenomenon that claims a person’s life every 40 s. The suicide-mortality rate in India is higher than the worldwide average for health care professionals (HCP). The treatment gap for mental health care is alarming, more than 80% in India which has improved compared to a decade. Among the methods chosen by HCPs for dying by suicide, violent suicide methods are more common. Hanging is the most common means, followed by lethal injection and jumping from a building. Among the medical students and professionals in India, academic stress is the leading cause of suicides, followed by mental illness and harassment. Stressfully long working hours, starvation for long hours, inadequate diet, sleep deprivation, inadequate rest, high levels of personal expectations, knowledge of lethal suicide methods, easy access to potentially fatal drugs, apathy, and fearlessness towards death are some of the contributing factors. Primary preventive measures to minimize suicides in HCPs would be to conduct stress-management workshops at an institutional level, routine mental health check-ups in healthcare institutions, mental-health screening for students enrolling into healthcare courses, and prompt referrals to mental healthcare facilities. In addition, telehealth services or mental health services for medical professionals of India are the need of the hour.
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Affiliation(s)
- Nishant Das
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai 400022, India; (N.D.); (N.S.)
| | - Prerna Khar
- Department of Psychiatry, TNMC and BYL Nair Charitable Hospital, Mumbai 400008, India;
| | - Sagar Karia
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai 400022, India; (N.D.); (N.S.)
- Correspondence:
| | - Nilesh Shah
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai 400022, India; (N.D.); (N.S.)
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Kumar S, Ramanathan V. Doctors’ suicide and the vulnerability of medical profession. MGM JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4103/mgmj.mgmj_72_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Patel R, Mehta R, Dave K, Chaudhary P. Effectiveness of gatekeepers' training for suicide prevention program among medical professionals and medical undergraduate students of a medical college from Western India. Ind Psychiatry J 2021; 30:217-223. [PMID: 35017803 PMCID: PMC8709527 DOI: 10.4103/ipj.ipj_31_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/20/2021] [Accepted: 06/20/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Suicide risk among Indigenous populations is a multifaceted phenomenon, influenced by biological, psychological, and social factors at the individual level, as well as cultural, political, and economic issues at the family and community level. The global prevalence of depression among medical students was recently estimated to be 28.0 % according to a meta-analysis of 77 studies. In the field of suicide prevention, the term gatekeeper refers to "individuals in a community who have face-to-face contact with large numbers of community members as part of their usual routine." They may be trained to "identify persons at risk of suicide and refer them to treatment or supporting services as appropriate". In our study we aimed to improved attitude and knowledge in gatekeeper to improve detection and referral of individuals who are at risk of suicide. METHODS AND MATERIAL We adapted an evidence-based gatekeeper training into a two-hour, multi-modal and interactive event for medical professional and undergraduate students. Then we evaluated the intervention compared to free-recall knowledge and attitudes questions were examined before and after participation in a student and faculty gatekeeper training program. Focus groups with students enriched interpretation of quantitative results. STATISTICAL ANALYSIS USED Knowledge, attitudes, and skills of both students and teachers were analyzed by Mann-Whitney U-test. Comparison of knowledge, attitudes, and skills between both groups was analyzed by Wilcoxon signed-rank test. RESULTS Undergraduate students developed more positive attitude for suicidal behavior where faculties developed more confident in their skill after training sessions. CONCLUSION brief gatekeeper training found effective in improving knowledge about suicide. Also, increasing participants' accuracy to identify warning signs, risk factors and protective factors about suicide.
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Affiliation(s)
| | - Ritambhara Mehta
- Department of Psychiatry, Government Medical College, Surat, Gujarat, India
| | - Kamlesh Dave
- Department of Psychiatry, Government Medical College, Surat, Gujarat, India
| | - Pradhyuman Chaudhary
- Department of Psychiatry, GMERS Medical College and Hospital, Sola, Ahmedabad, Gujarat, India
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Rozatkar A, Ghosh S, Kumar M. Suicidality among medical students. INDIAN JOURNAL OF SOCIAL PSYCHIATRY 2021. [DOI: 10.4103/ijsp.ijsp_140_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Shamim T. Spiritual intelligence: A hidden tool at workplace. J Family Med Prim Care 2021; 10:4328. [PMID: 35136817 PMCID: PMC8797096 DOI: 10.4103/jfmpc.jfmpc_1374_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/24/2021] [Indexed: 11/04/2022] Open
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