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Suicidality among university students in the Eastern Mediterranean region: A systematic review

  • Hasti Fadakar,

    Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Writing – original draft, Writing – review & editing

    Affiliation Faculty of Medicine, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada

  • Jane Kim ,

    Roles Data curation, Formal analysis, Methodology, Visualization, Writing – original draft, Writing – review & editing

    Affiliation Faculty of Medicine, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada

  • Lauren C. Saunders,

    Roles Writing – original draft, Writing – review & editing

    Affiliations Faculty of Medicine, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada, School of Environmental and Life Sciences, University of Newcastle, Ourimbah, Australia

  • Mostafa M. Kamel,

    Roles Conceptualization, Validation, Writing – original draft

    Affiliations Faculty of Medicine, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada, Faculty of Medicine, Department of Psychiatry, Tanta University, Tanta, Egypt

  • Mohsen Kianpoor,

    Roles Supervision, Writing – review & editing

    Affiliation Faculty of Medicine, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada

  • Arash Hoseyni Moghadam,

    Roles Data curation, Writing – original draft

    Affiliation Faculty of Medicine, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada

  • Dianah Hayati,

    Roles Data curation, Methodology

    Affiliation Faculty of Medicine, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada

  • Noor Ramadhan,

    Roles Data curation, Methodology

    Affiliation Faculty of Medicine, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada

  • Tala Maragha,

    Roles Data curation, Methodology

    Affiliation Faculty of Medicine, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada

  • Maximilian Meyer,

    Roles Writing – review & editing

    Affiliations Faculty of Medicine, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada, University of Basel Psychiatric Clinics, University of Basel, Basel, Switzerland

  • Kerry Jang,

    Roles Conceptualization, Supervision, Writing – review & editing

    Affiliation Faculty of Medicine, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada

  • Reinhard M. Krausz

    Roles Conceptualization, Investigation, Supervision, Writing – review & editing

    Affiliation Faculty of Medicine, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada


The prevalence of suicide attempts and suicidal ideation among university students is a global concern. Cultural values, social determinants, religion, and especially growing stress all play an important role in this. This systematic review aimed to identify potential protective and risk factors thought to be associated with suicidal ideation among students in the Eastern Mediterranean region and highlight the importance of developing an effective health care response. MEDLINE, CINAHL, Embase, PsycINFO, WHO Global Health Library, IMEMR, Web of Science Core Collections and Farsi and Arabic databases were searched for papers in English, Farsi, and Arabic. A combination of validated filters, free text keywords, and Mesh and Non-Mesh terms were used to retrieve relevant literature. A total of 2774 papers were found after the search, 257 selected for full-text review, and 72 papers included in the final review. Family and peer support play a potential protective role in the development of suicidal ideation among university students, while adverse life events, bullying, depression, anxiety, and other mental health conditions were identified as risk factors. Suicidality was likely under-reported due to stigma around social and cultural factors. Factors involving religion and culture may act as both protective and risk factors and require more in-depth investigation. The student population in the Eastern Mediterranean region face many challenges. The common theme of suicidality emerged as an indicator of an imbalance of resources and stress, which needs to be addressed proactively, given a most likely underreporting of suicidal ideation and attempts due to stigma.


Suicide is a serious mental health issue and public health problem that claims the lives of 703,000 people every year, worldwide [1]. It is estimated that for each suicide, there are between 10 to 30 attempts, and an exponentially greater number of individuals suffering from suicidal ideation [1]. While suicide occurs across all ages, genders, and ethnicities, its rate is especially concerning among adolescents and young adults, ranking the fourth leading cause of death among people aged 15 to 29 in 2019 [2]. In adolescence, it is the main reason for death in most countries.

A cross-national study of students from 12 countries showed that nearly a third (29%) had contemplated and 7% attempted suicide in their lifetime [3]. The increased risk of suicide among this population compared to the general is indicative of the stresses and challenges unique to students, such as academic stress, financial burdens, and increased social and familial pressure to meet academic expectations [46]. Students are further challenged by the sudden transition to university, competition with peers, and separation from family [79]. Academic stress is known to be a major contributor to the risk of suicide, that also increases reluctance to seek help and access formal treatment [10,11].

The World Health Organization (WHO) classifies the Eastern Mediterranean region to include 23 countries, most of which are classified as low-and-middle-income (LMICs) [12]. In 2019, LMICs accounted for 77% of all suicide deaths across the world [2]. However, official suicide rates among these nations are often reported as being lower than global rates [2], likely due to the widespread stigma and “illegal nature” of suicide in Islam [1316]. Religion plays a prominent role in the social and cultural values of these countries and condemns suicide as an unforgivable sin [15,17]. In consequence, suicide statistics are likely not collected, underreported, or deliberately hidden from records [18,19].

Little is known about how university students in the Eastern Mediterranean region are impacted by suicide. A preliminary literature search revealed that most studies have been cross-sectional and only sampled from a single institution. The purpose of this study is to provide a thorough review of suicidality among the population of university students in the Eastern Mediterranean region and identify their social, cultural, and other specific challenges.


Search strategy and inclusion/exclusion criteria

The databases MEDLINE; EMBASE; Web of Science Core Collection; PsycINFO; IMEMR; CINAHL; and WHO Global Health Library were searched for published articles in English, French, Farsi, and Arabic. Articles were retrieved using search filters and database-specific filters and tools, a combination of search terms, MeSH and non-MeSH words and variations of the key terms “suicide”, “student”, and the Eastern Mediterranean countries (S1 Appendix). Farsi and Arabic databases and journals were also searched for relevant citations using translated keywords. Keywords were translated independently by two bilingual speakers and reviewed by an additional native speaker. For this review, an earlier review conducted in December 2021 was completed with updated evidence from a search in May 2023. The review was not registered.

