DEPARTMENT OF COMMUNITY MEDICINE

MALABAR MEDICAL COLLEGE HOSPITAL AND RESEARCH

CENTRE

STUDENTS PROJECT WORK DONE UNDER

COMMUNITY MEDICINE

Done by: 5th semester students

SUICIDAL IDEATION AND ASSOCIATED FACTORS AMONG MBBS

STUDENTS IN NORTH KERALA

Under the guidance of

Dr. Roshni S S (Assistant Professor)

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 CERTIFICATE

This is to certify that the project work entitled “Knowledge, attitude and
perception towards LGBT patients among medical students in Kerala”
submitted to the KUHS(Kerala University Of Health Sciences) in partial
fulfilment of the requirement the community medicine third year MBBS
examination, is a record of original work done by
________________________________ and 10 students during the period
of their study in the Department of Community Medicine, Malabar
Medical College under my supervision and guidance.

Signature of guide Signature of Head of Department

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 TEAM MEMBERS

Team members Registration no

Akshara V M 190010854
Alakananda S 190010855
Aliena Johny 190010856
Alka B C 190010857
Amal swaliha mundoly 190010858
Amalu Anil 190010859
Ameer Suhail A V 190010860
Ameya Ajay 190010861
Amrita S 190010862
Anagha S 190010863
Anila K S 190010864

3
 TITLE

SUICIDAL IDEATION AND ASSOCIATED FACTORS AMONG MBBS STUDENTS IN

NORTH KERALA

INDEX

4
Sno CONTENTS PAGE NO
1 INTRODUCTION 7
2 OBJECTIVES 9
3 REVIEW OF LITERATURE 10
4 HYPOTHESIS 18
5 JUSTIFICATION 19
6 METHODOLOGY 20
7 DATA COLLECTION 21
8 DATA ANALYSIS 22
9 RESULTS 24
10 DISCUSSION 42
11 SUMMARY 44
12 RECOMMENDATION 46
13 LIMITATION 47
14 REFERENCE 48
15 BIBLIOGRAPHY 50
16 QUESTIONNAIRE 51

5
 LIST OF TABLES AND FIGURES:

FIG NO: HEADING OF CHART PAGE NO:

1 Gender 27
2 Year of Study 28
3 Reason for joining MBBS 29
4 Ever been diagnosed with Psychiatric Illness 30
5 Family History of Psychiatric Illness 31
6 History of Suicide in Family 32
7 Voluntary Admission of Substance 33
8 Stressful Events 34
9 Stressful Events 35
10 Comorbidities 36
11 Sleeping Difficulty in Past 12 Months 37
12 Thought of Committing Suicide in Past 12 Months 38
13 Thoughts of Committing Suicide in Past 12 Months 39
14 Made Plan of Committing Suicide in Past 12 40
Months
15 Ever Attempted Suicide 41
16 Relationship between Gender and Suicidal 42
Thoughts
17 CHI SQUARE TEST 43

6
 INTRODUCTION

 Suicidal ideation is the thought or idea about the possibility of ending one’s
own life.
 It is not a diagnosis but is a symptom of some mental disorders and also
occur in response to adverse events without the presence of a mental
disorder.
 Most people who have suicidal thoughts do not go on to make suicide
attempts, but suicidal thoughts are considered as risk factor.

 Medical students are vulnerable to suicidal ideation because of personal

and professional distress resulting from several factors which include
academic stress, lack of pleasure time, financial debt, being away from
home, family problems, substance abuse etc.

7
 Despite easy access to medical care, students are often found to be
reluctant to seek medical help.
 This survey is significant because nowadays the suicide rate among medical
students is increasing at an alarming rate.

8
 OBJECTIVES

 To estimate the prevalence of suicidal ideation among MBBS

students
 To analyse the factors associated with suicidal ideation

9
 REVIEW OF LITERATURE

Suicidal ideations (SI), often called suicidal thoughts or ideas, is a broad term used
to describe a range of contemplations, wishes, and preoccupations with death
and suicide. There is no universally accepted consistent definition of SI, which
leads to ongoing challenges for clinicians, researchers, and educators. For
example, in research studies, SI is frequently given different operational
definitions. This interferes with the ability to compare findings across studies and
is frequently mentioned as a limitation in meta-analyses associated with
suicidality. Some SI definitions include suicide planning deliberations, while others
consider planning to be a discrete stage.

