A study of the prevalence and correlates of suicidal ideation and psychiatric morbidity among undergraduate medical students in Tamil Nadu, India

Abstract

Background: Understanding the risk factors for psychiatric morbidity and suicidal ideation among medical undergraduates is gaining importance given the increasing trend in suicides among this population. This study aimed to analyze the prevalence of suicidal ideation, depression, and anxiety among medical undergraduates and to compare their socio-demographic, familial, and behavioral characteristics to identify potential risk factors.

Methods: We performed a cross-sectional online survey among 500 consenting medical undergraduates in Tamil Nadu, South India. Ethical approval was obtained. We used a semi-structured proforma to obtain the sociodemographic, family relationships, and lifestyle information of our participants. The beck depression inventory and the hospital anxiety depression scale were used to quantify depression and anxiety among our students. We performed univariate and multivariate logistic regression analyses and computer-based predictive modelling using Classification and Regression Tree (CART) analysis on our data.

Results: We found a prevalence of 20.2% for suicidal ideation, 35.8% for depression, and 53% for anxiety among our students. Significantly increased odds of having suicidal ideation were observed among students who were from disharmonious families (odds ratio [OR] = 10.80; CI: 9.30–30.15; p = 0.008), had poor satisfaction with maternal love (OR = 2.21; CI: 0.79–3.34; p = 0.03), frequently visited shopping malls (p = 0.05; OR = 5.71; CI: 0.88–17.12) and never exercised (OR = 1.95, CI: 0.81–2.74; p = 0.03). Significantly lower odds of suicidal ideation were observed among students who consumed food with friends in restaurants on weekends (OR = 0.08; CI: 0.01– 0.045; p = 0.005). We observed lower odds of anxiety and depression among students who visited religious places (OR = 0.49; CI: 0.04–3.13; p = 0.05) and places of sightseeing (OR = 0.45; CI: 0.07–2.94; p = 0.05), respectively. Among students who reported difficulty in decision-making, CART analysis predicted 36.1% of suicidal ideation, 74.6% of depression, and 80.5% of anxiety. Increased fatiguability, feelings of unattractiveness, and feelings of being punished predicted depression among 49.2% of our students. Ideas of guilt and blaming oneself predicted anxiety among 66.5 and 68.4% of our students, respectively.

Conclusions:One-fifthofmedicalgraduatesreportedsuicidalideation,one-thirdexperienceddepression,andhalf had anxiety, with risk factors including poor relationships with family and classmates, female gender, academic stress, substance use, and lack of exercise. CART analysis identified depression as the strongest predictor of anxiety and suicidal ideation, with decision-making difficulties and fatigue being significant contributors. CART has demonstrated high accuracy, highlighting its value in clinical research.