Prevalence of suicidal behaviours among medical students in South Asia in the 1st quarter of the 21st century: a systematic review and meta-analysis protocol

Abstract

Background: Medical students in South Asia face intense mental and psychosocial challenges, increasing their vulnerability to suicidal behaviours. Despite sporadic studies, no comprehensive meta-analysis has yet examined the prevalence and associated risk factors in this region. Limited mental health resources and underreporting further obscure the true burden. This study protocol aims to systematically assess suicidal behaviours among South Asian medical students.

Methods and analysis: This systematic review and meta-analysis will encompass Medline (PubMed), Scopus, Web of Science, EMBASE, PsycINFO, Google Scholar and regional databases for studies published between 1^st January 2000 and 1^st May 2025 on suicidal behaviours, adhering to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and Meta-Analysis of Observational Studies in Epidemiology guidelines. Cross-sectional, longitudinal and cohort studies using validated assessment tools and including South Asian medical students, published without any language restriction will be included. Excluded studies will include review articles, intervention studies, commentaries, preprints, meeting abstracts, protocols, unpublished research and letters. Screening, data extraction and quality assessment will be conducted independently by reviewers using tools such as EndNote and Rayyan, with quality assessed via the modified Newcastle-Ottawa Scale. Data synthesis will involve calculating pooled prevalence estimates using a random effect meta-analysis models, where applicable, narrative synthesis of risk factors. Forest plots will visualise pooled estimates, heterogeneity will be assessed using the I² statistic, and funnel plots along with Egger's test will be used to evaluate publication bias. Subgroup and sensitivity analyses will be conducted if substantial heterogeneity is detected. Statistical analysis will be conducted using R(v.4.3.2) with built-in meta-packages and GraphPad Prism v.9.

Ethics and dissemination: As this review involves only pre-published data, ethical approval is not required. The region-specific findings will be submitted to an international peer-reviewed journal and shared through scientific conferences, webinars and relevant platforms to disseminate the burden of suicidal behaviours among South Asian medical students. Key insights will be disseminated to policymakers, educators, clinicians and researchers to inform suicide prevention strategies and guide future research.

Prospero registration number: CRD420251032718.

Keywords: Prevalence; Suicide & self-harm; Systematic Review.

Figure 1. Prevalence of global suicidal behaviours among different population group. The heatmap and sankey diagrm illustrating the prevalence of suicidal behaviours among medical students, university students and the general population was generated by author (MR) using R v.4.3.2 based on aggregated data from the cited studies. References: Medical Students; University Students; General Population. Data Source: Mudiyanselage et al; Crispim et al; Zimmermann et al; Seo et al, 2021 and Blacker et al.

Figure 2. PRISMA 2020 flow diagram for systematic reviews including databases, registers and other sources. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 3. PICO (Population, Intervention, Condition, Outcome). framework and tree network plot of key search terms (MeSH terms).

Figure 4. Prevalence of suicidal behaviours among medical students across the global regions The world map showing the prevalence of suicidal behaviours among medical students across regions was created using R v.4.3.2 and is based on data extracted from the aforementioned published studies. Data sources: Rotenstein et al; Dyrbye et al; Rahman et al.