Suicidal Behavior Risk And Its Related Factors In Medical Undergraduate Students

BackgroundSuicide,identified as acting deliberately or voluntarily to end one’s own life,is one of the most serious public health problems in the world.Suicide is the second leading cause of death among people aged 15 to 29.Medical students at this age,not only need to complete medicine academic requirements of learning theoretical knowledge and skills,but also face the intensified competition for jobs,current tense physician-patient relationship and a series of social environmental problems.The development of psychological health is not mature,and they may lack of the ability to cope with difficulties and handle problems,which increase the potential risk for suicide.The aim of this study was to find right measurements for the screening of suicide high-risk groups,to identify the influence factors for suicidal behavior risk,effectively to reduce the suicide rate,which might provide scientific theory basis for implementation of suicide prevention and intervention strategies.MethodsThis study was carried out in Jinan,Shandong province from November 2016 to January 2017,and the multi-stage sampling method was adopted to determine the interviewees.We selected two colleges similarly as the primary sampling unit from each university.Stratified on grades,three or four classes from each grade were randomly selected to be the secondary sampling units.All students in the sampled classes present on the day of the survey were invited to complete the questionnaires.This study used self-administered questionnaires to collect data,including social demographic characteristic(like gender,age,grade,household type,nationality,height,weight,grade,sleep status,smoking and drinking,parents’ marital status,one-child or not,family economic level,etc.).The suicidal behavior risk was measured by revised suicidal behavior questionnaire(SBQ-R).Depression Anxiety and Stress Scale(DASS-21),Beck Hopelessness Scale(BHS),Meaning in Life Questionnaire(MLQ)and Orientations to Happiness Scale(OTH)were taken to measure psychology factors.Coping skills was measured by Brief Cope Scale(BCS).The students were asked to fill in the questionnaire anonymously according to the standard instruction during the class time,and the average time was 20-30min.After finishing,the questionnaires were collected,sorted and numbered by the responsible investigators.The Epidata 3.0 software was used to establish the database,and the statistical analysis of the obtained data was performed by SPSS 24.0 and Amos 17.0 software.The Cronbach’s alpha and the half-reliability Spearman-Brown coefficient test scale was calculated for internal consistency.The structural validity of the test scales was analyzed by exploratory factor analysis and confirmatory factor analysis.We used t test or single factor variance analysis to describe continuous variables and the chi square test to analyze categorical variables.Pearson correlation and multivariable logistic regression model were analyzed,corresponding odds ratio(OR)with 95%confidence interval.The structural equation model was used to explore the effects among correlated variables on suicidal behavior risk.ResultsTo evaluate quality of measurements in the target population,most of the scale and subscales’ Cronbach ’s alpha values and Spearman-Brown coefficient values were above 0.7,showing good internal consistency.Exploratory factor analysis result showed that,the depression anxiety stress scale(DASS-21),orientation to happiness(OTH)scale and brief cope scale(BCS-28)accumulated to explain variance as 52.072%,53.250%and 57.942%,respectively.Except DASSs-21,the items of the remaining scales were loaded in the original dimension,and the loading was above 0.5,and the communality were all above 0.3,indicating that the scale had satisfactory structural validity.We conducted confirmatory factor analysis and knew adequate fit of the model to the sample.As a whole,the scales used in this study had a relatively satisfactory factor structure and reliability estimates.There were 706(34.0%)medical students having brief passing suicidal thoughts,121(5.8%)ones having plan to kill himself at least once,and 24(1.2%)attempted to suicide.In the past year,463(22.3%)students had suicidal thoughts,252(12.2%)told other people they were going to commit suicide or might to do it.The number of students who thought to be possible suicide attempts in the future were 141(6.8%).In this study,the total score of SBQ-R was 4.86±2.47 for 2074 students,including 428(20.6%)in the high suicide risk group with a total score of 7 and above,and 1 646(79.4%)in the low suicide risk group.The univariate logistic regression analysis found that study scores,sleep situation,drinking history,parents marriage,family economic level,depression,anxiety,stress,hopelessness,the meaning of life-searching and-presence,positive coping style,negative coping style and happiness orientation were associated with suicidal behavior risk(P<0.05).After adjusting the variables,the multi-factor regression analysis showed that the inharmonious parents’ marriage was positively correlated with suicidal behavior risk compared with a harmonious parenting relationship(OR=2.113,95%CI:1.670～2.674).In psychological factors,depression(OR=1.101,95%CI:1.047～1.158),stress(OR=1.046,95%CI:1.003～1.090)and hopelessness(OR=1.023,95%CI:1.011～1.036)were positively related to suicidal risk.Negative avoidance in coping style was also significantly correlated with suicidal behavior risk(OR=1.026,95%CI:1.004-1.049).The sense of meaning of life(OR=0.973,95%CI:0.948～0.999)had a signficantly negative correlation with suicidal behavior risk.The remaining variables were not significantly associated with suicidal behavior risk.The structural equation model(SEM)result showed that negative psychological emotion was the main risk factor of suicidal behavior risk.The standardized total effect and direct effect was 0.424 and 0.385,separately,and the standardized regression weight was 0.385.In the model,the negative coping style had direct effect(0.092)on suicide and its standardized regression coefficient was 0.092.The regression coefficient of meaning in life was-0.049,moderating the indirect effects(-0.126)between negative emotion and suicidal behavior risk.There was a positive correlation between inharmonious parent’s marital status and negative emotions,both of which had direct effects(0.140)on suicidal behavior risk and its standardized regression coefficient was 0.140.Conclusions(1)The scales used in this study have stable reliability and validity,and are suitable for medical students.(2)The reporting rates of suicidal ideation,suicide plan,suicide attempt and suicidal behavior risk of medical students are relatively high.(3)Depression,stress,hopelessness and negative coping style are positively related to high suicidal behavior risk.The sense of meaning of life has a significantlynegative correlation with high suicidal behavior risk.(4)Medical students’ negative emotion and coping styles have direct effects on suicidal behavior risk.Meaning in life and inharmonious parent marriage have influence on suicidal behavior risk indirectly through negative emotion.