All studies that reported proportions or mean scores of suicidal ideations among university students in the Eastern Mediterranean region were eligible to be included. Initially, both high school and university students were included. However, after completing the abstract screening, only studies including populations of university students were included. The country list was obtained from the WHO-identified countries in the Eastern Mediterranean region. Papers about other countries or regions that were not on the WHO report of the world were excluded, and only original peer-reviewed articles were selected for this review. Conference abstracts, letters, other reviews, commentaries, and editorials were excluded.

Screening and data extraction

The PRISMA method was used for the selection of relevant articles. Two reviewers (HF, JK, AH, MMK, TM, DH, NR) independently screened the titles and abstracts of the studies using the inclusion and exclusion criteria. Any inconsistencies were reviewed by a third reviewer for inclusion or exclusion. Following the title and abstract screening, the full texts of the resulting studies were obtained and separately reviewed by two reviewers. Any discrepancies were resolved through a consensus discussion with all reviewers. A total of 72 studies were included in the review.

After screening, selecting, and evaluating the quality of selected studies, studies with missing data in their published reports were excluded, and data from the remaining studies were extracted in Microsoft Excel. Items for data extraction included information relevant to the publication (e.g., title, author, publication year), methods (e.g., type of the study, recruitment method, timeline, country, methodology of data collection and analysis), and the population of the study (e.g., sample size, age, gender, marital status, name of the school, place of residence, socioeconomic status). Population demographics, study methods, risk and protective factors of suicide were independently collected using the table. Risk and protective factors were defined as those that precede and are associated with a higher or lower likelihood of suicidality. Results were described both quantitatively and qualitatively to account for the high between-study heterogeneity observed, due to differences in instruments, environments, and mental health diagnoses.

Study quality assessment

The Newcastle-Ottawa Quality Assessment Scale for both cohort and cross-sectional studies were employed to assess quality and evaluate bias in all the articles included in the review. There were no randomised controlled trials, case-control studies, qualitative studies, or case reports found appropriate for analysis in this study.


Search results

The search in MEDLINE, CINAHL, Embase, PsycINFO, WHO Global Health Library, IMEMR, Web of Science Core Collections databases as well as 3 Farsi databases including Noormags, CIVILIKA, and SID, resulted in 2774 papers that were in English and French, 2333 after the removing the duplications, of which 257 were selected for full-text review and 72 were included in the study (Fig 1). We were not able to access the full text version of any papers in Arabic as they were not available to the public.

A summary of all included studies is provided in Table 1. Students included were from twelve different countries, with the most studies conducted in Iran (N = 42), followed by Pakistan (N = 11), Saudi Arabia (N = 8), Tunisia (N = 5), and Egypt (N = 4). Other countries include Palestine (N = 3), Lebanon (N = 3), Morocco (N = 2), Kuwait (N = 2), Libya (N = 1), Sudan (N = 1), and United Arab Emirates (N = 1). A total of 42 studies disclosed the programs of students, and of those, the majority were medicine (N = 30, 71.4%). The studies’ publication years ranged from 2000 to 2016.

Table 1. A summary of all included studies investigating suicide in university students of the Eastern Mediterranean region.

Risk factors.

The risk factors identified in this review include demographic and personal factors, mental health factors, and school-related factors. The demographic factors that increase the likelihood of suicidal ideation in Eastern Mediterranean students include being single [64,92], being part of the LGBTQI+ community [75], being widowed or otherwise separated from a partner [56], and residing in, or having connection to, high politicised regions [46]. Living circumstances, specifically living alone, also increased the likelihood of having suicidal thoughts compared to students living with roommates [56].

Only 4 studies found higher rates of suicidality in females than males [26,56,63]; the remainder showed no significant differences [24,29,48,49,55,60,61,64,65,93]. Two studies found males to be associated with greater suicidal behaviour [28,31]. Specific to females, the overriding expectation that familial duties should take precedence over their education or other personal goals has been positively associated with increased suicidal behaviour [28,94]. However, most studies also reported having a smaller sample of males in comparison to females [21,22,29,34,38,45,70,94].

Personal risk factors include adverse life events, negative family environments, and substance use. There is a non-linear association between negative life events and suicidal ideation [40]. Factors including witnessing physical violence, familial mistreatment or neglect, and sexual abuse significantly enhance the risk for present suicidality, while parental separation and neglect significantly increase future risk for suicidal ideation [76]. The feeling of helplessness within in the family, or perceived parental control has been observed to have significant, positive relationship with suicidal ideation [51]. In one study of medical students, 10% reported that the decision to study medicine was imposed on them by family, resulting in their increased suicidality [42]. Consumption of psychoactive substances, in particular illicit drugs, has also been associated with suicidal ideation [26,33].

Mental health symptoms are among the most consistently reported risk factors for suicide. Depression is consistently highly correlated with suicidal ideation in students [34,41,53,61,65,67,7072,77,86,94,95], to an extent that it has been observed to have the strongest predictive power over suicidality [72,77]. Suicidal ideation was found to be increase by the severity of depression [74,75]. Females with suicidal ideation were more likely to experience depressive symptoms than their male counterparts [49,53]. Frequently, depression occurred with other mental health conditions, including but not limited to; anxiety, stress, panic, and pessimism [21,24,38,53,70,71], which compounds the likelihood of suicidal ideation [38]. Anxiety was also present in a large number of students with suicidal ideation [21,31,33,34,38,42,53,70,71,86]. Similar to depression, females had a higher prevalence of anxiety than males [49,53]. History of taking anxiety medication was also found to be significantly associated with suicidal ideation in students [79]. Other symptoms including neuroticism, borderline and schizotypal personality disorders, perfectionism, and conditions affecting sleep quality, were also associated with enhanced suicidality in the Middle Eastern student population [42,56,87,89].

