Research

TITLE: Suicidal ideation among medical students in Karachi.
KEYWORDS: Suicidal ideation, suicide, medical students, Karachi.
INTRODUCTION:
Suicidal ideation is defined as a risk factor for suicide attempts and completions,
it is most common of all suicidal behaviors, but only a minority of people engage in
overt self harm.
The thoughts may range from a detailed plan to merely a consideration and does
not include the final act of killing one self. Some studies propose that over one fifth of the
people who actually died by suicide had discussed their aim with a doctor or other health care
professional during their last session. The most common causes of suicidal ideation among
medical students include anxiety and stress associated with competitiveness of medical school
and the sense of not being good enough, other causes may be adjustment problems, financial
problems, unemployment, rejection, family problems, relationship problems and sexual abuse.
Most people with suicidal ideation keep their thoughts and feeling a secret but
the most common symptoms in the ones that fail to hide include hopelessness, anxiety, being
highly moody, personality changes, routine changes such as sleeping patterns and appetite,
engaging in risky behaviors example: driving carelessly and taking drugs, having depression and
panic attacks, impaired concentration and isolation.
Medical students in particular are more affected because of their increased

study load which takes up most of their time leaving only a little or even no time for relaxing or
leisure time activities.
The following methods and measures may help lower the suicidal thoughts:
exercise, sports, adequate sleep, seeking out things that give you pleasure, talking to a close
relative, focusing on the good things in life and taking professional therapy. (1)
LITERATURE REVIEW:
The studies conducted to investigate the prevalence of suicidal ideation among
medical students are scanty in number. A limited number of studies have been conducted in
the western world were fewer in the developing countries. Most researches have concluded
that medical students are at a greater risk of having suicidal ideation due to their academic as
well as personal issues. Most importantly the studies conducted in developing world are spare
and most importantly in Pakistan only two reports have been found on suicidal ideation among
student published in year 2005 and 2014, the later indicated that the more females than males
had suicidal thoughts. The greater risk factor was found to be substance abuse followed by
parental negligence and psychiatric disorders. In the study conducted in 2014 it was found that
118(35.6%) of a total of 331 students had suicidal ideation in the past one year. 46(13.9%)of all
331 had made a plan in their lifetime to commit suicide. 16(4.8%) of the 331 had tried to
commit suicide in some point of their life. (2)
A study conducted in Poland published in international J.Res Public health 2014

to 2015 shows the relation of chronic stress and anxiety to suicidal thinking in medical students.
It also revealed several methods used by the student to cope with stress like music, sports and
talking to friends or relatives. (3)
Two studies conducted in China respectively showed that rate of suicidal

ideation was significantly increases in second year medical students as opposed to first year
medical students(P<0.01) and that the frequency of suicidal ideation did not significantly differ
between second year and third year medical students. The former (4) revealed that students
with low socioeconomic back ground and sleep disorder are more likely to have experienced
suicidal ideation. While the later (5) showed that depression and suicidal ideation were strongly
correlated out of 348 students only 7.5% reported suicidal ideation and nearly 30% of
depressed students reported suicidal ideation. Another study in the same country showed that
most first suicide attempts occurred within first year of developing suicidal ideation and the
most prevalent risk factor found to be parents divorce, physical abuse, impulsity and anxiety
scores. Out of total 10297 participants 16.52%(1701) reported lifetime ideation and 1.47%(151)
attempted. (6)
A Serbian study revealed that previous suicide attempts and depression were
associated with GPA, age, relationship status, gender, mental illness and drug use. (7) One
study conducted in western Nepal indicate that suicidal ideation is mainly family related
followed by self related. In this study total 206 students were selected it was found that suicidal
ideation in the last 1 year was present in nearly 1/10th of study population and in almost 1/5th of
them lifetime suicidal ideation was present. (8) Suicidal ideation in Turkish and Austrian
students was found to be culture related. More Austrian(37.8%) than Turkish(27.3%) students
reported lifetime, past 12 months or current suicidal ideation. While more Turkish(6.4%) than
Austrian(2.2%) students reported lifetime or past 12 months suicide attempt out of total 320
Austrian and 326 Turkish medical students. (9)
In contrast to most reports the prevalence of suicidal ideation in medical

students in UAE were low. The negative attitude towards suicide was associated with religiosity
and strong support of friends. Out of a total of 115 medical students the previous lifetime
suicidal ideation was 17.5% and of attempts were 1.8%. (10)
1. [Online] http://www.medicalnewstoday.com/.
2. Suicidal ideation among medical students of Pakistan: a cross sectional study. Osama M, Islam MY,
Hussain SA, Masroor SM, Burney MU, Masood MA, Menezes RG, Rehman R. Karachi : s.n., October
2014, J Forensic Leg Med, Vol. 27, pp. 65-8.
3. Chronic Stress and Suicidal Thinking among Medical Students. Rosiek A, Rosiek-Kryszewska A,
Leksowski L, Leksowski K. 2, February 2016, Int J Environ Res Public Health, Vol. 13, p. 212.
4. Suicidal ideation in medical students: who is at risk? Fan AP, Kosik RO, Mandell GA, Tran DT, Cheng
HM, Chen CH, Su TP, Chiu AW. 9, Singapore : s.n., September 2012, Ann Acad Med, Vol. 41, pp. 377-82.
5. Depression And Suicidal ideation in medical students in China: a call for wellness curricula. Sobowale
K, Zhou N, Fan J, Liu N, Sherer R. February 2014, Int J Med Educ, Vol. 5, pp. 31-6.
6. Risk and risk factors of suicide attempt after first onset of suicide ideation: findings from medical
students in grades 1 and 2. Yang L, Zhang Z, Sun L, Wu H, Sun Y. 1, China : s.n., January 2014 , Wei
Sheng Yan Jiu, Vol. 43, pp. 47-53.
7. Demographic risk factors for suicide and depression among Serbian medical school students. Miletic V,
Lukovic JA, Rathkovic N, Aleksic D, Grgurevic A. 4, April 2015, Soc Psychiatry Epidermiol, Vol. 50, pp.
633-8.
8. Suicidal Ideation among students of a medical college in Western Nepal: a cross-sectional study.
Menezes RG, Subba SH, Sathian B, Kharoshah MA, Senthilkumaran S, Pant S, Arun M, Kundapur R, Jain
A, Lobo SW, Ravi Shankar P. 4, July 2012, Leg Med (Tokyo), Vol. 14.
9. A cross-cultural invetigation of suicidal behavior and attitudes in Austrian and Turkish medical
students. Eskin M, Voracek M, Steiger, Altinyazar. 9, September 2011, Soc Psychiatry Psychiatr
Epidermiol, Vol. 46, pp. 813-23.
10. Suicidal behavior and attitude among medical students in the United Arab Emirates. Amiri L, Voracek
M, Yousef S, Galadari A, Yammahi S, Sdedeghi MR, Eskin M, Dervic K. 2, 2013, Crisis, Vol. 24, pp. 116-
23.

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TITLE: Suicidal ideation among medical students in Karachi.

KEYWORDS: Suicidal ideation, suicide, medical students, Karachi.

Medical students in particular are more affected because of their increased

A study conducted in Poland published in international J.Res Public health 2014

Two studies conducted in China respectively showed that rate of suicidal

In contrast to most reports the prevalence of suicidal ideation in medical

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