Association of Depression, Anxiety and Stress on Suicidal Ideation among Medical Aspirants in Hyderabad, Sindh

Abstract

Medical aspirants preparing for competitive entrance examinations frequently experience intense academic pressure and psychological distress, increasing their vulnerability to suicidal ideation. Depression, anxiety, and stress have each been identified as significant contributors to suicidal risk through distinct psychological pathways. Depression elevates suicidal vulnerability through persistent hopelessness and negative self-perception that diminish the will to live. Anxiety contributes through chronic physiological arousal and psychological entrapment, the felt impossibility of escaping an aversive situation which research recognizes as a direct precursor to suicidal motivation. Stress, when perceived demands consistently exceed coping resources, produces emotional exhaustion that intensifies both depressive and anxious symptoms, further compounding suicidal risk. Despite growing literature on enrolled medical students, their combined effect among pre-admission candidates in Pakistan remains insufficiently examined. The present study therefore aimed to examine the association between depression, anxiety, stress, and suicidal ideation among medical aspirants; determine the prevalence of psychological distress; explore gender-based differences; and identify the strongest predictor of suicidal ideation. A quantitative cross-sectional design was adopted with data collected from 200 medical aspirants in Hyderabad, Sindh, using the DASS-21 and SIDAS. Non-parametric procedures were employed due to non-normal data distributions. Anxiety emerged as the most prevalent concern affecting 69% of participants, followed by depression at 44%. Spearman's correlation confirmed a significant positive association between combined psychological distress and suicidal ideation. Multiple regression identified anxiety as the strongest predictor, followed by depression, while stress showed a suppressed effect. The model explained 23.8% of variance in suicidal ideation, emphasizing the urgent need for early psychological screening and mental health interventions within preparatory institutions in Pakistan.