Several school-related risk factors were associated with student suicide. While the majority of papers did not address the impact of bullying on suicidal ideation, those that did found that an overwhelming percentage of students had been bullied at least once throughout their lifetime [34], which significantly increased the likelihood of suicidal ideation [34,76]. While both genders reported high rates of bullying, males had higher risk of suicide from school events in comparison to females [76]. Feelings of anomie were observed to have a significant, positive correlation to suicidality [35,51,76]. Females’ suicide outcomes were affected more by feelings of anomie compared to males [76]. There were considerable inconsistencies between studies investigating university programs and their correlation with suicidal ideation. Some papers posited that program choice may affect risk of suicidal ideation [70,76], whereas others argue that there is no significant relationship [63,71]. Most studies agree that studying medical sciences are a particularly high-risk group [26,28,31,60,70]. Level of education, specifically early-year and bachelor level, was also significantly correlated to suicidal ideation [26,63,70]. Generally, heavy academic workloads, academic pressure, fear of failure, and lengthy courses all contributed to an increased risk of suicidal ideation in students [28,59]. There is evidence that just being enrolled in university classes is associated with suicidal ideation [33]. The societal pressure surrounding education and an expectation to perform, in some circumstances regardless of poor educational policies or less than ideal learning environments, is a major contributor to suicidality among students [34,42].

Protective factors.

Interpersonal factors such as family and social support networks were identified as protective factors. Familial support is reported to be the primary source of support for students [26], seemingly acting as a mitigating factor against suicidal ideation [26,31,72]. Perceived support from family has been observed to have an inverse relationship with the risk of suicidal ideation [26,27,31,67,72,83]. Particularly, living with family members and effective parental communication were found to be especially protective [26,30,31,70]. Outside of family members, multiple studies also observed a strong, negative correlation between suicidality and peer support [41,67,80]. Only one study found no significant association between social support and suicidal ideation [37].

Both risk and protective factors.

Sociocultural and religious factors were found to be both positively and negatively associated with suicide. Middle Eastern nations overwhelmingly favour traditional beliefs and conservative social values [34,49,94]. This includes, but is not limited to, the stigmatisation of aberrant mental health and the strong condemnation of suicide, to the extent of prohibition in some localities [49,53]. Consequentially, these social norms have directly contributed to both a lack of mental health professionals and an underutilisation of services that do exist, and high rates of psychological distress in the student population [34,60,94]. While the stigmatisation of suicide has not been observed to be directly correlated with suicide in any of the studies, it has a number of indirect, negative impacts on Middle Eastern students, such as the avoidance of mental health services [34,53]. Medical students in particular showed strong disapproval towards suicide from the belief in punishment in the afterlife post-suicide [30]. One study has directly attributed suicidal stigma with a lower prevalence of suicidal thoughts reported in their sample population [49]. This also raises issues concerning the accuracy of reporting, with the negative stigma potentially creating an inhibitory effect and skewing official suicide statistics [30,53].

Suicidal ideation was found to be negatively associated with religiosity [21,39,41,67,72,79,92]. One study noted negative religious coping being significantly associated with suicide attempts, possibly due to the gradual loss of religious commitment when faced with adverse life experiences [39]. However, there was no significant association between negative religious coping and suicidal ideation [39]. Two studies also reported a negative association between religiosity and the acceptance of suicide [30,39]. In some studies, positive religious coping and religion were considered protective factors against suicidal ideation [39,72]. Students who expressed stronger religious beliefs were more likely to view suicide as an indicator of mental illness and demonstrated greater tendency and preparedness to support a suicidal friend [30]. One study found no significant association between attitudes towards suicide and religiosity or the knowledge of the Islamic prohibition of suicide [39]. Lastly, some studies indicated that suicidality might be under-reported in Eastern-Mediterranean countries due to religious restrictions [46] and suicide being considered a social taboo [34,60].

Study quality assessment

The 72 papers included in the review were all cross-sectional studies with a single exception. The lone paper was a cohort study and deemed of “good” methodological quality by the Newcastle-Ottawa Quality Assessment Scale, with a score of 8 of a possible 9, only losing a mark on the ability to compare cohorts based on the study design criteria. The overwhelming majority of the cross-sectional studies were rated as “good” methodological quality (a score of 6 or above up to 10). Eight papers were of “moderate” quality (with a score of 5) with flaws in their representativeness of the sample, affirming the exposure of the sample, or having an insufficient sample size. One paper was judged to be of “poor” methodological quality with a score of 3, with major issues regarding sample size, comparability, and assessment of the outcomes, amongst others (see S1 Table). Lastly, 67 papers discussed suicidal ideation, 4 discussed suicide attempts, and 5 discussed both, and none of the papers focused on fatalities through suicide.


To our knowledge, this is the first study to comprehensively explore and review literature around students’ suicide in the Eastern Mediterranean region. Our goal was to provide a summary of the available studies around this population to guide and inform prevention and intervention practices.

Our review revealed that adverse life events, bullying, depression, anxiety, and other mental health conditions were identified as risk factors of suicidal ideation in university students, whereas family and peer support can play a protective role. Religion and cultural factors may act as both risk and protective factors. Sociocultural factors play a crucial role in developing a sense of belonging that protects individuals from feeling alienated and outcasted from the community. However, extreme emphasis on these norms and traditions may contrarily have a destructive effect on the mental well-being of people within the community.