Beyond the lack of clear nomenclature, there are other concerns. A systematic
review of the numerous interprofessional clinical guidelines for suicide yielded no
consensus on a clinical gold standard for assessing and managing SI or people at
risk of suicide. Although scales to measure depression, SI and risk for suicide exist,
none produce a score that is sufficiently reliable or clinically useful in predicting
the very small subgroup of suicide idolators whose death by suicide is imminent.
(The American Psychiatric Association Practice Guidelines for Psychiatric
Evaluation of Adults, 3rd ed. 2016, p. 19).

It is evident that suicidal ideations present in a "waxing and waning manner" , so

the magnitude and characteristics of SI fluctuate dramatically. It is critically
important for healthcare professionals to recognize that SI is a heterogeneous
phenomenon. It varies in intensity, duration, and character. As there is no
"typical" suicide victim, there are no "typical" suicidal thoughts and ideations.
Unfortunately, healthcare records often document SI in a binary yes/no fashion,
although it encompasses everything from fleeting wishes of falling asleep and
never awakening to intensely disturbing preoccupations with self-annihilation
fuelled by delusions. Therefore, thoroughly assessing and monitoring the pattern,
intensity, nature, and impact of SI on the individual and documenting this
accordingly is important for all healthcare professionals. It is also important to
reassess SI frequently due to its fluctuating pattern.

10
The magnitude of SI fluctuations was studied using an ecological momentary
assessment method. Individuals who attempted suicide in the past year plus a
sample of suicidal in-patients recorded the intensity of their suicidal thoughts
from hour to hour for four weeks. Analysis of these data showed dramatic
fluctuations in the intensity of SI by all participants. All participants had SI, which
varied in its intensity, either upwards or downwards, by one standard deviation
on most days. Many had one standard deviation fluctuations several hours apart
within the same day. This knowledge is important for all healthcare professionals
to consider and highlights the need to monitor fluctuations and not dismiss the
possibility of sudden increases in suicidal urges, even when the current level is
mild, and the individual currently has control over them. Additionally, SI is
considered a better predictor of lifetime risk for suicide than imminent risk, so
assessments should include describing the characteristics and impact of prior SI as
well as current

Globally, the World Health Organization (WHO) collects mortality data, including
the prevalence and means of suicides, for all member nations. Beginning in 2013,
after declaring that the rising suicide rates constituted a "global public health
crisis," they advocated for evidence-based strategies to prevent suicides globally.
In developing nations, where the ingestion of pesticides was the leading cause of
fatal attempts, suicide prevention efforts promoted using less toxic pesticides.
Evidence exists that reductions in suicides can be achieved by reducing access to
lethal means, but this requires a comprehensive systemic approach that includes
collaboration between policy-makers, healthcare professionals, and interventions
to reduce modifiable risk factors

Active and Passive Suicidal Ideation

"Active" suicidal ideation denotes experiencing current, specific, suicidal

thoughts. Active SI is present when there is a conscious desire to inflict self-
harming behaviors, and the individual has any level of desire, above zero, for
death to occur as a consequence. The probable lethality of their actions, based on
the means used for the suicide attempt, is not the focus. Rather, the individual's
expectation that their attempt could produce a fatal outcome is the key
consideration.

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Example of an Active SI assessment item

Miller et al. (1991) Modified Suicidal Ideation Scale

 "Over the past day or two, when you have thought about suicide, did you
want to kill yourself? How often? A little? Quite often? A lot? Do you want
to kill yourself now?"

"Passive" SI refers to a general wish to die but when there is no plan of inflicting
lethal self-harm to kill oneself. Passive SI includes indifference to an accidental
demise which would occur if steps are not taken to maintain one's own life.
Passive SI receives less attention from clinicians and researchers than active SI.
Although most research studies do not distinguish between active and passive SI,
few studies focus on passive ideations. One author pointed out the underlying
assumption of healthcare professionals is that the desire for death is not typically
thought of as a harbinger of more severe suicidal outcomes.

