Prevalence of suicidal behavior in Medical students

Schlittler, Leandro Xavier de Camargo; Celeri, Eloisa Helena Rubello Valler; Azevedo, Renata Cruz Soares de; Dalgalarrondo, Paulo; Santos Júnior, Amilton dos

doi:10.1590/1981-5271v47.3-2023-0069.ING

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ORIGINAL ARTICLE • Rev. bras. educ. med. 47 (03) • 2023 • https://doi.org/10.1590/1981-5271v47.3-2023-0069.ING copy

Prevalence of suicidal behavior in Medical students

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

Introduction:

Physicians and medical students constitute groups at risk for suicide and suicidal behavior. Suicidal behaviors encompass phenomena ranging from thoughts, planning, and finally death by suicide. Little is known about suicidal behavior among Brazilian medical students.

Objective:

The aim of this study was to assess the prevalence of suicidal ideation, planning and suicide attempt in a sample of undergraduate medical students in Brazil, as well as to identify the sociodemographic, student life aspects and health factors most often associated with suicidal behavior.

Method:

A total of 722 medical students at Unicamp, during 2017 and 2018, voluntarily and anonymously answered a broad questionnaire, including sociodemographic data, aspects of academic life and suicidal behavior. A statistical analysis was performed using the chi-square test, Mann-Whitney test, and multivariate logistic regression. A statistical significance level of 95% was adopted.

Results:

The lifetime prevalence rates of suicidal thoughts, planning and attempts were respectively 196 (27.3%), 64 (8.9%), and 26 (3.6%). In the 30 days prior to the survey, 36 (5%) seriously thought about ending their own lives, and 11 (1.5%) concretely planned to end their own lives. Bullying, presence of mental disorder, seeking mental health care at the university, use of sedatives without a prescription, low socioeconomic level, living alone, religion (atheists, agnostics and spiritualists) and degree of religiousness are the factors that, together, best explain the chance of suicidal behavior.

Conclusion:

Medical students show important prevalence rates of suicidal behavior.

Keywords:
Suicidal Ideation; Suicide Attempt; Medical Students; Student Health

		Have you thought about suicide?	^OR OR: Odds Ratio, 95%CI: 95% Confidence Interval. (95%CI)	p-value	Total (N)
Gender	Female	119 (29.8%)	0.75 [0.5-1.0]	0.09	719
Gender	Male	77 (24.1%)	0.75 [0.5-1.0]	0.09	719
Age	22.4 (±3.2SD) years			0.56	718
Marital status	Single	182 (26.9%)	1.6 [0.6-2.3]	0.67	716
Marital status	Not single	12 (30%)	1.6 [0.6-2.3]	0.67	716
Socioeconomic level (ABEP)	A	89 (24.5%)		0.035	718
	B	89(28.3%)
	C/D/E	18 (42.9%)
Ethnicity or skin color	White	132 (26.4%)		0.66	711
	Black or Brown	33 (26.8%)
	Asian	24 (33.3%)

		Have you thought about suicide?	^{OR (95%CI)} OR: Odds Ratio, 95%CI - 95% confidence interval.	p-value	Total (N)
Year of the medical course	1^st and 2^nd	86 (26.9%)		0.98	715
	3^rd and 4^th	57 (27.7%)
	5^th and 6^th	51 (27.0%)
Bullying	Yes	115 (38.6%)	2.7 [1.9-3.8]	<0.001	716
Self-assessment of academic performance	Above average	60 (20.8%)		0.004	718
	Average	87 (29.2%)
	Below average	46 (37.4%)
	I don’t know	2 (22.2%)
With whom do you live?	Parents	50 (29.6%)		0.002	719
	Alone	68 (35.4%)
	With other people	78 (21.8%)
LGBTQIA+^* *Lesbians, Gays, Bisexuals, Transsexuals, Transvestites, Queers, Intersex, Asexuals; the ‘+’ is used to include other groups and variations of sexuality and gender.	Yes	51 (40.8%)	2.1 [1.4-3.2]	<0.001	704
Do you suffer discrimination because of your sexual orientation?	Yes	42 (38.9%)	1.9 [1.2-2.8]	0.004	704
Do you have a partner?	Yes	91 (26.5%)	0.9 [0.6-1.3]	0.57	707
Do you follow a religion?	No	85 (33.9%)	1.4 [1.1-1.8]	0.004	706
What is your religious affiliation?	Catholic	34 (17.2%)		0.001	712
	Evangelical	22 (24.2%)
	Spiritualist^ Kardecism + diffuse spirituality + ayahuasca + Umbanda + Candomblé + Buddhism + other oriental religions.	46 (36.2%)
	Atheist and agnostic	62 (33.9%)
	Others / More than one religion	32 (28.3%)
Degree of religiousness - frequency	None	104 (29%)		0.01	711
	1-10x a year	59 (32.6%)
	More than 10x a year	33 (19.3%)