The presented studies confirm that religious affiliation generally protects individuals against suicidal ideation, consistent with previous findings in which religiosity was shown to be significantly and negatively correlated with suicidal ideation [21]. However, the prohibition of suicide by many religions such as Islam may indirectly perpetuate the stigma around suicide. More religious individuals are more likely to consider suicide an unforgivable sin, intertwining with stigmatizing attitudes towards suicide. As a result, those experiencing suicidal thoughts may refuse to seek help due to the fear of being stigmatized and perceived as sinful. Moreover, the condemned view of suicide within religion may result in the under-reporting of suicide or attempting to disguise it, leading to inaccurate suicide statistics, and deflected attention from this concerning issue.

Students in the Eastern Mediterranean region are a high-risk population, not only due to their educational challenges, but from additional stressors specific to this region such as accessibility, national security concerns, social pressure, cultural restrictions, and potential lack of academic freedom. While all students require greater support, those under higher academic strain in the fields of humanities, sciences, or medicine may require focused interventions to reduce their perceived stress.

Furthermore, there is a substantial disparity between individuals needing care and those with access to mental health services within this region. The case is even worse for students due to the lack of awareness, support, and resources available to them. In a sample of Egyptian medical school students, Kamel et al. stated that only 6% of students with mental health problems could access professional assistance [25]. This is likely to exacerbate mental health conditions for students, which are predisposing factors for the development of suicidal ideation and behaviour.

The unique sociocultural fabric of the Middle Eastern youth and adolescents must be considered in order to develop safe, accessible, and trust-worthy resources that address their barriers to service utilization. Due to their significant role in the decision making of youth, family and peer support should be highly integrated in the new system. The heavy use of internet within the population of university students and their familiarity with this technology could be leveraged to better guide youth through the mental healthcare system with web-based solutions dedicated to psychoeducation and counselling services that fit students’ needs [20,23,96]. As a good start, looking at the Egyptian experience, the ministry of health in collaboration with the WHO and experts from the university of British Columbia, has just launched a platform for E-Mental Health, as an innovative and appropriate alternative, considering the current inadequacy in the current youth mental health care system with high demand from youth to use this platform [36].

This study has some limitations. Firstly, the chosen countries for this study were based on the WHO list of Eastern Mediterranean countries which does not include all the countries commonly considered as the Middle East (e.g., Turkey and Algeria). Secondly, we were not able to access Arabic and Hebrew databases. Hence, papers written in these languages were not included. Thirdly, literature representing some Eastern Mediterranean countries is scarce. Therefore, some countries and their populations were not represented (e.g., Afghanistan), whereas other countries were overrepresented (e.g., Iran). Additionally, Israel and Palestine share a geographical region, but Palestine is considered an Eastern Mediterranean country, whereas Israel is not. This makes it difficult to know whether a study’s population from this region is limited to the Eastern Mediterranean. Most studies were also carried out with medical or paramedical students, who are generally perceived as being under high academic stress. Future studies could explore the interrelatedness of suicidal ideation with medical studies among other studies of similar and dissimilar rigor, as well as identify specific interventions that could better understand and promote students’ well-being and coping in medical school. Lastly, the vast majority of studies did not control for receiving treatment for suicidal ideation, with some going to the extent of excluding participants who gained access to medication or psychotherapy [93]. Not controlling for receiving treatment could be due to the extremely limited number of students who received actual treatment for suicidal ideation, either caused by a lack mental health resources or even a lack of awareness of psychological disorders among the Middle Eastern population.


Risk for suicidality among students in the eastern Mediterranean is related to demographics, individual factors, mental health, and school-related stress and bullying. Peers and family support has potential to protect students from developing suicidal ideation. Religion and cultural values play an important role in stigma and underreporting the extent of suicide in this population. The awareness of these high prevalence of suicidality among youth is low and no specific preventative measures or treatment options are reported.

Supporting information

S1 Table. Newcastle-Ottawa Quality Assessment Scale.



