Student-supervisor relationship and suicidal behavior among Chinese medical postgraduates: The mediating effect of insomnia and depression
Yanshu Wang, Yan Wu, Yunhao Zheng, Zheng Ye, Zhenlin LiBACKGROUND:
Suicidal behavior is a leading mental health concern among medical students, particularly in China where postgraduates face intense academic pressure and hierarchical dependence on supervisors. The quality of the student–supervisor relationship (SSR) has been associated with psychological distress, but its contribution to suicidal behavior and the potential mediating roles of depression and insomnia remain unclear.
MATERIALS AND METHODS:
A total of 1,304 validated questionnaires designed to collect demographic information and study programs, including the Suicidal Behaviors Questionnaire-Revised (SBQ-R), the Leader-Member Exchange 7 (LMX-7), the Patient Health Questionnaire-2 (PHQ-2), and the Insomnia Severity Index-7 (ISI-7) scale were distributed to participants. The relationship between variables was explored through multiple regression analysis. A serial mediation analysis with 10,000 bootstrap simulations was conducted to explore the mediating effects of depression and insomnia on the relationship between SSR and suicidal behaviors.
RESULTS:
Among 1,304 respondents, 6.7% participants were at risk of experiencing suicidal behaviors. The proportions of depression, suicidal behaviors, and severity of insomnia were higher in the medium-to-low quality SSR group (LMX-7 score <25) compared with the high-quality SSR group. Multiple regression analysis revealed that LMX-7, PHQ-2, and ISI-7 strongly correlated with the SBQ-R. Depression and insomnia mediated 57.3% of the total effect of the SSR on the risk of suicidal behavior.
CONCLUSION:
SSR influences the risk of suicide in medical postgraduates partly by modulating depression and insomnia. Therefore, strategies for identifying students with poor SSR are needed to improve the implementation of psychological interventions and insomnia treatment to mitigate the occurrence of suicide.