{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T12:12:36Z","timestamp":1778501556424,"version":"3.51.4"},"reference-count":45,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Deanship of Scientific  Research at Imam Mohammad ibn Saud Islamic University","award":["IMSIU-DDRSP2601"],"award-info":[{"award-number":["IMSIU-DDRSP2601"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Healthcare"],"abstract":"<jats:p>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\u201319.3) and self-injury endorsement was 16.9% (95% CI: 14.8\u201319.2). 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 &lt; 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 &lt; 0.001), chronic disease (AOR = 2.19, p = 0.001), and diagnosed mental illness (AOR = 2.35, p &lt; 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.<\/jats:p>","DOI":"10.3390\/healthcare14101295","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T10:50:52Z","timestamp":1778496652000},"page":"1295","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence of Suicidal Behavior and Self-Injury Endorsement Among Saudi Medical Students: A Cross-Sectional Study of Academic Year Trajectories and Associated Factors"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7587-9689","authenticated-orcid":false,"given":"Bander A.","family":"Haddad","sequence":"first","affiliation":[{"name":"Psychiatry Department, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11623, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1080\/0142159X.2018.1457213","article-title":"Professional burnout among medical students: Systematic literature review and meta-analysis","volume":"41","author":"Erschens","year":"2019","journal-title":"Med. 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