  1. 1. Bachmann S. Epidemiology of Suicide and the Psychiatric Perspective. Int J Environ Res Public Health. 2018 Jul;15(7):1425. pmid:29986446
  2. 2. World Health Organization. Suicide in the world: global health estimates [Internet]. World Health Organization; 2019. Report No.: Licence: CC BY-NC-SA 3.0 IGO. Available from:
  3. 3. Eskin M, Sun JM, Abuidhail J, Yoshimasu K, Kujan O, Janghorbani M, et al. Suicidal Behavior and Psychological Distress in University Students: A 12-nation Study. Arch Suicide Res. 2016 Jul 2;20(3):369–88. pmid:26954847
  4. 4. Beiter R, Nash R, McCrady M, Rhoades D, Linscomb M, Clarahan M, et al. The prevalence and correlates of depression, anxiety, and stress in a sample of college students. J Affect Disord. 2015 Mar 1;173:90–6. pmid:25462401
  5. 5. Kruisselbrink Flatt A. A Suffering Generation: Six Factors Contributing to the Mental Health Crisis in North American Higher Education. Coll Q [Internet]. 2013 [cited 2022 Jul 29];16(1). Available from:
  6. 6. Stallman H. Psychological distress in university students: A comparison with general population data—STALLMAN—2010—Australian Psychologist—Wiley Online Library [Internet]. 2010 [cited 2022 Jul 29]. Available from:
  7. 7. Barbayannis G, Bandari M, Zheng X, Baquerizo H, Pecor KW, Ming X. Academic Stress and Mental Well-Being in College Students: Correlations, Affected Groups, and COVID-19. Front Psychol. 2022;13:886344. pmid:35677139
  8. 8. Cleary M, Walter G, Jackson D. “Not Always Smooth Sailing”: Mental Health Issues Associated with the Transition from High School to College. Issues Ment Health Nurs. 2011;32(4):250–4. pmid:21355760
  9. 9. Thurber CA, Walton EA. Homesickness and Adjustment in University Students. J Am Coll Health. 2012 Jul 1;60(5):415–9. pmid:22686364
  10. 10. Cage E, Stock M, Sharpington A, Pitman E, Batchelor R. Barriers to accessing support for mental health issues at university. Stud High Educ. 2020 Aug 2;45(8):1637–49.
  11. 11. Reddy KJ, Menon KR, Thattil A. Academic Stress and its Sources Among University Students. Biomed Pharmacol J. 2018 Mar 25;11(1):531–7.
  12. 12. World Health Organization. Eastern Mediterranean Region [Internet]. 2022. Available from:
  13. 13. Gearing RE, Alonzo D. Religion and suicide: new findings. J Relig Health. 2018;57(6):2478–99. pmid:29736876
  14. 14. Rockett IRH, Kapusta ND, Bhandari R. Suicide Misclassification in an International Context: Revisitation and Update. Suicidol Online. 2011;2:48–61.
  15. 15. Shah A, Chandia M. The relationship between suicide and Islam: a cross-national study. J Inj Violence Res. 2010 Jun;2(2):93–7. pmid:21483204
  16. 16. World Health Organization. Preventing suicide: A global imperative [Internet]. 2014. Available from:
  17. 17. Eskin M, Poyrazli S, Janghorbani M, Bakhshi S, Carta MG, Moro MF, et al. The Role of Religion in Suicidal Behavior, Attitudes and Psychological Distress Among University Students: A Multinational Study. Transcult Psychiatry. 2019 Oct 1;56(5):853–77. pmid:30734653
  18. 18. Malakouti SK, Davoudi F, Khalid S, Asl MA, Khan MM, Alirezaei N, et al. The Epidemiology of Suicide Behaviors among the Countries of the Eastern Mediterranean Region of WHO: a Systematic Review. Acta Med Iran. 2015;257–65. pmid:26024698
  19. 19. Rezaeian M, Khan MM. Suicide prevention in the Eastern Mediterranean region. Crisis J Crisis Interv Suicide Prev. 2020;41(Suppl 1):S72–9. pmid:32208764
  20. 20. Abdel-Khalek A, Lester D. Can Personality Predict Suicidality? A Study in Two Cultures. Int J Soc Psychiatry. 2002 Sep 1;48(3):231–9. pmid:12413251
  21. 21. Abdel-Khalek AM, Lester D. Religiosity, health, and psychopathology in two cultures: Kuwait and USA. Ment Health Relig Cult. 2007 Sep 1;10(5):537–50.
  22. 22. Abdollahi A, Carlbring P. Coping Style as a Moderator of Perfectionism and Suicidal Ideation Among Undergraduate Students. J Ration—Emotive Cogn—Behav Ther. 2017 Sep;35(3):223–39.
  23. 23. Ahmadboukani S, Ghamari H, Kiani AR, Rezaeisharif A. Testing Thwarted Belongingness and Perceived Burdensomeness in Suicidal Ideation and Behavior in Students: Investigating the Moderating Role of Hopelessness: A Descriptive Study. J Rafsanjan Univ Med Sci. 2021 Aug 10;20(5):519–38.
  24. 24. Ahmadi J, Ahmadi N, Soltani F, Bayat F. Gender Differences in Depression Scores of Iranian and German Medical Students. Iran J Psychiatry Behav Sci. 2014;8(4):70–3. pmid:25798177
  25. 25. Ahmadpoor J, Mohammadi Y, Soltanian AR, Poorolajal J. Psychiatric disorders and associated risky behaviors among Iranian university students: results from the Iranian PDABs survey. J Public Health. 2021 Oct 1;29(5):1197–204.
  26. 26. Ahmed SA, Omar QH, Abo Elamaim AA. Forensic analysis of suicidal ideation among medical students of Egypt: A crosssectional study. J Forensic Leg Med. 2016 Nov;44:1–4. pmid:27589377
  27. 27. Akbari A, Panaghi L, Habibi M, Sadeghi MA. Perceived Family Functioning and Suicidal Ideation Among University Students: Hopelessness as a Moderator. Iran J Psychiatry Clin Psychol. 2017 Feb 10;22(4):284–91.