		Have you thought about suicide?	^OR OR: Odds Ratio, 95%CI - 95% confidence interval.	p-value	Total (N)
Mental disorder?	Yes	106 (49.1%)	4.6 [3.2-6.5]	<0.001	711
Psychological treatment?	Sim	121 (37.3%)	2.6 [1.8-3.6]	<0.001	716
Psychiatric treatment?	Sim	84 (50.6%)	4 [2.8-5.8]	<0.001	716
Have you taken or are taking psychiatric medications??	Sim	74 (47.4%)	3.2 [2.2-4.7]	<0.001	715
Did you seek mental health care at the University?	Sim	89 (45.9%)	3.4 [2.4-4.9]	<0.001	711
Has anyone in the family had a mental health problem?	Sim	122 (31.4%)	1.5 [1.1-2.1]	0.02	705
Alcohol use (AUDIT >7)		70 (32.3%)	1.4 [1.0-2.0]	0.048	719
Smoking	At least 1x in the last year	100 (33.9%)	1.7 [1.2-2.4]	0.001	711
Marijuana	At least 1x in the last year	95 (29.3%)	1.2 [0.9-1.7]	0.21	711
Non-prescription tranquilizers	At least 1x in the last year	38 (38.8%)	1.8 [1.2-2.9]	0.007	708
Solvents	At least 1x in the last year	48 (32.2%)	1.4 [0.9-2.0]	0.13	705
Ecstasy	At least 1x in the last year	34 (29.3%)	1.1 [0.7-1.7]	0.58	705

Factor	OR	^LL LL and UL are the lower and upper limits, respectively, the 95% confidence interval of the OR.	^UL LL and UL are the lower and upper limits, respectively, the 95% confidence interval of the OR.	p-value
Bullying	1,87	1,27	2,77	0,002
Mental disorder?	3,12	2,07	4,73	0,000
Has sought mental health care at the university	2,05	1,34	3,13	0,001
Uses non-prescription tranquilizers	1,53	1,03	2,29	0,037
Socioeconomic level B	1,27	0,85	1,90	0,239
Socioeconomic levels C/D/E	2,43	1,12	5,18	0,022
With whom do you live? Parents	1,69	1,03	2,76	0,036
With whom do you live? Alone	2,01	1,27	3,19	0,003
Do you have a religion? Catholic	0,45	0,23	0,87	0,018
Do you have a religion? Spiritualist^* * Kardecism + diffuse spirituality + ayahuasca + Umbanda + Candomblé + Buddhism + other oriental religions.	1,05	0,59	1,85	0,870
Do you have a religion? Evangelical	0,82	0,37	1,81	0,634
Do you have a religion? Others / More than one religion	0,81	0,44	1,46	0,481
Degree of religiousness. Yes, more than 10 times a year	0,99	0,51	1,89	0,970
Degree of religiousness. Yes, from 1 to 10 times a year	1,73	1,03	2,90	0,038

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[1] Chief Editor: Rosiane Viana Zuza Diniz. Associate Editor: Kristopherson Lustosa Augusto.