Examples of Passive SI assessment items

Beck et al. (1979) Scale for Suicidal Ideation (SSI) was the first to measure "passive
suicidal desire"

 0 = Would take measures to save [one's own] life

 1 = Would leave life/death to chance
 2 = Would avoid steps necessary to save or maintain life

European Depression Scale item,

 "In the past month, have you ever wished you were dead?"

Miller et al. (1991) Modified Suicidal Ideation Scale

 "Would you deliberately ignore taking care of your health? Do you feel like
trying to die by eating too much (too little), drinking too much (too little), or
by not taking needed medications?"
 Suicide Risk Assessment and Suicide Risk Formulation
 The suicide risk assessment (SRA) focuses on identifying the risk factors and
protective factors for any given individual. This is followed by the suicide
risk formulation (SRF), which assigns a level of imminent suicide risk. The

12
 subsequent triage and treatment plans are based on the SRF. One of the
concerns discussed in the literature is the emphasis on the patient's
communication of suicide ideation. The American Psychiatric Association
(2016) Practice Guidelines for the Psychiatric Evaluation of Adults states,
"When the clinician is communicating with the patient, it is important to
remember that simply asking about suicidal ideas or other elements of the
assessment will not ensure that accurate or complete information is
received." (p. 21).
 Not all ideators are apt to share their SI. Over a dozen research studies
have shown that 75% of patients who die by suicide denied SI the final time
they were asked by a healthcare professional. Typically, their death by
suicide occurred within the month of their last visit . Berman completed
chart reviews of 157 patients throughout the USA who died by suicide
within 30 days of being evaluated by a healthcare professional. All victims
were either receiving in-patient or out-patient mental health care; or were
evaluated in an emergency department or by their primary care
professional. The Joint Commission requires healthcare professionals in
these practice settings to assess SI for anybody at risk of suicide. However,
despite being asked, the majority (66%) denied SI. Within two days, 50% of
these individuals who had denied SI ended their lives by suicide. Berman
noted that the denial of SI provides a basis for patient discharge if the
individual was admitted due to SI. While this may be an incentive for a
patient to deny SI, particularly if they want to be discharged, caution should
be exercised. Berman states that too frequently, clinicians assume that SI
must exist for suicide to occur when SI is only a risk factor for suicide.
Additionally, SI is a weak predictor of increased lifetime risk, it does not
predict imminent risk -- but, then again, nothing does.
 Ribet et al. examined the root causes that may have contributed to 141
veteran suicides within a week of their hospital discharge. Flaws in
communication were frequently cited. It was also noted that almost half of
the suicides occurred following an unplanned discharge. The Joint
Commission released multiple sentinel event warnings over the past
decade based on reports of patient deaths in hospitals or shortly after
discharge from mental health units or release from emergency
departments. They stated, "there is no typical suicide victim” and cautioned
against assuming only certain individuals are at risk based upon their
diagnosis or treatment setting.

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  Previous studies have indicated that suicidal ideation is prevalent in
medical students. The factors related to school admission processes and
medical school environments contribute to this high prevalence. The
consequences of suicidal ideation include suicide attempts and completed
suicide. This article reviewed the recent literature on suicidal ideation in
medical students in kerala

A systematic review of the literature was conducted to identify the articles

published on the prevalence of suicidal ideation and associated factors in medical
students

The most frequent factors said to be associated with suicidal ideation in medical
students were depression and depressive symptoms, a previous diagnosis of a
psychiatric disorder, lower socioeconomic status/financial difficulties, having a
history of drug use, and feeling neglected by parents. We did not find studies on
interventional studies on suicidal ideation in medical students published in recent
years.

