The relationship between authenticity and suicidal ideation among medical university students in Iranshahr, southeastern Iran: a cross-sectional study

Abstract

Introduction

University students face significant challenges while adapting to academic life and transitioning into adulthood, which may lead to suicidal ideation. Among key factors influencing suicidal thoughts is the perception of life’s meaning. Accordingly, this study investigates the association between authenticity and suicidal ideation among university students.

Methods

This cross-sectional correlational study was conducted on 400 medical university students from February to May 2025 at Iranshahr University of Medical Sciences in southeastern Iran, selected through stratified random sampling. Data were collected using the Authenticity Questionnaire and the Suicidal Ideation Scale, both of which demonstrated validity and reliability.

Data analysis was performed using SPSS software, including Pearson correlation and linear regression.

Results

The mean suicidal ideation score among university students was 8.2 ± 4.3 and the mean authenticity score was 3.35 ± 0.35. The study results revealed a significant inverse relationship between authenticity and suicidal ideation (p = 0.000). Students’ suicidal ideation was predicted by total authenticity scores and its dimensions, including awareness, unbiased processing, and relational orientation.

Conclusions

The results of this study revealed an inverse relationship between students’ authenticity scores and their suicidal ideation scores. It appears essential for administrators to implement interventions targeting suicidal thoughts by strengthening authentic living criteria.

Background

Suicide represents one of the most critical indicators of a population’s mental health and ranks among the most significant psychosocial issues [1]. As an intentional act of self-harm leading to death, suicide constitutes a major cause of mortality across various age groups [2]. According to World Health Organization (WHO) statistics, approximately one million people die by suicide annually worldwide [3]. In 2021, suicide ranked as the 11th leading cause of death [4]. Previous studies have demonstrated a significant increase in suicidal behaviors, suicidal ideation, and fatal suicide attempts in many developing countries over the past decade [3, 5]. According to reports from the Office of Mental-Social Health at Iran’s Ministry of Health, annually 6 per 100,000 people in the general population die by suicide [4].

Suicidal ideation is defined as self-reported thoughts about suicide, ranging from a vague intrusive desire to die to fully formulated suicide plans. In fact, suicidal ideation represents a concept encompassing any self-destructive thinking [6]. Suicidal ideation may occur at any age, but its prevalence is increasing among adolescents and young adults, with the highest suicide rates observed in the 15–24 age group [7, 8]. Various studies from Iranian provinces including Kerman, Jiroft, Ilam, Mazandaran, and Hamadan indicate that the highest suicide rates in Iran occur among youth [9, 10]. University students represent one of the most vulnerable populations at risk for suicidal ideation [11].

Students face significant challenges while adapting to this new environment [12]. During this transition, they encounter numerous difficulties, such as separation from family and friends, adjusting to university life, managing daily responsibilities, meeting new peers, entering unfamiliar social settings, budgeting, emotional struggles, academic performance anxiety, dormitory living, and more [13, 14]. At this stage, while attempting to navigate the complexities of adolescence, they must also prepare for adulthood. Simultaneously, they must address the unique physiological, emotional, academic, and social demands of university life [15]. These cumulative stressors may contribute to depression, suicidal ideation, or suicide attempts [13].

One critical factor influencing suicidal ideation is an individual’s perception of life meaning [16]. Life meaning has a cognitive nature, as this concept encompasses personal beliefs, the existence of an ultimate purpose in life, and faith in spirituality and the afterlife [17, 18]. Attaining a meaningful life represents one of humanity’s most fundamental existential concerns. Authenticity, as a psychological construct, is a key determinant influencing one’s perception of life meaning [19, 20]. Heidegger was the first to introduce this term, defining it as ‘the conscious appropriation of one’s personal identity and existence’ [21, 22]. According to Maslow, authenticity represents congruence between an individual’s self-perception and their lived experiences and actions [23].

Rogers posits that authenticity is the congruence between an individual’s self-concept and their lived experiences and actions. A lack of authenticity, or incongruence, results in a discrepancy between a person’s self-perception and their actual experiential life [24]. Tracing the intellectual history of authenticity leads back to existential philosophers such as Kierkegaard, who implored, “be that self which one truly is,” and Nietzsche, who asserted, “You shall become who you are.” These perspectives may be synthesized to suggest that an individual provided with conditions conducive to growth will invariably choose to become their authentic self [25]. Viktor Frankl, a renowned logotherapy theorist, further argued that life cannot be sustained without a resilient meaning to grasp. He maintained that it is not suffering itself, but the loss of meaning in life, that ultimately defeats a person [26].

