Prevalence of Suicidal Behavior and Self-Injury Endorsement Among Saudi Medical Students: A Cross-Sectional Study of Academic Year Trajectories and Associated Factors
Healthcare (Basel). 2026 May 11;14(10):1295. doi: 10.3390/healthcare14101295.
ABSTRACT
OBJECTIVE: This study examined the prevalence and correlates of suicidal behavior and self-injury endorsement among Saudi medical students, with particular attention to academic year trajectories.
METHOD: A cross-sectional survey was conducted among 1138 medical students from colleges across all five Saudi administrative regions. Outcomes were self-reported endorsement of suicidal behaviors and self-injury behaviors. The Rosenberg Self-Esteem Scale assessed self-esteem. Multivariable logistic regression identified independently associated factors.
RESULTS: The prevalence of suicidal behavior endorsement was 17.0% (95% CI: 14.9-19.3) and self-injury endorsement was 16.9% (95% CI: 14.8-19.2). Both outcomes peaked during the 2nd year of training (suicidal: 24.1%; self-injury: 26.3%) and were significantly higher among pre-clinical compared to clinical-stage students (suicidal: 21.5% vs. 13.8%, p < 0.001; self-injury: 20.9% vs. 14.1%, p = 0.003). In multivariable analysis, pre-clinical stage (AOR = 1.69, p = 0.019), living alone (AOR = 1.81, p = 0.025), current smoking (AOR = 2.27, p < 0.001), chronic disease (AOR = 2.19, p = 0.001), and diagnosed mental illness (AOR = 2.35, p < 0.001) were independently associated with suicidal behavior endorsement. High self-esteem was strongly associated with lower odds of both outcomes (suicidal: AOR = 0.19, p = 0.003; self-injury: AOR = 0.32, p = 0.014).
CONCLUSIONS: Saudi medical students demonstrate substantial prevalence of suicidal behavior and self-injury endorsement, with a pronounced vulnerability window during the pre-clinical years. Findings support targeted mental health screening and intervention during early medical training, with self-esteem enhancement as a potentially modifiable protective factor.
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