  28. 28. Akram B, Ahmad MA, Akram A. Coping mechanisms as predictors of suicidal ideation among the medical students of Pakistan. J Pak Med Assoc. 2018 Nov 30;68(11):1608–1608. pmid:30410137
  29. 29. Almoammar S, Alqarni KA, Alnazeh AA, Alshahrani RM, Sundram F, Alyami M, et al. Depression and suicidal ideation among dental students of Southern Saudi Arabia: A cross sectional study. J Dent Educ. 2021;85(12):1837–46. pmid:34416011
  30. 30. Amiri L, Voracek M, Yousef S, Galadari A, Yammahi S, Sadeghi MR, et al. Suicidal behavior and attitudes among medical students in the United Arab Emirates. Crisis J Crisis Interv Suicide Prev. 2013;34(2):116–23. pmid:23195458
  31. 31. Amr M, Amin T, Sahoo S. Depression and Anxiety among Saudi University Students: Prevalence and Correlates = القلق و الإكتئاب بين طلاب الجامعة السعوديين: الإنتشار و المصاحبات. Arab J Psychiatry. 2013 May 1;24:1–7.
  32. 32. Aryapouran S, Shaibani H. Students’ Suicidal Thoughts during Covid-19 pandemic: The Role of Attachment to God, Spiritual Well-Being, and Psychological Resilience. فرهنگ در دانشگاه اسلامی. 2021;11(40):465–86.
  33. 33. Barrimi M, Maazouzi M, Malakt S, Lazaar S, Khaoulani H. Les idées et les tentatives de suicide chez les étudiants en médecine au Maroc: résultats d’une étude multicentrique. Ann Méd-Psychol Rev Psychiatr. 2020 May;178(5):481–6.
  34. 34. Bibi A, Blackwell SE, Margraf J. Mental health, suicidal ideation, and experience of bullying among university students in Pakistan. J Health Psychol. 2021 Jul 1;26(8):1185–96. pmid:31441329
  35. 35. Borji M, Farshadnia E, Khorami Z, Ghahari S. Prediction of Suicidal Ideations Based on Meaning in Life and Early Maladaptive Schemas among University Students. Salāmat- Ijtimā̒ī. 2019 Feb 1;6(2):196–207.
  36. 36. Dadfar M, Lester D, Hosseini AF, Eslami M. The Patient Health Questionnaire-9 (PHQ-9) as a brief screening tool for depression: a study of Iranian college students. Ment Health Relig Cult. 2021 Sep 14;24(8):850–61.
  37. 37. Dar S, Hasan S, Dar LK. Psychosocial factors and suicidal ideation in medical students. Rawal Med J. 2022;47(1):202–202.
  38. 38. Elhadi M, Buzreg A, Bouhuwaish A, Khaled A, Alhadi A, Msherghi A, et al. Psychological Impact of the Civil War and COVID-19 on Libyan Medical Students: A Cross-Sectional Study. Front Psychol [Internet]. 2020 [cited 2022 Jul 27];11. Available from: pmid:33192858
  39. 39. Eskin M, Baydar N, El-Nayal M, Asad N, Noor IM, Rezaeian M, et al. Associations of religiosity, attitudes towards suicide and religious coping with suicidal ideation and suicide attempts in 11 muslim countries. Soc Sci Med. 2020 Nov 1;265:113390. pmid:33007656
  40. 40. Eskin M, Baydar N, Harlak H, Hamdan M, Mechri A, Isayeva U, et al. Cultural and interpersonal risk factors for suicide ideation and suicide attempts among Muslim college students from 11 nations. J Affect Disord. 2021 Nov;294:366–74. pmid:34315098
  41. 41. Fekih-Romdhane F, Tounsi A, Rejeb RB, Cheour M. Is Religiosity Related to Suicidal Ideation Among Tunisian Muslim Youth After the January 14th Revolution? Community Ment Health J. 2020 Jan;56(1):165–73. pmid:31440942
  42. 42. Fekih-Romdhane F, ElKhouni C, Sassi H, Cheour M. The role of personal factors and learning environment in suicidal ideation among Tunisian medical students. Crisis J Crisis Interv Suicide Prev. 2021;42(1):20–31. pmid:32343167
  43. 43. Fekih-Romdhane F., Amri A., & Cheour M. (2022). Suicidal ideation, suicide literacy and stigma, disclosure expectations and attitudes toward help-seeking among university students: The impact of schizotypal personality traits. Early Intervention in Psychiatry, 16(6), 659–669. pmid:34477298
  44. 44. Ghadampour E, Shafiei M, Heidarirad H. Relationships among Cyberbullying, psychological vulnerability and suicidal thoughts in female and male students. 2017 Nov 10;11(3):28–40.
  45. 45. Ghaderi D, Amirsardari L, Poorsadegh K. The comparison of profile and personality traits in the female students with and without suicidal thoughts. EBNESINA. 2018 Jul 10;20(2):46–54.
  46. 46. Goldney RD, Harris LC, Badri A, Michael S, Fisher L. Suicidal ideation in Sudanese women. Crisis J Crisis Interv Suicide Prev. 1998;19(4):154–8. pmid:10331312
  47. 47. Habib O, Qureshi MA, Mahmood K, Javed M, Iqbal N, Anser A. Prevalence of Suicidal Ideation and Planning in Senior Medical Students. Pak J Med Health Sci. 2022 Oct 26;16(09):243–243.
  48. 48. Habibi F, Ahmadinia H, Rezaeian M. Frequency of Thoughts and Planning for Suicide Attempt in Paramedical Students of Rafsanjan University of Medical Sciences in 2019: A Cross-Sectional Study. مجله دانشگاه علوم پزشکی رفسنجان. 2021 Mar 13;19(12):1260–1245.
  49. 49. Hakami RM. Prevalence of Psychological Distress Among Undergraduate Students at Jazan University: A Cross-Sectional Study. Saudi J Med Med Sci. 2018;6(2):82–8. pmid:30787826
  50. 50. Hamdan S, Hallaq E. Prolonged exposure to violence: Psychiatric symptoms and suicide risk among college students in the Palestinian territory. Psychol Trauma Theory Res Pract Policy. 2021;13(7):772–82. pmid:34180684
  51. 51. Heydari A, Teymoori A, Nasiri H. Development of Suicidality within Socioeconomic Context: Mediation Effect of Parental Control and Anomie. OMEGA—J Death Dying. 2014 Feb 1;68(1):63–76.