Authenticity has been conceptualized across four dimensions: awareness, unbiased processing, authentic behavior, and relational orientation [27]. Awareness refers to better understanding one’s motivations, desires, emotions, and true self. Unbiased processing denotes the ability to perceive oneself without distortion, prejudice, or illusion. The behavioral dimension focuses on acting in accordance with personal values. The relational dimension emphasizes the capacity for honesty, openness, authenticity, and sincerity in interpersonal relationships [28, 29]. Authenticity enables individuals to endure, persevere, and anchor themselves during difficult times rather than being overwhelmed [30]. Authentic individuals demonstrate resilience when facing life’s severe challenges because they possess an internal anchor - a clear and genuine sense of self. They understand who they are and recognize their place within the broader context of the world [31].

Possessing meaning in life fosters hope and enables individuals to perceive greater satisfaction in their existence [28]. When a person lacks any sense of purpose and perceives life as futile and worthless, coping with its hardships becomes considerably more challenging [32]. Indeed, authenticity empowers students to develop greater resilience in confronting adversities, allowing them to manage their lives with enhanced energy and motivation [33].

As Heidegger argues, inauthenticity arises when individuals yield to social conformity, prioritizing group consensus over their own values [22]. Authenticity, in contrast, requires resisting such external pressures to remain true to one’s essence [34]. The degree to which one overcomes external pressures while remaining true to their character, spirit, and essence determines their level of authenticity [19]. Authenticity fundamentally concerns one’s relationship with the surrounding world [21]. Living authentically eliminates all forms of pretense and duplicity, empowering people to base their life decisions on deeply held personal beliefs [35]. These individuals consciously evaluate external influences before accepting them, while maintaining complete accountability for their actions and outcomes [36] .

Social norms and expectations can profoundly shape an individual’s perception of meaning and authenticity [34]. In the Iranian context, social structures are deeply rooted in familial and kinship networks, where maintaining robust intergenerational and relational bonds is highly prioritized. Within this cultural framework, the family unit functions as a central institution that not only allocates social status but also dictates life trajectories, governs emotional stability, and provides unwavering support throughout an individual’s lifespan [37].

Despite the crucial importance of reducing suicidal ideation among students and the established role of authenticity in enhancing psychological well-being, our extensive literature review revealed no studies examining the relationship between authenticity and suicidal thoughts in this population. Given that university students represent a nation’s human capital and future leaders, their mental health is vital for achieving professional goals. Suicidal ideation compromises their functionality and endangers their lives. Thus, investigating suicidal thoughts and their association with authenticity in students is imperative. Considering the variance in suicidal thoughts across academic levels and disciplines, this study aims to analyze the relationship between authenticity and suicidal ideation among medical students at Iranshahr University of Medical Sciences.

Methods

Study design and setting

This cross-sectional correlational study was conducted from February to May 2025 at Iranshahr University of Medical Sciences in southeastern Iran. Located in Sistan and Balochistan Province, the university hosts approximately 2,000 students across three faculties: Nursing and Midwifery, Medicine, and Health and Paramedical Sciences.

Participants and sample size

This study was conducted among students enrolled at Iranshahr University of Medical Sciences. A stratified random sampling method was employed, with each faculty serving as a stratum. Participants were randomly selected from all four faculties: Medicine, Nursing and Midwifery, Health, and Paramedical Sciences. The sample size was calculated based on Morgan’s table, resulting in a total of 322 participants. Accounting for a 25% attrition rate, a sample size of 400 was determined. The study achieved a power of 0.99 with an effect size of 0.187. The inclusion criteria were: (1) willingness to participate (2), current student status at Iranshahr University of Medical Sciences, and (3) not taking any psychotropic medications. Incomplete questionnaires were excluded from the analysis.

Measures

Demographic form

This form included data on age, sex, marital status, academic semester, field of study, grade point average of the previous semester, parental survival status, birth order, and other relevant demographic information.

