Volume 8, Issue 5, May – 2023 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Frequency of and Potentiating Risk Factors for

Suicidal Ideation Among Medical Students of
Rawalpindi Medical University in the Year 2021
Dr. Haris Kamran1
Asad Nizami (Professor)2
Dr. Anam Fatima3
Dr. Ahmed Salmaan4
Dr. Gulfam Khan Shairwani5
Institute of Psychiatry, Rawalpindi Medical University, Pakistan

Corresponding Author:- Dr Haris Kamran

Abstract:- activities. In third year, 60% students with suicidal

ideation were unaware about the availability of the
 Background: campus mental health resources.
According to the World Health Organization, more
than 800,000 people die from suicide each year. Doctors  Conclusion:
have the highest rate of suicide among all the A significant percentage of medical students in
professionals. No detailed study investigating the Rawalpindi Medical University report suicidal ideation,
frequency of suicidal ideation and its associated risk which should be recognized, acknowledged, and
factors among medical students has been conducted in addressed at an early stage by the University
Pakistan. This is the first study of its kind to be administration and the mental health department.
conducted among medical students of Pakistan. The
aims and objectives of the study were to find the Keywords:- Suicide, Suicidal Ideation, Potentiating Factors,
frequency of suicidal ideation among the medical Rawalpindi Medical University, Mental Health.
students of RMC in the year 2021, to find out the most
common associated risk factors, and to suggest I. INTRODUCTION
interventions and recommendations.
According to the World Health Organization more
 Methods: than 800,000 people die from suicide each year which
The study was carried out at the Old and New corresponds approximately to 1 death every forty seconds. It
teaching blocks of the Rawalpindi Medical University. is considered to be the 3rd leading cause of death among
The screening questionnaire used for phase 1 was those aged 15-44 years, and the second leading cause of
“Suicide Behaviors Questionnaire-Revised (SBQ-R)” death in the 10-24 years age group.1 As compared to the
with the cut-off score of > 7. For phase 2, a questionnaire general population, physicians and medical students are
containing twenty-eight questions detailing the found to have an increased risk of committing suicide.2 The
potentiating risk factors based on internationally incidence of suicide is rising in Pakistan,3 but authentic data
standardized questions was developed. Data analysis was of suicidal rates is still lacking as this area has not been
done using SPSS version 22. given due importance due to various social, cultural, legal,
and religious factors.
 Results:
The sample size was 862 using stratified sampling Various studies have been done on suicidal ideation
technique. The frequency of suicidal ideation among and the factors responsible for it among medical students in
medical students of RMC in 2021 was 20.2%. This developed countries but very few are available from
translates to roughly 1 in every 5 students. The mean developing countries. In USA, suicidal ideation was found
frequency of male students was significantly higher than to be higher in medical students than in the general
that of the females (24.7% vs 19.4%), with no significant population.4 According to another study from Portuguese,
difference between the mean frequencies associated with suicidal ideation was found to be approximately four times
the boarding status. Third year students reported the higher in medical students than in the general population.5
highest percentage of suicidal ideation at 26%, with No detailed study investigating the frequency of suicidal
fourth year having the highest mean score of 11.59, ideation and its associated risk factors among medical
denoting the maximum severity. The three most common students has been conducted in Pakistan. A pilot study in
potentiating factors across all academic years were AKU was conducted, but it does not detail the possible
communication problems, academic failures, and risky associated risk factors.6

