The hidden risk factors behind of suicidal behavior in medical students: a cross-sectional cohort study in Mexico

Margarita L Martinez-Fierro ^1* Jorge R. Reyes-Hurtado ¹ Anayantzin E. Ayala-Haro ¹ Lorena Avila-Carrasco ¹ Leticia A. Ramirez-Hernandez ² Georgina Lozano-Razo ³ Javier Zavala-Rayas ³ Sodel Vazquez-Reyes ¹ Alejandro Mauricio-Gonzalez ¹ Perla Velasco-Elizondo ¹ Vladimir Juarez-Alcala ¹ Ricardo Flores-Vazquez ¹ Ivan Delgado-Enciso ⁴ Dr. Iram Rodriguez-Sánchez ⁵ Idalia Garza-Veloz ^1*

• ¹ Academic Unit of Human Medicine and Health Sciences, Universidad Autonoma de Zacatecas, Carretera Zacatecas-Guadalajara Km.6. Ejido la Escondida, 98160, Zacatecas, Mexico
• ² Unidad Academica de Matematicas, Universidad Autonoma de Zacatecas, Paseo la Bufa, Av. Solidaridad, 98066, Zacatecas, Mexico
• ³ Unidad Academica de Psicologia, Universidad Autonoma de Zacatecas, 98160, Zacatecas, Mexico
• ⁴ School of Medicine, University of Colima, Av. Universidad 333, Las Víboras, 28030, Colima, Mexico
• ⁵ Laboratory of Molecular and Structural Physiology, Universidad Autonoma de Nuevo Leon. San Nicolas de los Garza, 66455, Nuevo León, Mexico

The suicidal behavior in medical students is a significant concern, requiring a thorough understanding for effective intervention and prevention strategies. The aim of this study was to generate a situational diagnosis and establish the risk factors associated with suicidal behavior in medical students. In a cross-sectional cohort design, we surveyed 688 medical students in Zacatecas, Mexico, employing 14 validated questionnaires to assess suicidal behavior, aspects of their lifestyle, perceived support, risk factors, including mental health disorders, and substance use. Univariate and multivariate analyses were performed to examine associations between study variables and suicidal behavior. Suicidal behavior was associated with the following variables: female gender, nonheterosexual orientation, history of psychiatric illness, childhood trauma, bullying, symptoms suggestive of attention-deficit/hyperactivity disorder (ADHD), and contexts of substance use such as unpleasant emotions (p < 0.05). Multivariate analysis revealed that mild tobacco use, alcohol consumption, severe hopelessness, family history of mental disease, material and affective support, significantly increased the odds of suicidal behavior (OR values: 1.56 -8.78, p < 0.05). Anhedonia, sexual orientation, and problematic consumption of cannabis, were significantly associated with suicide attempt with the higher OR values: 9.92, 6.49, and 5.56, respectively. In conclusion, sexual orientation, substance use, and lack of material and affective support were identified as significant risk factors for suicidal behavior and suicide attempts among medical students. Additionally, hopelessness, a history of mental health diseases, and ADHD symptoms were associated with increased risk. These findings underscore the need for targeted interventions that include behavior modification for substance use and the reinforcement of emotional and social support networks.