Authenticity inventory

The Kernis-Goldman Authenticity Inventory (KGAI) is a 45-item self-report instrument designed to assess authenticity across four distinct domains, rated on a 5-point Likert scale ranging from “strongly disagree” to “strongly agree.” Higher composite scores reflect greater perceived authenticity. The “Awareness subscale (12 items)” evaluates self-understanding of one’s values, motives, and beliefs. The “Unbiased Processing (10 items) assesses the acceptance of one’s self-understanding without distortion. The “Behavior subscale (11 items)” gauges the consistency between actions and personal convictions. Lastly, the “Relational Orientation subscale (12 items)” measures the degree of transparency and openness in interpersonal relationships.

Following the procedure used in the original inventory, the average score of the items was calculated, which formed a total score [38]. The mean score ranged from 1 to 5. Kenris and Goldman confirmed the construct validity of the inventory using factor analysis. Kenris and Goldman also measured the reliability of this instrument using the test–retest method, reporting Cronbach’s alpha ranging from 0.8 to 0.9 [39]. In Iran, this Inventory was translated into Persian by Nazari et al. (2023). The content validity of the questionnaire was assessed by fifteen faculty members.To examine the content validity index (CVI) for the originality questionnaire was calculated to be 0.92. Its reliability was also measured using the internal consistency method, with Cronbach’s alpha calculated to be 0.78 [36]. In the present study, the construct validity of the Authenticity Scale was examined using confirmatory factor analysis (CFA). The results confirmed that all items demonstrated acceptable factor loadings, ranging from 0.49 to 0.88. The model fit indices were also within acceptable ranges (CFI > 0.90, TLI > 0.90, RMSEA < 0.08, and χ²/df < 3), indicating a satisfactory fit of the conceptual model to the empirical data. Darban et al. (2025) also assessed the reliability of this instrument using internal consistency measures, obtaining a Cronbach’s alpha coefficient of 0.85 [30].

The Beck Scale for Suicide Ideation (BSSI)

The Beck Suicide Ideation Scale (BSIS) is a 19-item self-report instrument designed to assess suicidal attitudes, thoughts, and planning. Each item consists of three response options, scored on a 0–2 scale (0 = none, 1 = moderate, 2 = severe). Subscale scoring ranges “wish to die” (5 items): 0–10, “passive suicidal ideation” (4 items): 0–8, “active suicidal ideation” (10 items): 0–20. Total scores range from 0 to 38, with higher scores indicating greater severity of suicidal ideation. Interpretation is as “0–5: no clinically significant suicidal ideation, 6–19: Moderate risk (preparatory suicidal thoughts), 20–38: High risk (active intent or planning). Construct validity was assessed using concurrent validity, yielding a coefficient of 0.83. Reliability was evaluated through internal consistency, with a Cronbach’s alpha of 0.96 [40]. In Iran, this scale was translated into Persian by Esfahani et al. (2015). Construct validity was examined via concurrent validity with the General Health Questionnaire (GHQ), demonstrating a correlation coefficient of 0.76. Reliability was confirmed through internal consistency, achieving a Cronbach’s alpha of 0.95 [40]. In the present study, the validity of the Sareh scale was examined using confirmatory factor analysis (CFA), which demonstrated acceptable fit for all items, with factor loadings ranging from 0.6 to 0.9. To evaluate internal consistency, the inventory was administered to 30 students, resulting in a Cronbach’s alpha coefficient of 0.81.

Data collection

Sampling

Following approval by the university’s research council and ethical committee, as well as obtaining an official letter from Iranshahr University of Medical Sciences, the researchers initiated sampling.

The distribution of students across various academic disciplines at this university differs substantially. For example, programs in radiology and occupational health enroll fewer than ten students per semester, whereas the medicine program enrolls approximately eighty. Moreover, these students face distinct functional expectations, program durations, and course loads, all of which may influence their levels of originality and suicidal ideation. Consequently, stratification by academic discipline was employed to improve the study’s precision. A stratified random sampling method was employed based on the academic disciplines including school of medicine (stratum 1): 100 students, school of nursing (stratum 2): 170 students (including nursing, midwifery, and medical emergency programs), school of health (stratum 3): 40 students (including occupational health, public health, and environmental health programs), school of paramedical sciences (stratum 4): 90 students (including operating room, anesthesia, radiology, and laboratory sciences programs). The corresponding and the third authors visited the respective faculties according to the academic schedules and participants availability. Following class sessions, the researchers introduced themselves to the participnats, explained the study objectives, and obtained their informed consents. Detailed instructions were provided regarding the research procedure, questionnaire completion guidelines, and clarification of any ambiguities. Participants sequentially received the questionnaires in the presence of the researchers demographic information form, Authenticity Scale, Beck Suicide Ideation Scale (BSIS). The researchers addressed any participant questions or uncertainties during the completion process. All questionnaires were collected immediately after completion by the researchers. The average time required to fill out the questionnaires was 20 min.

