Suicidal thoughts and attitudes towards suicide in crises among university students in Tehran, Iran: A cross-sectional study

Background University students are a high-risk population for suicidal ideation, but few studies from Iran examine both suicidal thoughts and attitudes toward crisis situations that may precipitate suicidal behavior. This study assessed the prevalence of suicidal ideation and its relationship with crisis attitudes among university students in Tehran. Methods In this cross-sectional study, 407 university students (mean age 23.72 ± 2.94 years; 61.2% female) from three academic disciplines completed the Beck Scale for Suicide Ideation (BSSI) and the Predicament Questionnaire (PQ), which assesses aversiveness of 32 hypothetical crisis scenarios. Descriptive statistics characterized the sample and score distributions. Spearman correlation assessed the association between BSSI and PQ scores. Binary logistic regression identified independent predictors of high-risk suicidal ideation (BSSI ≥ 12). Nonparametric tests were used for group comparisons following normality testing. Results High-risk suicidal ideation prevalence was 20.9% (n = 85), with an additional 45.0% showing mild ideation. Mean BSSI and PQ scores were 6.07 ± 7.46 and 72.75 ± 18.08, respectively. Both instruments demonstrated excellent internal consistency (Cronbach’s α = 0.855 and 0.935, respectively). BSSI and PQ scores were moderately correlated (Spearman’s ρ = 0.439, 95% CI 0.357–0.514, p < 0.001), representing 19.2% shared variance. Binary logistic regression (Nagelkerke R² = 0.147) identified three significant independent predictors: history of suicide attempts (OR = 4.24, 95% CI 1.74–10.36, p = 0.002), PQ total score (OR = 1.05, 95% CI 1.03–1.07, p < 0.001), and economic status (marginally significant, OR = 1.33, 95% CI 0.95–1.85, p = 0.096). Gender and academic field were not significant predictors in the multivariate model. Conclusions One in five Tehran university students demonstrated high-risk suicidal ideation, with crisis aversiveness, suicide attempt history, and economic hardship as key correlates. These findings suggest that comprehensive screening incorporating both direct suicide assessment and crisis attitude evaluation may enhance identification of at-risk students. University mental health services should consider targeted.