IJISRT23MAY107 www.ijisrt.com 1359

Volume 8, Issue 5, May – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Accounts of suicidal deaths by medical students are The questionnaire consisted of three portions. The first
frequently reported in Pakistan,7 however, not much formal portion consisted of questions related to the socio-
research has been conducted on this topic. Our research demographic profile. The second portion consisted of four
study aims at bridging this gap in the research literature by questions related to suicidal ideation according to the
finding the frequency of suicidal ideation among medical Suicidal Behaviors Questionnaire-Revised (SBQ-R).The
students of Rawalpindi Medical University, and the score can range from 3-18. For Adult General Population
potentiating factors that lead to such ideation. The objective the cut off score is equal to or greater than 7. The third
of the study is to find the common and the most frequently portion of the questionnaire (phase 2) consisted of questions
incurred potentiating factors, so that due and proper related to the potentiating risk factors of suicidal ideation.
intervention can be carried out and the factors corrected as a For phase 2 we used another questionnaire in which we
practical application of this research study to reduce the observed the frequencies of the potentiating risk factors for
frequency of suicidal ideation among the medical students suicidal ideation. Phase 2 questionnaires were filled by only
of Rawalpindi Medical University. those students who were found to have suicidal ideation.
There were 28 questions in this questionnaire. 11 questions
This is the first study of its kind to be conducted had further sub parts.
among medical students of Pakistan.
Data entry and analysis were done using SPSS 22.
II. PATIENTS AND METHODS Cross-tab between each of the background variables (age,
gender, boarder/non-boarder status, year of study in MBBS)
 Our Study was Conducted in Two Phases: and the three most common potentiating risk factors was
done to find out the relationship between each of the
 Phase 1: Screening: to find out the frequency of background variables and the common factors.
suicidal ideation among the medical students of RMU
 Phase 2: Factors: to find out the possible correlation Since the nature of the research project was sensitive
between different potentiating risk factors and suicidal and the questions in the questionnaire were direct and
ideation among the students reporting such ideation personal, the purpose and procedure of the research project
were explained to the participants in detail prior to the
The aims and objectives of the study were to find out distribution of the questionnaires. A fully informed consent
the frequency of suicidal ideation among the medical was taken from the participants, who could choose to
students of RMU in the year 2021, to find out the most withdraw from the process by not filling the questionnaire.
common associated risk factors, and to suggest interventions Only relevant information was taken from the participants;
and recommendations. Some of the operational definitions their contact information was not taken. Whereas their
are as follows:8,9 names were required to fill out the consent form, this
particular variable was not used anywhere in the study, and
 Suicide: an intentional, self-inflicted act that results in was detached from the questionnaires later. Whereas no
death. compensation was provided to the participants, the study
 Suicidal ideation: Thinking about, considering, or posed no risk of harm to them, whether in physical, social,
planning for suicide. or mental form. Complete confidentiality and anonymity of
the participants were observed throughout the study. Only
 Potentiating Risk Factor: the five investigators had access to the collected data. The
A factor associated with a person contemplating data were stored till the graduation of the final year class.
suicide at one point in time over a long term e.g.
unemployment or recent financial difficulties, III. RESULTS
divorced/separated/widowed, social isolation, prior
traumatic life events, previous suicidal behavior, chronic Amongst 862 students who duly filled our
mental illness, and chronic debilitating physical illness. questionnaire for phase 1, there were 706 (81.9%) female
students and 150 (17.4%) male students, 6 (0.7%) students
The study was conducted in the Old and New did not mention their gender. There were 351 (40.7%)
Teaching Blocks of Rawalpindi Medical University, the boarders and 493 (57.1%) non-boarders, 18 (2.2%) students
study population being only the medical students of RMU. It did not mention their boarding status. Age range of students
took 8 months for the study to be completed, from February was from 17 to 29 with mean age of 20.9 years (S.D +1.7
through September of 2021. It was a cross-sectional study, years).
and the sampling technique used was stratified sampling.
The total sample size was 1500 students, however, only 862  Phase 1:
students duly filled the questionnaires, so the effective Based on the Suicidal Behaviors Questionnaire-
sample size was 862. Only undergraduate medical (MBBS) Revised SBQ-R for our first phase, suicidal ideation was
students of RMU were included in the study, and house present in 174 students’ i.e. 20.2%. This translates to
officers (foundation year students) and BSc students of roughly 1 in every 5 students.
RMU were excluded. Structured questionnaires were used,
the data collection tool being closed-ended questions with
pre-determined options (MCQs) for a quantitative analysis.

IJISRT23MAY107 www.ijisrt.com 1360

Volume 8, Issue 5, May – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Table 1 Comparison of Suicidal Ideation in Students of
RMU based on their Academic Year
Academic Without Suicidal With Suicidal Total
Year Ideation F Ideation F
(% Age) (% Age)
1st year 142 (78.9%) 38 (21.1%) 180
(100%)
2nd year 117 (79.6%) 30 (20.4%) 147
(100%)
3rd year 127 (74.3%) 44 (25.7%) 171
(100%)
4th year 135 (83.3%) 27 (16.7%) 162
(100%)
Fig 1 Frequency of Suicidal Ideation Among Medical 5th year 166 (82.6%) 35 (17.4%) 201
Students of RMC, 2014 (100%)
Total 687 (79.8%) 174 (20.2%) 861
When the comparison of those with suicidal ideation Count (100%)
was done based on gender status and boarding status, no
statistically significant difference was observed with p- The difference of mean scores of suicidal ideation of
values of 0.14 and 0.10 respectively, the difference of students of different academic years was also found to be
proportion being displayed in figure 2. statistically non-significant with a p-value of 0.90 on
ANOVA.
Among those who had suicidal ideation there were 137
(78.7%) female students and 37 (21.3%) male students, and  Phase 2:
when compared for their residential status 81 (47.1%) Although there were 174 (20.2%) students with
boarders had suicidal ideation as compared to 91 (52.9%) suicidal ideation from all academic classes, only 88 students
non boarders. filled the second phase questionnaire from four classes. No
student of 2nd year filled the questionnaire.