Ethical considerations

This study was conducted in full compliance with the ethical principles outlined in the Declaration of Helsinki. Formal ethical approval was granted by the Institutional Review Board of Iranshahr University of Medical Sciences (Approval Code: IR.IRSHUMS.REC.1403.025). Prior to participation, all participants provided written informed consent after detailed explanations on the voluntary participation in the research, with explicit emphasis on their unconditional right to withdraw at any stage without consequence.

Data analysis

Data were analyzed using SPSS software (version 23). Demographic characteristics were described using mean, standard deviation, and frequency distribution tables (absolute and relative frequencies). The Kolmogorov-Smirnov test confirmed that quantitative variables followed a normal distribution. The association between authenticity and suicidal ideation was examined using Pearson’s correlation and linear regression analysis. One-way ANOVA was employed to assess the relationship between students’ demographic characteristics and scores of suicidal ideation and authenticity. A 95% confidence interval (CI) and a significance level of 0.05 (α = 0.05) were applied for all statistical analyses.

Results

The mean age of the students was 21.7 ± 2.4 years, ranging from 18 to 35 years, singled (89.6%) and female (59.5%). The study sample included 21.2% first-year, 26.3% second-year, 24.7% third-year, and 29.8% fourth-year university students. Among participants, 80.5% had both parents alive, while 19.5% lived with only one parent. Regarding parental education, 44.3% of fathers had university degrees, compared to 44% of mothers who had middle school education or lower. Most students (81.3%) lived in university dormitories. Approximately 53% reported interest in their academic major, and 46.3% participated in extracurricular activities. The mean GPA across participants was 16.1 (SD = 1.5) on a 0–20 scale (Table 1).

Table 1.

Demographic charactristics of participants

Variable		N (%)
Age	18–20	140(35.0)
21–22	140(35.0)
≤ 23	120(30.0)
Gender	Women	220(55.0)
	Men	180(45.0)
Marital status	Single	355(88.8)
	Married	41(11.2)
Living arrangement	University dormitory	240(60.0)
	Living with parents	150(37.5)
	Private rental accommodation	10(2.5)
Parental survival status	Both alive	322(80.5)
	Mother deceased	21(5.25)
	Father deceased	53(13.25)
	Both deceased	4(1.0)
Academic year	First year	96(24.0)
	Second year	103(25.75)
	Third year	91(22.75)
	Fourth year	110(27.5)
Interest in academic major	Low	38(9.5)
	Moderate	152(38.0)
	High	210(52.5)
Academic performance: GPA	< 15	119(29.75)
	15–17	199(49.75)
	> 17	82(20.5)
	No suicidal ideation	308(77.0)
Suicidal Ideations	Suicide preparedness	57(14.2)
	Active suicide intent	35(8.8)

The mean suicidal ideation score was 8.2 (SD = 4.3) on a 0–38 scale. As shown in Tables 2 and 77% of students reported no suicidal ideation, 14.2% showed suicide preparedness, and 8.8% had active suicide intent.

Table 2.

Inverse correlation between suicidal ideation and authenticity (total score and dimensions)

Variables			Suicidal ideations (4.30 ± 8.21)
Authenticity Total/dimensions	Mean ± SD		Correlation coefficient	p value
Total	0.35 ± 3.35		-0.318	< 0.0001
Awareness	0.49 ± 3.51		-0.260	< 0.0001
Unbiased processing	0.60 ± 3.02		-0.130	0.009
Behavior	0.51 ± 3.41		-0.186	< 0.0001
Relational orientation	0.51 ± 3.41		-0.266	< 0.0001

The mean authenticity score among university students was 3.35 ± 0.35 (range: 2.47–4.53). Among authenticity dimensions, the highest scores were observed for self-awareness, while unbiased processing showed the lowest scores. Pearson correlation analysis revealed a significant inverse relationship between authenticity scores and suicidal ideation (p < 0.001), indicating that higher authenticity scores were associated with lower suicidal thoughts. All authenticity subscales similarly demonstrated significant inverse correlations with suicidal ideation scores (p < 0.001 for all dimensions) (Table 2).

