How Academic Burnout Is Linked to Suicidal Ideation in Medical Students: Exploring the Mediating Role of Repetitive Negative Thinking and the Moderating Role of Gender

Abstract

Background: Academic burnout and suicidal ideation are major concerns among medical students. Although their association has been widely studied, the underlying mediating mechanisms require further clarification. Objectives: This study examined a structural model of the association between academic burnout and suicidal ideation among medical students, focusing on the mediating role of repetitive negative thinking (RNT) and the moderating role of gender. Methods: This descriptive-correlational, cross-sectional study included 373 medical students at Shiraz University of Medical Sciences who were selected through multistage cluster random sampling during the 2024 - 2025 academic year. Participants completed the Beck Scale for Suicidal Ideation (BSSI), the Maslach Burnout Inventory-Student Survey (MBI-SS), and the Perseverative Thinking Questionnaire (PTQ). Data were analyzed using IBM SPSS Statistics version 25.0 and the PROCESS macro. Results: Academic burnout was not directly associated with suicidal ideation; however, an indirect association was observed via RNT. Gender significantly moderated this association, with male students showing greater vulnerability in the RNT pathway, suggesting different cognitive responses to burnout across genders. Conclusions: These findings indicate that suicidal ideation among medical students is influenced by academic stress and maladaptive cognitive processes, particularly RNT. To address burnout and RNT, we recommend (1) implementing routine mental health screening for early identification of risk, (2) developing prevention programs to enhance cognitive resilience, (3) establishing targeted intervention services for students with high burnout and suicidal ideation, and (4) creating risk-prediction algorithms to support effective early warning systems. Future longitudinal studies are needed to further examine these causal relationships.