About 1 million people die from suicide every year, and in the past 45 years, the
rate of suicide has increased by 60% worldwide. Suicide is the second leading
cause of death among young people after car accident. Medical doctors are one
of the high-risk groups for suicide. It seems that this problem arises during
medical school. Medical students in their first year of studies have similar rates of
psychological morbidity to the age-matched general population, but experience a
worsening of their mental health as they progress through medical studies. In
addition to depression, suicidal ideation is a strong predictor of attempted
suicide. Suicidal ideation includes thinking about, considering, or planning
suicide. The rates of suicidal ideation in medical students vary widely, ranging
from 6.0% to 43.0%. In addition, female medical students have been found to
have higher rates of suicidal ideation than male students. Medical students are
vulnerable to suicidal ideation because of personal and professional distress
resulting from several factors. These include information overload, lack of leisure
time, financial debt, being away from home, academic load, and work
pressure. Also, contact with suffering, confronting with death, and caring for
14
vulnerable persons could be other factors that trigger emotional problems in
medical students. Some studies also showed that medical students experience
depression, burnout, and mental disorders at higher rates than the general
population, with deterioration over the medical course. Research has also
reported that school admission processes led to the selection of individuals at risk
of vulnerability to depressive disorders and suicidal ideation, namely the traits of
perfectionism, obsession, neuroticism, and introversion, as well as low self-
esteem. Negative consequences of poor mental health among medical students
include poorer academic performance, substance use (including alcohol),
dropout, and suicide. Despite their knowledge of the negative consequences,
alcohol and drug use are quite high among medical students and do not differ
significantly from other university students.

Despite easy access to medical care, medical students are often reluctant to seek
psychiatric help. Concerns about time, confidentiality, stigma, and the potential
negative effects on their careers are associated with undertreatment of medical
students for mental health problems. Identification of the prevalence and factors
associated with suicidal ideation in medical students can help the timely detection
and provision of appropriate interventions to reduce the magnitude of the
problem. Furthermore, intervening at an early stage of medical training provides
a way to help prevent later mental health problems, including the risk of suicide
once students become practicing physicians.

 Significance of Suicidal Ideation Scale:

 The rate of suicide is alarmingly increasing owing to varying affecting

factors in the present times. According to World Health Organization, close
to 800 000 people die due to suicide every year, which is one person every
40 seconds (https://www.who.int /mental_health/).Suicide is the second
leading cause of death among 15-29-year-olds globally and the rate of
suicide is 8 lakh every year (India Today, 2018). Suicide is the leading cause
of death in the 15-39-year age group (Economic Times, 2018). Statistics of
Suicide in India reports, every year, more than 1,00,000 people commit
suicide in India. There are various causes of suicides like
professional/career problems, discrimination, sense of isolation, abuse,

15
 violence, family problems, mental disorders, alcoholism, financial loss,
chronic pain and more (Ngilneii, 2017). The range of suicidal ideation varies
from self-harm and unsuccessful attempts, which may be deliberately
constructed to fail or be discovered, or may be fully intended to result in
death.
 Suicidal ideation is “a form of mild suicidal behaviour, a predictor of suicidal
behaviour, a clinical phenomenon in its own right” (Linden, Zaske & Ahrens
2003). Although most people who undergo suicidal ideation do not go on to
make suicide attempts, a significant proportion do. Suicidal ideation is
generally associated with depression; however, it seems to have
associations with many other psychiatric disorders, life events, and family
events, all of which may increase the risk of suicidal ideation. Currently,
there are many different treatment options available for those experiencing
suicidal ideation. (Gliatto & Rai, 1999).The increasing suicidal rate and that
too among the youth and the availability of so many suicide prevention
organizations makes the formulation of the tool significant with human
concern and social responsibilities

WHO WMH-CIDI SCALE is the scale used in this study for the assessment of
suicidal ideation among medical students

The WHO WMH-CIDI is a comprehensive, fully-structured interview designed to

be used by trained lay interviewers for the assessment of mental disorders
according to the definitions and criteria of ICD-10 and DSM-IV. It is intended for
use in epidemiological and cross-cultural studies as well as for clinical and
research purposes. The diagnostic section of the interview is based on the World
Health Organization’s Composite International Diagnostic Interview (WHO CIDI,
1990).

The WHO WMH-CIDI allows the investigator to:

– Measure the prevalence of mental disorders

– Measure the severity of these disorders
– Determine the burden of these disorders

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– Assess service use
– Assess the use of medications in treating these disorders
– Assess who is treated, who remains untreated, and what are the barriers to
treatment

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 HYPOTHESIS

Suicidal ideation among medical students is high

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 JUSTIFICATION

 Suicide among medical students continue to be a serious problem even

now.
 Right from the beginning to the end of medical course, students face lot of
problems and challenges which are of far greater magnitude than the
students of other courses.
 Gaps exist in knowledge of medical student suicide rates, risk factors and
targets for intervention. Significant barriers have impeded information
collection.
 Yet more comprehensive data collection is needed to understand suicide
risk in this population and to implement and improve effective intervention
strategies .
 No significant studies were documented till now under the study setting.
 Hence, in the current study the magnitude of suicide ideation, attempt and
their possible association with various factors were assessed among the
MBBS students in North Kerala for the first time.

