In the current study, the magnitude of suicidal ideation, attempt, and their possible association with various factors were assessed among medical students in Ethiopia for the first time. The prevalence of lifetime suicidal ideation and attempts were found to be 14% and 7.4%, respectively. Regarding prevalence of suicide ideation, our result is consistent with those of reported magnitude other studies carried out among medical students in Taiwan, China, Australia, and Turkey, in the prevalence estimated at 11.5%, 17.7%, 11.3%, 12%, respectively (22, 32, 33).
On the other hand, this finding is higher than a study done in China, the magnitude reported at 7.5% (17). The variation may be because of instrumental, for instance, in China, suicidal ideation among medical students was assessed item nine of patient health questionnaire the scale using the phrase “thoughts that would be better off dead or hurting yourself.” However, the prevalence of suicidal ideation in the current study is lower than the study done in South Africa among medical students were asked surrounding suicidal ideation, from the standardized Paykel’s instrument, which has been used to assess suicidal ideation was 32.3% (21), in India, by using do you have thought suicide/ death? was 53.6% (34), in Turkey and Austria, students were asked five questions with dichotomous(yes/no) response format related to ever suicidal behavior were 27.3% and 37.8%, respectively (33) and in the USA, the impact of medical school on student mental health by using three suicide questions from the inventory developed by Meehan was 29.9% (35). The variation may be due to distinctions study designs, sample size, and the socio-cultural variations between Ethiopia, and the other countries. In addition to the above, the difference was suicidal ideation and reactions to suicide among medical students were cultural factors of the countries (31).
Regarding factors associated with suicidal ideation, female sex had five times more risk of suicidal ideation compared with male medical students. This was supported by those of other studies carried out a meta-analysis among the university students in China female students had higher suicidal thoughts than male students(10), in Pakistan female medical students a greater risk of suicidal ideation than male students(5), and another meta-analysis was done among medical students and medical professionals, psychological distress was higher for female physicians and medical students compared with males (15). Female physicians have a greater risk of suicide than other women (2).
In this study, medical students with depression were strongly associated with suicidal ideation. The odds of suicidal ideation were ten times higher who had depression than those without depression. Our results are consistent with findings reported in other studies that have shown medical students’ depression was the most common predictor of suicidal ideation (11, 14).
In this study, current khat chewing was 4.46 times more risky for the development of suicidal ideation compared to students who had no suicidal ideation. Which was supported by other studies done among the university students of Ethiopia, Current khat chewing was nearly two times increased suicide (13), having drug misuse among medical students were a strong predictor of suicidal thoughts (20). Suicide risks among those who abuse substances were high in different studies (2).
Poor social support increased more than four times among medical students compared to their counterparts in this study. This is in line with a study done in Ethiopia (13). Lack of social support was two times risk of suicidal ideation among the University students in Ethiopia compared to students had moderate or good social support. Suicidal ideation was highly prevalence among people who had less social support from their family, friends, and other relatives(36).
On the other hand, our result of suicide attempts was in line with those of other studies conducted among medical students. For example, a study in South Africa medical students reported magnitude was 6.2% (21) and a cross cultural investigation among similar study participants in Turkey the prevalence of suicide attempts estimated at 6.4% (33). Similarly, the prevalence of suicide attempts among study participants was higher than those of other studies conducted in United Arab Emirates 1.8% (32), Germany, suicide attempts among medical students and young doctors was assessed by using one question from patient health questionnaire nine was 1.4% (32), in Delhi, 2.6% had attempted to commit suicide at least once in their life (33), China pooled prevalence of suicide attempts was 2.7% (9).
Our study revealed that the female sex was eight folds of attempts suicide among medical students compared to their counterparts. This is supported by a study done in Nepal, girls were nearly two folds of more likely to attempt suicide compared to boys (37). There were different studies documented in Uganda, South Africa, and Iran, females were more risky to have suicide attempt compared to males (38-40). Women attempt suicide or suicidal thoughts three folds as often as males (2).
In this study, depression and other history of mental illness were strong predictors for suicide attempts. Depression is more than ten times risky for suicide attempts compared with those who had no depression and history of mental disorders was more than fifth folds of suicide attempts compared to students who had no history of mental illness. These were agreed from the previous studies done in South Africa (21), and (18). Previous diagnosis of depression or psychiatric disorders had strong correlations with suicide attempts (21) and suicidal behavior or attempt was higher in medical students who had depression (12). Depression disorders accounts for 80% of suicide attempts while previous psychiatric disorders risk for suicide is three to twelve times that of non-psychiatric patients, but the degree of risk varies depending on sex, age, diagnosis, and treatment (2). Since the questionnaire is self administered the participants may not give genuine response. A cross-sectional study design cannot permit conclusions for some variables, for example, to decide whether social anxiety symptoms are risks for or consequence. This study also was not included sixth year medical students so this is not representative all medical students. This finding is likely only to hint at the complex interactions between suicidal ideation and attempt with explanatory variables (risk factors). Moreover, this study was on self-reported data, which might reduce objectivity and introduced the possibility of reporting bias. This study, conducted in one university in Ethiopia, which confines generalized to other settings and finally, the use of retrospective items in the questionnaire may have incurred recall bias.