The three most common potentiating risk factors were

found to be communication problems with others 50
(58.8%), recent academic failure 48 (54.5%), and risky
behavior (carrying a weapon/fighting/rash driving/rarely
wearing seat belts) 40 (45.5%). When these most common
factors were looked into separately for all academic years,
information was missing for second year, but for the
remaining four years, statistically significant association
were observed with p- value of 0.034 for academic failure.
However, no statistical association was observed for
problems in communicating feelings with others and risky
behavior with the status of academic year in these students
with p- values of 0.715 and 0.392 respectively.

Fig 2 Gender and boarding status association

Interestingly, the comparison of the mean scores of

suicidal ideation revealed highly statistically significant
difference (p-value 0.001) with higher mean value of 5.97
(SD + 4.44) in male students and comparatively lower value
of 4.90 (SD +3.18) among female students. However, the
mean scores of suicidal ideation were 5.33(SD +3.64) and
4.92 (SD +3.28) for boarders and non-boarders respectively,
with a non-statistically significant difference with p-value of
0.09.

When suicidal ideation was compared for each

academic year, no statistically significant difference was
observed with a p-value of 0.23, but proportion of those
with suicidal ideation was observed to be highest
comparatively amongst third year students as shown in table Fig 3 Distribution of the three Most Common Factors
1: Among Four Academic Years

IJISRT23MAY107 www.ijisrt.com 1361

Volume 8, Issue 5, May – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
In 3rd year, the class with the highest frequency of It is important to note here that the resulting figure of
suicidal ideation, the most common factor was the 20.2% does not merely represent the current suicidal
awareness about a recent (past 12 months) celebrity suicide; ideation. Each of the four screening questions assesses a
however, 96% were coping well with this information. 60% different value: Q1 taps into lifetime suicidal ideation, Q2
students with suicidal ideation were unaware about the assesses the frequency of suicidal ideation over the past
availability of the campus mental health resources. twelve months, Q3 assesses the threat of suicide attempt,
and Q4 evaluates self-reported likelihood of suicidal
Comparison of the severity of suicidal ideation shows behavior in the future. Therefore, this figure denotes not
that it was the highest in 4th year, as revealed by the mean only the current, but also the past and the future (lifetime)
scores in the following figure: suicidal ideation frequency.

A comparison of ideation frequency between genders

reveals no significant gender difference; nevertheless, males
reported a higher percentage than females, which is in
contrast with the study at AKU.6 Similarly, no significant
difference was observed as associated with the boarding
status; however, boarders reported a higher percentage than
non-boarders, again in contrast with the study at AKU.6

A comparison of the ideation among different

academic years reveals that the 3rd year students had the
highest frequency. It is also important to note that out of all
the factors, the potentiating factor of academic failure had a
statistically significant value when year-wise variation is
considered. Therefore, it can be postulated that the third-
year students faced most of the academic problems, as a
result of which academic failure had such a profound effect
on them. Another important angle here is that, although this
Fig 4 Academic Year Variation in Mean Scores study formally does not take into account the severity of
suicidal ideation, the highest severity in terms of the mean
IV. DISCUSSION scores was found among 4th year students. Therefore,
whenever, and in case, an intervention is planned based on
This is the first study of its kind among the this study, it should be the 4th year students and not the 3rd
government medical colleges of Pakistan, although a similar year students who should be addressed first.
study, considered to be the pilot study in Pakistan, has been
conducted in a private medical college, the Aga Khan The three most common potentiating factors for
University (AKU). However, the aforementioned study suicidal ideation as revealed by the study were
focuses mainly on the frequency of suicidal ideation and communication problems, academic failure, and risky
does not try to investigate the possible associating risk behavior. Overall, across all the academic years, students
factors that could potentiate such ideation. Our study had a problem with expressing their feelings and in
explores in detail the possible risk factors that could be communicating with each other. This was followed by
associated with such ideation. Given the novel nature of this academic failures and risky behavior, such as carrying a
study, it is bound by some constraints; however, there are weapon, fighting, rash driving, or rarely wearing seat belts.
many interesting findings of this research. The overall
reported rate of suicidal ideation among medical students of It is important to study the results of the third year
Rawalpindi Medical University is 20.2%, which is lower separately. Individually, among the third-year students, the
than the rate in the study by the Aga Khan University most frequent potentiating factor was the knowledge about
(31.4%).6 Internationally, the rate is lower than that found the death of a celebrity in the past 12 months. It could be
among medical students of Delhi (53.6%) and of South assumed that the students were adversely affected by this
Africa (32.3%). The comparison with AKU might be news or even mentally traumatized. However, since the
important in signifying the difference between stress levels majority of the students were coping well with news, this
in private and government medical colleges, and that with factor can be sidelined. The next most common factor for
students of Delhi is important since both countries have such ideation among the third-year students was the lack of
similar cultures, and it is expected that some of the awareness about the availability of and access to a mental
potentiating factors for suicidal ideation would overlap. The health facility on campus. Despite such a facility right at
comparison with the students of South Africa signifies the hand, the students were unaware as to whom to approach for
fact that cultural factors alone do not determine the help or intervention.
frequency of suicidal ideation, and points towards the
universality of some associated factors for suicidal ideation
among medical students across different cultures.