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 METHODOLOGY

Study setting – Medical colleges in North Kerala

Study design - Cross sectional study
Study period - 25/7/2022-28/9/2022
Study population - MBBS students of North Kerala
Inclusion criteria - Students from first year to final year
Exclusive criteria - Those who are not willing to participate

DATA COLLECTION

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 Study tool- Pretested semi structured questionnaire was distributed to the
participants and were asked to complete the questionnaire via google form.
Questionnaire was categorized as follows :
 Sociodemographic data
 Questions to assess suicide ideation
 Questions to assess factors associated with suicidal ideation .Data of
suicidal ideation was assessed by WHO-CIDI suicidal ideation questionnaire

 From the questionnaire we selected 3 questions that specified the

psychological behaviour of the person towards suicide in the past 12
months
Among these if the respondent provided ‘YES’ answer to the question
(Have you ever thought of committing suicide in the past 12 months after
joining MBBS) is considered to have had suicidal ideation or increased risk
of attempting suicide

ref :suicide ideation attempt and determinants among medical students

North West Ethiopia

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 DATA ANALYSIS

 The collected data was entered in excel and the obtained data was
analysed using SPSS version 20 software.
 Quantitative data expressed as mean and SD and qualitative data as
frequencies and percentage.
 Chi square test was done to see the association between risk factor and the
outcome.
 Those variables a p value <.05 is considered as significant.

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23
 RESULTS

SOCIODEMOGRAPHIC DATA

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 GENDER (N=256)

Among the 256 students studied, 181 students were females and 75 were males.
Majority of the student were females(29.3%) rest were males(70.7%)

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 YEAR OF STUDY
(N=256)

Year of study
160
147
no of students

120
80
40 48
43
0 18
1st year 2nd year 3rd year 4th year
Year of study

Among the 256 students studied, 147 were third years, 48 were fourth years, 43
were second years and 18 were first years

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 REASON FOR JOINING MBBS
(N=256)

Reason for joining MBBS

11
22

48

175

self interest parental pressure social pressure peer pressure

Among the 256 students studied, 175 joined MBBS with selfinterest,48 with
parental pressure,22 with social pressure and 11 with peer pressure

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 PSYCHOLOGICAL REASONS

EVER BEEN DIAGNOSED WITH PSYCHIATRIC ILLNESS

(N=256)

9.8%,25

90.2% 231

Yes No

Among the 256 students studied, 25 of them had been diagnosed with psychiatric
illness (9.8%)

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 FAMILY HISTORY OF PSYCHIATRIC ILLNESS
(N=256)

Family history of psychiatric

illness

16%

84%

Yes No
Among the 256 students studied, 42 of them had family history of psychiatric
illness in the family (16%)

HISTORY OF SUICIDE IN FAMILY

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 (N=256)

Among the 256 students studied, 54 of them had history of suicide in the family
(21%)

VOLUNTARY ADMISSION OF SUBSTANCE

30
Among the 256 students studied, 188 of them never used any abusive substances
(73.4%), 53 of them are currently using abusive substances (20.7%) and 15 of
them used the abusive substances before and are not currently using them (5.9%)

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 STRESSFUL EVENTS
(N=256)

Stressful Events

16%

84%

No Yes

Among the 256 students studied, 168 ie,84% of them had experienced stressful
events like exam issues, financial, relationship, social, family, ragging, academic
issues etc.

STRESSFUL EVENTS

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 Ragging 11,4.3%

Academic issues 42,16.3%

Financial issues 45,17.5%

Not applicable 47,18.3%

Social rejections/isolation 51,19.8%

Family issues 62,24.1%

Relationship issues 64,24.9%

Exams 154,59.9%

Others 5,2%

0 20 40 60 80 100 120 140 160 180

COMORBIDITIES
(N=256)

33
Among the 256 students studied, 13 ie,5% of them suffered from comorbities like
hypothyroidism , PCOD, Asthma, Hereditary spherocytosis, CSOM and chronic
heart disease.