  52. 52. Hidarisharaf P, Dabirian M, Parvaneh A, Naderi G, Karimi P. Relationship Of Quality Of Life, Spirituality And Resilience With Suicidal Thoughts In Students. Islam Health J. 2015 Jan 1;2(2):23–9.
  53. 53. Inam SNB. Anxiety and Depression among Students of a Medical College in Saudi Arabia. Int J Health Sci. 2007 Jul;1(2):295–300. pmid:21475441
  54. 54. Khaleghi M, Leahy RL, Akbari E, Nasab NS, Bastami M. Emotional Schemas Contribute to Suicide Behavior and Self-Harm: Toward Finding Suicidal Emotional Schemas (SESs). Int J Cogn Ther. 2021 Sep 1;14(3):485–96.
  55. 55. Khokher S, Khan MM. Suicidal Ideation in Pakistani College Students. Crisis J Crisis Interv Suicide Prev. 2005;26(3):125–7. pmid:16276755
  56. 56. Khosravi M, Kasaeiyan R. The relationship between neuroticism and suicidal thoughts among medical students: Moderating role of attachment styles. J Fam Med Prim Care. 2020 Jun 30;9(6):2680–7. pmid:32984107
  57. 57. Kiaei Y, Kachooei M. The Relationship Between Suicidal Ideation and Perfectionism in Iranian Students: The Mediating Role of Self-criticism. Iran J Psychiatry Behav Sci. 2022;16(3):e122102.
  58. 58. Klibert JJ, Aftab S, Tarantino N, Miceli M, Lamis D. A Protective Model for Suicidal Behaviors in American and Pakistani College Students. Omega (Westport). 2021 May;83(1):84–103. Epub 2019 Apr 16. pmid:30991890.
  59. 59. Landrault H, Jaafari N, Amine M, Malka G, Selimbegović L, Chatard A. Suicidal Ideation in Elite Schools: A Test of the Interpersonal Theory and the Escape Theory of Suicide. Suicide Life Threat Behav. 2020;50(1):201–10. pmid:31376217
  60. 60. Madadin M, Menezes RG, Alassaf MA, Almulhim AM, Abumadini MS, Alnemer FA, et al. Suicidal ideation among medical students in Dammam, Saudi Arabia: A cross-sectional study. Crisis J Crisis Interv Suicide Prev. 2021;42(4):278–83.
  61. 61. Modaresesabzevari S, Nouri Ghasemabadi R. The role of rumination subtypes, hopelessness and depression in the prediction of suicidal ideations in college students. J Res Psychol Health. 2016;9(4):62–73.
  62. 62. Mohamed MY, Elbatrawy AN, Mahmoud DAM, Mohamed MM, Rabie ES. Depression and suicidal ideations in relation to occupational stress in a sample of Egyptian medical residents. Int J Soc Psychiatry. 2023 Feb;69(1):14–22. pmid:35166153
  63. 63. Mohammadinia N, Rezaei M, Sameizadehtoosi T, Darban F. Assessing suicidal ideation frequency in medical students. Q J Nurs Manag. 2012 Dec 10;1(1):83–91.
  64. 64. Monirpoor N, Khoosfi H, Gholamy Zarch M, Tamaddonfard M, Tabatabaei Mir SF, Mohammad Alipour M, et al. Vulnerability to Substance Abuse and the Risk of Suicide in Students of Region 12 of Islamic Azad University. Int J High Risk Behav Addict. 2014 Jun 15;3(2):e11229. pmid:25032157
  65. 65. Mousavi SG, Keramatian K, Maracy MR, Fouladi M. Suicidal Ideation, Depression, and Aggression Among Students of Three Universities of Isfahan, Iran in 2008. Iran J Psychiatry Behav Sci. 2012;6(1):47–53. pmid:24644469
  66. 66. Mousavi SG h., Malekian A, Keykhaei N, Keykhaei F, Mahmoudi M. Relative frequency of suicidal ideation in students of Isfahan universities in 2005. 2008;55–9.
  67. 67. Movahedi Y, Movahedi M, Hashemi T, Machachi AN. Predicting students’ suicidal tendency based on religiosity, social support, family atmosphere, and depression. J Cult Islam Univ. 2013;3(6):83–106.
  68. 68. Mufti RE, Aljohani RO, Kaiwa SM, Alharbi GT, Aldarsi LA, Jorob SM, et al. Psychological well-being and its effect on suicidal behavior among medical students in Madinah. Med Sci. 2022;26.
  69. 69. Muneeb NUA, Hassan SMU. Psychological strain and suicidal ideation in young university students during Covid-19 outbreak: the mediating roles of rumination and depression. Curr Psychol. 2022;42(27):23731–42. pmid:35915773
  70. 70. Naghavi A, Teismann T, Asgari Z, Mohebbian MR, Mansourian M, Mañanas MÁ. Accurate Diagnosis of Suicide Ideation/Behavior Using Robust Ensemble Machine Learning: A University Student Population in the Middle East and North Africa (MENA) Region. Diagnostics. 2020 Nov;10(11):956. pmid:33207776
  71. 71. Naseem S, Munaf S. Suicidal ideation, depression, anxiety, stress, and life satisfaction of medical, engineering, and social sciences students. J Ayub Med Coll Abbottabad. 2017;29(3):22–427. pmid:29076675
  72. 72. Nemati Sogolitappeh F. Predicting student’s suicidal thoughts based on depression, borderline personality disorder, religiosity, social support and coping strategies. J Mod Psychol Res. 2013;12(45):255–80.
  73. 73. Panaghi L, Ahmadabadi Z, Peiravi H, Zahra Abolmasoomi F. Suicide trend in university students during 2003 to 2008. Iran J Psychiatry Clin Psychol. 2010;16(2):87–98.
  74. 74. Poorolajal J, Mohammadi Y, Soltanian AR, Ahmadpoor J. The top six risky behaviors among Iranian university students: a national survey. J Public Health. 2019 Dec 20;41(4):788–97. pmid:30452701
  75. 75. Poorolajal J, Ghaleiha A, Darvishi N, Daryaei S, Panahi S. The Prevalence of Psychiatric Distress and Associated Risk Factors among College Students Using GHQ-28 Questionnaire. Iran J Public Health. 2017 Jul;46(7):957–63. pmid:28845407
