What covariates drive medical students to the brink of suicidal ideation, plan, and attempt? A double-centric cross-sectional study in a resource-constrained rural setting in North India

Abstract

Background: Medical students face great stress and put their mental health at risk to become an individual contributing to society, and impulsively attempt suicide. Little is known in the Indian context, so additional knowledge on the magnitude and covariates is required. Aims: This study aims to evaluate the magnitude and covariates of suicidal ideation, plan, and attempts among medical students. Methods: This was a cross-sectional study conducted in two medical colleges located in rural Northern India and enrolled 940 medical students for a period of two months from February to March 2022. A convenience sampling method was executed to collect the data. The research protocol incorporates a self-administered questionnaire regarding sociodemographic and personal domains, as well as standardized tools to assess psychopathological domains such as depression, anxiety, stress, and stressors. The Suicidal Behavior Questionnaire-Revised (SBQ-R) scale was used to measure the outcomes. Stepwise backward logistic regression (LR) analysis was used to determine the covariates associated with suicidal ideation, plan, and attempts. Results: A sample of 787 participants (87.1% response rate) were finally enrolled in the survey, with a mean age of 21.08 (±2.78) years. Around 293 (37.2%) of respondents had suicidal ideation, 86 (10.9%) claimed planning suicide, and 26 (3.3%) mentioned attempting suicide in their lifetime as well as 7.4% of participants assessed the risk of suicidal behavior in the future. The identified covariates poor sleep, family history of psychiatric illness, never seeking psychiatric aid, regret for choosing the field of medicine, bullying, depressive symptoms, high stress, emotion-focused coping, and avoidant coping, were significantly associated with a higher likelihood of lifetime suicidal ideation, plan, and attempt. Conclusion: A high frequency of suicidal thoughts and attempts, indicates the need of addressing these concerns promptly. The incorporation of mindfulness techniques, resilience, faculty mentorship programs, and proactive student counseling may help foster the mental health of the students.

A Moderation Model for Bolstering Resilience to Suicidal Psychopathology

“…All the research subjects were recruited only after the acquisition of written informed consent. The detailed study design, settings, and sampling and data collection procedures are already described in the published manuscript (Garg et al, 2023) and are discussed here in brief.…”

“…Hence, previous studies (Johnson et al, 2011; Brailovskaia et al, 2020; Seo et al, 2022) implied that mental well-being, life satisfaction, ego resiliency, and social support have moderated the influence of depression on suicidal ideation among college students and were especially noteworthy for the diminution and prevention of suicidal ideations, whereas self-efficacy, problem-solving abilities, and psychosocial stress resistance were identified to have weaker evidence as a moderator (Johnson et al, 2011). Recently, multiple researchers (Cheng et al, 2014; Stange et al, 2017) investigated coping flexibility as a resilience construct to depression and stress, as opposed to conventional approaches that concentrate on the effect of a specific coping mechanism, which is not considerably adaptive (Garg et al, 2022; Garg et al, 2023), whereas only two studies have investigated the association between coping flexibility and suicidal psychopathologies (Heffer and Willoughby, 2017; Kato, 2022). Thus, making assumptions about the nature of resilience is challenging because the components analyzed have varied greatly between the studies and the results.…”

“…The suicide epidemic, an intricate and multifaceted phenomenon, is a societal health concern that disproportionately impacts millennials between the ages of 18 and 25 years globally and in India (Naghvi, M., 2019; Singh, 2022; Garg et al, 2023). According to the literature, medical graduates who began to have academic hardships when they started their medical training were more likely to have suicidal thoughts and attempts (Garg et al, 2022; Garg et al, 2023). Among Indian medical students, current research revealed that 37.2% had lifetime suicidal thoughts, 10.9% had made suicide plans at some point in their lives, and 3.3% had attempted it.…”

“…Among Indian medical students, current research revealed that 37.2% had lifetime suicidal thoughts, 10.9% had made suicide plans at some point in their lives, and 3.3% had attempted it. Among those who have attempted suicide in the last 12 months, around 35% to 45% have had suicidal ideation and are making suicidal ideations and attempts significant predictors of suicidal psychopathology (Garg et al, 2023). Furthermore, the literature has established that experiencing daily life stress among medical students (academic pressure, future expectations, interpersonal issues, and financial difficulties) is a persistent and strongest antecedent of psychological distress and suicidal psychopathologies compared with other risk factors (Bae and Lee, 2018; Garg et al, 2022; Song and Bae, 2022; Garg et al, 2023).…”

“…Among those who have attempted suicide in the last 12 months, around 35% to 45% have had suicidal ideation and are making suicidal ideations and attempts significant predictors of suicidal psychopathology (Garg et al, 2023). Furthermore, the literature has established that experiencing daily life stress among medical students (academic pressure, future expectations, interpersonal issues, and financial difficulties) is a persistent and strongest antecedent of psychological distress and suicidal psychopathologies compared with other risk factors (Bae and Lee, 2018; Garg et al, 2022; Song and Bae, 2022; Garg et al, 2023). Considerable research has been conducted to identify the risk variables that triggered suicidal thoughts and behavior in the past few decades; nevertheless, suicidal intervention strategies concentrated on these risk factors have provided upsetting results, and a rising trend has been observed (Sher, 2019; Kessler et al, 2020).…”