SLEEPING DIFFICULTY IN PAST 12 MONTHS

(N=256)

34
Among the 256 students studied, 146 of them suffered from difficulty in sleeping
in the past 12 months(57%)

35
 SUICIDAL IDEATION

THOUGHT OF COMMITING SUICIDE IN PAST 12 MONTHS

Among the 220 students studied,168 had thoughts of committing suicide in past 12
months (20.3%)
(36 students among 256 under the study were not sure whether they had suicidal
thoughts)

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MADE PLAN OF COMMITING SUICIDE IN PAST 12 MONTHS
37
 (N=256)

Among the 233 students studied,21 had planned for committing suicide in past 12
months (8.2%)
(23 students among 256 under the study were not sure whether they had planned
for committing suicide in past 12 months)

38
 EVER ATTEMPTED SUICIDE
(N=256)

214

Among the 248 students studied,15 had attempted suicide(5.9%)

(8 students among 256 under the study were not sure whether they had attempted
suicide)

GENDER DISTRIBUTION FOR SUICIDAL IDEATION

39
 140
121,66.9%
120
100
80
60
47,62.7%
40 34,18.8%
18,24.0%
20
0
Yes No

Female Male

The prevalence of suicidal ideation among females is 66.9% and in males 62.7%
respectively.
Hence our study shows that the female students have higher tendency of suicidal
ideation than the male students.

40
41
 DISCUSSION

 In the current study, the prevalence of suicide ideation thoughts and attempt
during their medical education was found to be 65.6% and 5.9 %
respectively.

 In a study conducted on suicidal ideation among medical students in New

Delhi , showed that the overall prevalence of suicidal ideation among the
sample of medical students was 53.6%. 2.7% of them had also attempted to
commit suicide at least once.

 The variation may be due to distinctions in study designs, sample size, and
the socio-cultural variations between students in North Kerala and New
Delhi.

 From the studies of Taiwan, China, Australia, and Turkey, the prevalence
estimated at 11.5%, 17.7%, 11.3%, 12%, respectively

 Regarding the prevalence of suicide ideation, our result are higher than
those of reported
 The prevalence of suicidal ideation among males and females was found to
be 45.6 % of males and 62.2% females showing suicidal ideation from the
study conducted in New Delhi

 Where as in our study, suicidal ideation among females is 66.9% and in males
62.7% - shows that males have higher prevalence compared to above
mentioned study

 According to the study on Chronic stress and suicidal thinking among medical
students, shows that chronic exposure to stressful conditions may lead to
psychological discomfort, mental health problems, depression and anxiety
symptoms which might increase risk for suicidal thinking, which is similar to
the results of our study.

42
 In a meta-analysis on risk factors for Suicidal Ideation and Suicide attempt
among medical students , smoking cigarette, family history of mental illness
and suicidal behaviour were not significant risk factors for Suicidal ideation,
which is similar to the results of our study.

43
 SUMMARY

 Suicide is an emergency and serious public health issue in India.

 Medical students are found to be the vulnerable groups.
 Despite having one of the world’s largest medical education consortium,
India lacks comprehensive and nationally representative data on suicide
deaths among medical students unlike the one found in most of the
developed nations of the world
 Our survey on suicidal ideation among MBBS students recorded 256
responses and study revealed that 65.6 % have suicidal thoughts.
 5.9% had tried to attempt suicide.
 70.8% respondents were females and 29.2% are males. Among this 66.9%
of females and 62.7% of males have suicidal tendency
 About 16.3% of the respondents having family history of psychiatric illness
 21.4% having history of suicide in family.
 59.9% of students facing stressful events like exams ,relationship issues.
 42.4% having sleeping difficulties .

 Chi square results show that there’s statistical significant association

between reason for joining MBBS and stressful events in the past 12
months with suicidal ideation
 In spite of joining MBBS out of self interest 82.2% of them shows suicidal
tendency.
72.1% of students who had experienced stressful events in the past 12 months
had suicidal ideation

44
RECOMMENDATIONS

45
 LIMITATION

Since it is self reported the responses are inaccurate due to difference in

interpretation of the questions by the respondents.
Main Limitations are
•Sampling method used is convenience sampling.
•As suicide ideation being a sensitive topic, there is more chance of getting
incorrect response.

