Suicidality among medical trainees: a scoping review of multilevel associated factors using the Social-Ecological Model

Abstract Background Suicidality, including suicidal ideation, plans, and attempts, represents a significant mental health concern among medical trainees. Using the Social-Ecological Model (SEM) as a guiding framework, this scoping review aimed to map factors reported in association with suicidality across individual, interpersonal, community, and societal domains. Methods This scoping review followed the methodological framework of Arksey and O’Malley, with subsequent methodological refinements and Joanna Briggs Institute guidance, and was reported according to PRISMA-ScR. PubMed, Scopus, Web of Science, and APA PsycInfo were searched from inception to July 23, 2025. Medical trainees were defined as medical students, interns, residents, and fellows. Titles and abstracts and subsequently full texts were independently screened by two reviewers. Data were independently extracted using a standardized form, and reported factors were classified according to the four SEM levels. Results Of 11,260 records identified, 111 studies from 35 countries met the inclusion criteria. Most studies were cross-sectional and focused on medical students (80.2%, n = 89). Individual-level factors were frequently reported, including depression, anxiety, burnout, psychological distress, and sleep-related problems. Interpersonal factors included family dysfunction, poor social support, and harassment; community-level factors included academic pressure, workload, and workplace stressors; and societal-level factors included financial pressures, stigma, barriers to mental health services, and societal disruptions such as COVID-19. Individual-level factors were reported in 72.4% of studies published during 2000–2015 and 76.8% during 2016–2025, while community-level factors increased from 27.6% to 35.4%. Conclusion Factors reported in association with suicidality among medical trainees span all four SEM domains, supporting a multilevel framework for mapping the existing literature. However, the findings represent a heterogeneous evidence base and do not establish causal relationships. Evidence was weighted toward undergraduate medical students, with comparatively fewer studies involving postgraduate trainees. Future research should examine contextual and system-level factors, particularly among postgraduate trainees, using longitudinal and multilevel designs.