  76. 76. Pournaghash-Tehrani SS, Zamanian H, Amini-Tehrani M. The Impact of Relational Adverse Childhood Experiences on Suicide Outcomes During Early and Young Adulthood. J Interpers Violence. 2021 Sep 1;36(17–18):8627–51. pmid:31142213
  77. 77. Poursharifi H, Mojtaba H, Fariba Z, Ahmad A, Mitra H, Ahmad H, et al. The Role Of Depression, Stress, Happiness And Social Support In Identifying Suicidal Thoughts In Students. 2012 Jan 1;18(2):99–107.
  78. 78. Raeisei A, Mojahed A, Bakhshani NM. The Relationship between Personality Styles of Sociotropy and Autonomy With Suicidal Tendency in Medical Students. Glob J Health Sci. 2015 May;7(3):345–50.
  79. 79. Rahimi N, Asadolahi Z. Relationship between Spiritual well-being and the Outbreak of Suicidal Thoughts among Nursing and Midwifery Students of Rafsanjan University of Medical Sciences, 2015. Community Health J. 2017;10(3):28–35.
  80. 80. Rashid S, Kiani AR, Khorramdel K, Yeganeh N, Zeinaddini S. The Relationship Between Death Anxiety, Mattering, Perceived Burdensomeness And Thwarted Belongingness With Suicidal Behavior In College Students (The Interpersonal-Psychological Theory For Suicide). Iran J Emerg Care. 2017 Jan 1;1(1):32–42.
  81. 81. Rashid S, Kiani A, Khorramdel K, Mohammadnezhady B, Abdollahy B, Makaremi F. The relationship between perceived social support, perceived burdensomeness and thwarted belongingness with suicidal behavior in college students (the interpersonal-psychological theory for suicide). Pajoohandeh J. 2016;21(4):192–8.
  82. 82. Sadri Damirchi E, Kiani A, Khakdal Ghojebeygloo S. The relationship between sense of coherence and cognitive emotion regulation with suicidal thoughts among students at university of Mohaghegh Ardabili in 2017. Community Health J. 2018;11(3, 4):56–64.
  83. 83. Sadri Damirchi E, Honarmand Ghojebeyglou P, Khakdal Ghojebeyglou S, Amir SMB. The Role of Cognitive Flexibility and Perceived Social Support in Predicting Suicidal Tendency in University Students. Rooyesh-E- Ravanshenasi JournalRRJ. 2019 Aug 10;8(5):61–6.
  84. 84. Salman M, Shehzadi N, Mustafa ZU, Mallhi TH, Khan YH, Khan TM, et al. Self-harm and suicidal ideation in Pakistani youth amid COVID-19 pandemic: Findings of a large, cross-sectional study. Psychol Health Med. 2022;1–9. pmid:36062630
  85. 85. Shahbaziyankhonig A, Sheikhalizadeh S, Mohammadiyan Garibe AA, Rashbari Dibavar M, Alipour F, Anahid E. Discriminative Role of Moral intelligence, Mindfulness and Cell Phone Addiction in Suicide Probability among students. J New Thoughts Educ. 2020;15(4):203–22.
  86. 86. Shamsaei F, Yaghmaei S, Tapak L, Sadeghian E. Relationship between stress, depression, anxiety and suicide ideation in nursing students: A cross-sectional study. Minerva Psichiatr. 2019;60(4):174–9.
  87. 87. Talih F, Daher M, Daou D, Ajaltouni J. Examining Burnout, Depression, and Attitudes Regarding Drug Use Among Lebanese Medical Students During the 4 Years of Medical School | SpringerLink. Acad Psychiatry. 2018;42(2):288–96.
  88. 88. Tarsafi M, Kalantarkousheh SM, Lester D. The defeat-entrapment theory versus Beck’s hopelessness theory of depression and suicidality: A cross-national analysis in Iran and the United States. Int J Soc Psychiatry. 2015 Dec;61(8):777–80. pmid:25921982
  89. 89. Valikhani A, Firouzshahi A. Forecasting suicidal thoughts based on components of borderline and schizotypal personality in medical students. Thoughts Behav Clin Psychol. 2015 Sep 23;10(37):57–66.
  90. 90. Zarei M. The relationship between resilience and suicidal ideation in male and female students of Tehran universities. J Psychol New Ideas. 2021;9(13):e504–e504.
  91. 91. Zemestani M, Abdolmaleki S, McGrew SJ, Vujanovic A. Associations between Sleep Disturbance and Suicidal Ideation Severity in Iranian University Students: Evaluating Emotion Regulation Difficulties and Distress Tolerance. Arch Suicide Res Off J Int Acad Suicide Res. 2023 Mar 17;1–17. pmid:36927369
  92. 92. Ariapouran S, Sheibani H. The Prevalence of Suicide Ideation (SI) in Students in the COVID-19 Outbreak: the Role of Attachment to God, Spiritual Well-being, and Psychological Resilience. 2021 Nov 22;11(40):465–86.
  93. 93. Abdel-Khalek AM, Lester D. Constructions of religiosity, subjective well-being, anxiety, and depression in two cultures: Kuwait and USA. Int J Soc Psychiatry. 2012 Mar 1;58(2):138–45. pmid:21118855
  94. 94. Klibert JJ, Aftab S, Tarantino N, Miceli M, Lamis D. A Protective Model for Suicidal Behaviors in American and Pakistani College Students. OMEGA—J Death Dying. 2021 May 1;83(1):84–103. pmid:30991890
  95. 95. Shahbaziyankhonig A, Sheikhalizadeh S, Garibe AAM, Dibavar MR, Alipour F, Anahid E. Discriminative Role of Moral intelligence, Mindfulness and Cell Phone Addiction in Suicide Probability among students. J New Thoughts Educ. 2020;15(4):203–22.
  96. 96. Ariapouran S, Sheibani H. The Prevalence of Suicide Ideation (SI) in Students in the COVID-19 Outbreak: the Role of Attachment to God, Spiritual Well-being, and Psychological Resilience. 2021;11(40):465–86.