46
 REFERENCE

1. World Health Organization. Preventing Suicide: A Global Imperative. Geneva:

World Health Organization; 2014

2.Moutinho Coentre R, Luisa Figueira M.Depression and suicidal behavior in

medical students: a systematic review. Curr Psychiatry
3.Carson AJ, Dias S, Johnston A, et al. Mental health in medical students. A case
control study using the 60 item General Health Questionnaire.
Scott Med J.
4.Rosal MC, Ockene IS, Ockene JK, Barrett SV,Ma Y, Hebert JR. A longitudinal
study of students' depression at one medical school. AcadMed.
5.Ricardo Coentre and Carlos gois,suicidal ideation in medical students:recent
insight
6.Nimisha D Desai,prevalence and prediction of suicide ideation among
undergraduate students
7.Updesh Kumar ,manas k mandal,suicidal behavioural -assessement of people at
risk
8.Rajiv radhakrishnan and chittaranjan Andrade _suicide:An Indian perspective
9.World health organisation -south east Asia -india-suicide
10.Lakshmi Vijayakumar -indian research on suicide
11.aakanksha Singh, Ganesh Kumar saya ,vikas menon -journal of public
health,vol 43,issue 4 -prevalence of suicidal ideation ,plan attempts and it's
associated factors in skeletal rural and urban areas of puducherry,India
12.chronic stress and suicidal thinking among medical students.Anna Rosiek 1,*,
Aleksandra Rosiek-Kryszewska 2, Łukasz Leksowski 3 and Krzysztof Leksowski
13.Prevalence and predictors of suicide ideation among undergraduate medical
students from a medical college of Western India Nimisha D Desai et al. Med J
Armed Forces India
14.Risk factors for suicidal ideation and suicide attempt among medical students:
A meta-analysis

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15.Suicidal ideation among medicalstudents of Delhi-cross sectional study by
Abhinav Goyal, Jugal Kishore, Tanu Anand, Akanksha Rath

BIBLIOGRAPHY

48
 1. Textbook of Preventive and Social Medicine 26th Edition -K PARK
2. Exam Preparatory Manual for undergraduate PSM 4th Edition -Vivek Jain

QUESTIONNAIRE

49
Section 1: Demography
1. Age
2. Gender
● Male

● Female

● other
3. Year of joining MBBS
4. Year of study
● 1st year

● 2nd year

● 3rd year

● 4th year
5. Reason for joining MBBS
● Parental pressure

● Peer pressure

● Social pressure

● Self interest

● other
6. Marital status of parents
● Married, living together

● Married, separated

● Divorced

● Not married, living together

50
 ● One and or both parents deceased

7. Color of ration card

● White

● Blue

● Pink

● Yellow

● Other

Section 2: Psychological reasons

1. Have you ever being diagnosed with a psychiatric illness
● YES

● NO
2. Do you have family history of psychiatric illness
● YES

● NO
3. Have you ever had suicidal thought
● Before joining MBBS

● After joining MBBS

● Never
4. Have you ever attempted suicide
● YES

● NO
5. Has there being any history of suicide in your
51
 family or any close relatives
● YES

● NO

6. Voluntary admission of substance abuse

● Used before, not currently using

● Alcohol

● Smoking

● Other forms of nicotine

● Hard drugs

● I have never used any substance

7. In the past, one month I had experienced the following stressful
events in my life
● Not applicable

● Relationship issues

● Financial issues

● Social rejection/isolation

● Family issues

● Exams

● Ragging issues in college

● Academic issues including harassment by teacher

● other
8. Do you have any comorbidities or chronic illness

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 ● YES

● NO
If any, mention
9. Did you have any sleeping difficulty in past 12 months
● YES

● NO

Section 3: Suicide ideation

1. Have you ever thought of committing suicide in the past 12
months after joining MBBS
● YES

● NO

● Don’t know
2. Have you ever made a plan of committing suicide after joining
MBBS
● YES

● NO

● Don’t know
3. Have you ever attempted suicide
● YES

● NO

● Don’t know

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