A simple linear regression analysis indicated a statistically significant inverse relationship between total authenticity scores and suicidal ideation scores, with authenticity accounting for 10.1% of the variance (R2 = 0.101, p < 0.001). Specifically, for every one-unit increase in the total authenticity score, suicidal ideation scores were predicted to decrease by 7.4 points (Table 3).

Table 3.

Linear regression analysis of authenticity and its dimensions as predictors of suicidal ideation

	Dependent variables		B	SE	Beta	T	P	Model summary
Model 1		Constant Total authenticity	29.150 -7.419	3.739 1.110	- -0.318	7.796 -6.684	< 0.0001 < 0.0001	R = 0.318 R2 = 0.101 ADJ.R2 = 0.099
Model 2	Constant		30.551	3.782	-	8.078	< 0.0001	R = 0.341 R2 = 0.116 ADJ.R2 = 0.107
	Awareness		-3.016	0.919	-0.182	-3.281	0.001
	Unbiased processing		-2.002	0.677	-0.148	-2.959	0.003
	Behavior		0.476	0.953	0.030	0.499	0.618
	Relational orientation		-3.301	0.912	-0.206	-3.620	< 0.0001

Further analysis of subscales revealed that self-awareness, unbiased processing, and authentic relating significantly predicted suicidal ideation. An increase of one point in these specific subscales was associated with an estimated 11.6% reduction in suicidal ideation scores (Table 3).

The results of this study indicated no significant relationship between suicidal ideation scores and authenticity, as well as demographic variables such as age, gender, field, and level of education. As analysis showed no significant faculty-based differences in the suicidal ideation scores and authenticity, aggregated results were reported to maximize statistical power. Future work could explore these effects using advanced modeling.

Discussion

This study was designed to examine the association between authenticity and suicidal ideation among university students—a previously unexplored relationship in the literature. Despite comprehensive searches across multiple databases, no prior studies were identified that specifically investigated this linkage. Consequently, our results are contextualized within existing research on authenticity’s associations with related psychological variables.

Research demonstrates authenticity positively predicts role satisfaction [41], psychological well-being [42–44], meaning in life [45], and self-esteem [46]. It is also negatively associated with psychological difficulties including death anxiety [30], aggression and psychological distress [47], contingent self-worth [48], and somatization-depressive symptoms [30, 49].

Effect sizes linking self-esteem (0.07 to 0.3), resilience (0.3 to 0.5), and meaning in life (0.26 to 0.3) to suicidal ideation align with current findings [16, 50–53]. Authenticity is inferred to enhance the belief that life is worthwhile, thereby bolstering perseverance and resilience. This positive coping mindset leads individuals to actively seek solutions, fostering a positive outlook on life and a corresponding negative stance toward suicide [54]. Conversely, a lack of perceived meaning in life is associated with lower mood, devaluation of existence, reduced resilience, and increased hopelessness and despair [55] .

Leary (2003) posits that inauthentic behavior induces psychological distress [56]. This dissonance fosters feelings of worthlessness and existential guilt from betraying one’s identity and potential [34]. Consequently, such inauthenticity is strongly correlated with an increase in suicidal ideation [57]. Individuals with high levels of authenticity exhibit lower self-handicapping behaviors [34], greater life hopefulness [58], and stronger commitment to personal values. They focus on cultivating meaningful lives while maintaining self-respect [59]. Consequently, greater authenticity predicts suicidal ideation—a finding consistent with our study’s results.

The results of this study indicated that authenticity accounts for 10.1% of the variance in suicidal ideation. Although this effect is statistically significant, its magnitude cannot be considered clinically significant. While authenticity demonstrates a predictive role in suicidal thoughts among students, it alone is insufficient to fully explain this complex phenomenon. Therefore, the influence of potential confounding variables—such as social support, depression, personal experiences, and cultural or religious factors—must be considered as well in this complex and multilayered ecosystem of risk and protective factors [49, 60]. Although prior studies mentioned these factors, their explicit inclusion in our multivariate model was constrained by design. Given the modest R² values observed, as inclusion of variables such as depressive severity or perceived social support in future models could change the magnitude or direction of the observed effects. Future research should employ structural equation modeling to more precisely capture these influences and improve the explanatory power of the observed associations.

