Level and predictors of mental health literacy of depression and suicide among undergraduate medical students – Middle East Current Psychiatry

The study has revealed that 12.5% of medical students had suicidal ideations, which is consistent with the results of one meta-analysis conducted by Rotenstein et al. in 2016 [13]. This result is considered a red flag that should direct attention to the importance of increasing MHL for better prevention and treatment of mental problems. The study also demonstrated the poor literacy status of the studied students in terms of depression and suicide, as the mean D-Lit score was 7.8 with a range of 0–22, and the mean LOSS score was 4.4 with a range of 0–12. This result could be attributed to participants being recruited during the preclinical and early clinical phases prior to psychiatry training rotation. When comparing our results with other studies using the same scales among medical students, we found that the mean scores of D-Lit and LOSS were 12.05 and 4.05, respectively, for clinical students versus 8.05 and 3.1, respectively, for premedical students in the Sultanate of Oman [14]. The mean D-Lit score among Indian students was 13.21 [15], while among Bangladeshi students, it was 6.55 [9]. These differences can be attributed to the different methodology of the study, cultural background and educational status of the participants, the educational system, and the existing health promotional activities of the country.

The study also revealed that students scored lower on most items of the depression literacy scale. Many studies reported comparable results [9, 14, 15]. Although most students could identify the somatic symptoms of depression, only a few correctly identified its psychiatric symptoms. In addition, only a few of them correctly reported that hospitalization was necessary for depressed patients to be hospitalized, while none of them could correctly identify the various treatment options for depression. This finding may be due to a lack of training on mental health as reported by most of those students and limited exposure or lack of experience as only a few of them had a personal or family history of mental disorders.

On the suicide literacy scale, most students scored lower on the majority of questions. According to Islamic Sharia law, suicide is forbidden. All students in our study are Muslims, and suicide is forbidden. When persons commit suicide, their families will be rejected by the community because of the stigma associated with suicide in the religion [16, 17]. Religious restrictions against suicide would affect the awareness of suicide and may partially explain why there is a lower suicide literacy in Islamic culture. This finding is supported by research conducted in Canada and India, which found that stigma, social traditions, and culture can influence an individual’s level of awareness about mental health issues [18, 19]. In our study, we did not report or try to prove a relation between suicide literacy and Islamic religion because our sample was formed only of Muslims, i.e., we could not compare them with other religions. Furthermore, all religions, not only Islam, are considering suicide as a forbidden act from ALLAH”. Religious prohibitions against suicide did not prevent the students studied from having suicidal thoughts, but they may have affected their awareness of suicide. Therefore, Muslim communities must be reeducated on suicide phenomena and their correlation to psychiatric disorders in order to eliminate the stigma associated with suicide. Despite poor general suicide literacy, most students correctly identified that consulting a psychiatrist or psychologist can help prevent someone from suicide, which is promising for the success of preventive efforts.

Furthermore, our study revealed a statistically significant positive correlation between literacy of depression and literacy of suicide. A similar result was reported in the meta-analysis by Rosenstein et al. [13]. This relationship could be attributed to the overlap of suicidality and depressive symptoms. Depression and suicidality are interrelated; as evidenced by the fact that the lifetime risk of suicide for patients with untreated depression ranges from 2.2 to 15%, depression is present in at least 50% of all suicides, and finally, people with depression are at 25 times higher risk for suicide than the general population [20]. Hence, preventing depression is a crucial aspect of suicide prevention.

Regarding the predictors of high depression literacy scores, the study revealed that the male gender was one of these predictors. The results of studies regarding gender differences in depression literacy were variables where a study in Bangladesh found that gender had a minor role in depression literacy among the university students [9]. In contrast, a study in India found that depression literacy was higher in females [15]. Family history of depression was another predictor of high depression literacy scores in this study, which is consistent with Elsheshtawy et al. [14], who found that previous exposure to psychiatric patients (family or friends) was a predictor of higher depression and suicide literacy. The study also revealed that a history of suicidal ideations was one of the predictors of high depression literacy scores, confirming the previously discussed overlap between suicidality and depressive symptoms.

Limitations

It was a cross-sectional study among 2nd, 3rd, and 4th-year medical students from only a single faculty, which impedes generalizing the study results. Furthermore, large-scale, longitudinal, and interventional studies are required to generalize the results.