IJISRT23MAY107 www.ijisrt.com 1362

Volume 8, Issue 5, May – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
As there is no other study on this topic for any other [10]. Osman A, Bagge CL, Guitierrez PM, Konick LC,
government medical college, it is not possible to compare Kooper BA, Barrios FX. The suicidal behaviors
the suicide ideation frequency of RMU with any other questionnaire-revised (SBQ-R): validation with
government medical college. clinical and non-clinical samples. Assessment 2001;
5(): 443-454.
V. CONCLUSION [11]. Perlman C, Neufeld E, Martin L, Goy M, Hirdes
J. Suicide risk assessment inventory: a resource guide
A significant percentage of medical students in for Canadian healthcare organizations. Toronto, ON:
Rawalpindi Medical University report suicidal ideation. The Ontario Hospital Association and Canadian Patient
mean score of suicidal ideation is also significantly high. Safety Institute; 2011. (accessed 3 May 2014).
The college administration and campus mental health [12]. Preventing suicidal behavior among college and
institute should make an effort to recognize this problem university students. National center for the prevention
early on and carry out an active intervention to reduce this of youth suicide. Report number: .2013.
alarming figure, and create awareness among medical [13]. Randy A. Sansone, MD and Lori A. Sansone, MD.
students across the University. At least the three most Physician Suicide. Psychiatry (Edgmont) Jan 2009;
common potentiating factors should be addressed. It is 6(1): 18-22.
recommended that a 3rd phase of this research should be [14]. World health organization. Suicide prevention
undertaken, which is beyond the scope of this study, in (SUPRE). http://www.who.int/mental_health/
which active intervention should be done according to the prevention/suicide/ suicideprevent/en/ (accessed 6
severity for those who have shown suicidal ideation in phase May 2014).
2 of this study.

REFERENCES

[1]. American association of suicidology.

http://www.suicidology.org/web/guest/home
(accessed 3 May 2014).
[2]. Centre for Disease Control and
Prevention. Definitions: Self-directed Violence.
http://www.cdc.gov/violenceprevention/suicide/
definitions.html (accessed 11 May 2014).
[3]. Dawn news. Medical student commits suicide', Dawn
news. 14 april 2014: http://www.dawn.com /news/
1099703.
[4]. Dyrbye LN, Thomas MR, Massie FS, Power DV,
Eacker A, Harper W, Durning S, Moutier C, Szydlo
DW, Novotny PJ, Sloan JA, Shanafelt TD. Burnout
and suicidal ideation among U.S. medical
students. Ann Intern Med 2008 sep 2; 149(5): 334-41.
[5]. Harter S, Marold D, Whitesell N. Model of
psychosocial risk factors leading to suicidal ideation
in young adolescents. Development and
Psychopathology 2008; 4(1): 167-188.
[6]. Khokher S, Khan MM. Suicidal ideation in Pakistani
college students. Crisis 2005; 126(3): 125-127.
[7]. Millan LR, Rossi E, De Marco OL. Suicide among
medical students. Rev Hosp Clin Fac Med Sao
Paulo 1990; 45(3): 145-149.
[8]. Murad M. Khan , Haider Naqvi , Durrane Thaver &
Martin Prince . Epidemiology of Suicide in Pakistan:
Determining Rates in Six Cities.Archives of Suicide
Research 14 July 2011; 12(2): 155-160.
[9]. Ontario Hospital Association. Suicide Risk
Assessment Guidebook: A Resource for Health Care
Organizations. http://www.oha.com/CurrentIssues/
keyinitiatives/MentalHealth/Pages/SuicideRiskAssess
mentGuidebook.aspx (accessed 11 May 2014).

IJISRT23MAY107 www.ijisrt.com 1363