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

Abstract

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 and Factors Associated With Depression and Suicidal Ideation During the COVID-19 Pandemic Among University Students in Uganda: A Cross-Sectional Study

“…Despite the studies in China being conducted earlier, the students were exposed to constant sources of stress during the pandemic, and they would have developed coping strategies to overcome stress complications such as depression and related suicidal behaviors. Smoking cigarettes and/or marijuana was associated with suicidal ideation, a finding consistent with other studies prior to the COVID-19 pandemic ( 58 ). Substance use increased during the COVID-19 pandemic and led to multiple mental challenges, including suicide ( 59 – 63 ).…”

Prediction of suicidal ideation among Chinese college students based on radial basis function neural network

“…The same inconsistent results were observed when exploring relationship between study pressure and suicidal ideation among college students. Seo found that study pressure was a risk factor for suicide ideation ( 16 ). Wang revealed that increased study pressure and burden was associated with a higher risk of suicidal ideation ( 99 ).…”

“…Compared with other periods, college students experience a critical transition period, which is characterized by the stress from adapting to a new environment, losing and rebuilding social support systems. Therefore, besides aforementioned risk factors, study pressure, having been bullied, academic difficulties, and substance use were suggested by previous studies as risk factors for suicidal ideation among college students ( 16 – 20 ). However, the results of which predictors are most useful were inconsistent due to different sample populations, statistical methods and questionnaires.…”

Qualitative Study on Experiences of Suicidal Ideation and Behavior among College Students

“…대학생의 자살위험은 다양한 심리사회 요인들로 설명 될 수 있으며, 주요한 위험요인 중 하나는 우울과 같은 정신건강 문제이다 [7][8][9][10][11]. 실제, 우울증을 경험하는 대 학생은 그렇지 않은 경우에 비해 자살사고 위험이 6.87 배, 자살시도 위험이 9.34배 높았으며 [8], 무망감, 무력 감, 무가치감과 같은 우울 증상은 청소년 및 성인 초기 자살시도 동기의 42.8%를 설명하였다 [10].…”

“…대학생의 자살위험은 다양한 심리사회 요인들로 설명 될 수 있으며, 주요한 위험요인 중 하나는 우울과 같은 정신건강 문제이다 [7][8][9][10][11]. 실제, 우울증을 경험하는 대 학생은 그렇지 않은 경우에 비해 자살사고 위험이 6.87 배, 자살시도 위험이 9.34배 높았으며 [8], 무망감, 무력 감, 무가치감과 같은 우울 증상은 청소년 및 성인 초기 자살시도 동기의 42.8%를 설명하였다 [10]. 더불어 관계 갈등, 소외 및 외로움과 같은 대인관계 문제도 대학생의 자살위험을 높일 수 있는 요인인데 [9,10], 예를 들어, 타 인과 의미 있는 관계를 맺고 있지 못하다는 인식인 좌절 된 소속감은 자살의 대인관계 이론(interpersonal theory of suicide)에서 상정하는 자살사고의 주요 위험 요인이다 [12].…”