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

Background. Academic burnout and suicidal ideation are common psychological concerns among medical students, prompting extensive research on their association. However, the mediating mechanisms underlying this relationship remain insufficiently understood. This study aimed to examine a structural model linking academic burnout to suicidal ideation in medical students, focusing on the mediating role of repetitive negative thinking and the moderating role of gender. Method. Using a descriptive–correlational design, 373 medical students from Shiraz University of Medical Sciences were selected through multistage cluster random sampling in the 2024 academic year. After providing informed consent, participants completed the Beck Scale for Suicidal Ideation (BSSI), the Maslach Burnout Inventory–Student Survey (MBI-SS), and the Perseverative Thinking Questionnaire (PTQ). Results. Findings indicated that academic burnout did not have a significant direct relationship with suicidal ideation; however, it exerted a significant indirect effect through repetitive negative thinking. Gender further moderated these associations: male students showed greater vulnerability within the pathway involving repetitive negative thinking, suggesting that cognitive responses to burnout differ across genders. Conclusion. These results highlight that suicidal ideation among medical students is a multifactorial phenomenon shaped by the interaction of academic stressors and maladaptive cognitive processes. The findings underscore the need for comprehensive, gender-sensitive preventive interventions that target both burnout and repetitive negative thinking to reduce suicide risk in this population.