Reich et al. (2013) demonstrated that authenticity supports a coherent self-concept and promotes self-actualization. Authentic individuals possess awareness of their motives, emotions, and personal strengths and weaknesses, living in alignment with their own values rather than external expectations [61]. Similarly, Rogers viewed authenticity as encompassing self-acceptance and the acknowledgment of one’s emotions in their entirety [60].

Authenticity is understood as a dynamic process of self-formation [62]. While the essentialist perspective regards it as self-discovery achieved through alignment with one’s inner essence, the existentialist view frames it as an act of self-creation, characterized by the individual’s effort to construct the self independently of social norms, conventions, or pressures [63]. From a quantitative standpoint, Sutton (2024) conceptualizes authenticity as the deliberate enactment of one’s true self through conscious choice and personal accountability [64].

Functioning as a psychological buffer, authenticity fosters mental well-being and adaptive behavior; individuals exhibiting high authenticity more readily accept their emotions [49], which subsequently diminishes suicidal ideation—an effect linked to the awareness component of authenticity [38].

Authenticity, characterized by freedom from external pressures, self-acceptance, and behavioral congruence, reduces negative self-perception and suicidal ideation. This protective effect likely stems from unbiased information processing [62]. When individuals utilize cognitive biases, academic challenges are perceived as threats, potentially leading to negative outcomes like anxiety, depression, and maladaptive coping mechanisms, including suicidal ideation [65]. Conversely, unbiased processing allows individuals to view outcomes as neutral assessments of the “state of affairs,” rather than attaching significant positive or negative value to their self-concept [60].

In this study, the behavioral dimension of authenticity did not predict suicidal ideation. This discrepancy may be attributed to cultural variations in the expression of behavioral authenticity. In Iranian culture, “ta’ārof” (a ritualized form of politeness and deference) often requires individuals to act contrary to their genuine feelings in order to maintain social harmony and demonstrate respect. Such behavior is considered a sign of politeness, refinement, and moral virtue. From an early age, individuals are socialized to believe that self-worth is contingent upon self-sacrifice for the family, prioritizing collective needs over personal desires, and striving to uphold social integrity [37]. Moreover, Iran’s collectivist culture pressures students to present themselves as resilient, strong, and unaffected by psychological or physical distress, even when their internal reality differs significantly. Maintaining appearances—pretending that everything is fine—is deeply embedded as a cultural value in Iranian society [66]. Furthermore, the potential for Socially Desirable Response (SDR) cannot be disregarded, as participants might underreport behaviors perceived as socially undesirable, thereby attenuating the observed correlation. In particular, within the Iranian academic context, cultural norms and hierarchical structures may lead participants to provide responses that align with socially or academically desirable traits. Furthermore, the reliance on self-report measures inherently magnifies this risk, thereby potentially confounding the observed associations between authenticity and suicidal ideation.

A plausible explanation for this finding lies in measurement limitations; the current scale may lack the fidelity to accurately capture the subtle nuances of behavioral authenticity as expressed within a collectivist milieu. Furthermore, a cognitive–behavioral mismatch is likely present, where socio-contextual demands prevent the reliable translation of an individual’s internal feeling of authenticity into overt, observable behavior. These factors suggest that the observed non-significance may stem from methodological constraints inherent in assessing complex cultural behaviors, rather than solely from the absence of a true relationship.

Conclusions

This study advances the understanding of factors influencing suicidal ideation among university students. The study’s key innovation lies in examining the association between students’ authenticity scores and their suicidal ideation.Individuals with higher authenticity—characterized by heightened self-awareness, unbiased acceptance of experiences, behavioral congruence, and positive relational functioning—cultivate a stronger sense of self-worth, thereby mitigating suicidal thoughts. The present study suggests an association wherein fostering authenticity may be linked to suicidal ideation among youth, particularly university students. A notable strength of this study is its enhanced generalizability; participants were recruited from diverse faculties, representing varied ethnicities, cultures, and socioeconomic backgrounds, with no dominant majority group. These results can inform the design of targeted interventions aimed at reducing suicidal ideation by promoting core components of authentic living.

Limitations

This study has several limitations. The generalizability of these results is restricted to medical students in Iran. It is conceivable that specific cultural and academic stressors inherent to this population may have influenced the observed outcomes. Consequently, for a more comprehensive understanding and enhanced external validity, future investigations are advised to employ larger cohorts and include more heterogeneous populations. The data were collected through self-report measures, and no objective quality criteria for authenticity were employed. As a result, social desirability bias may have influenced respons, given the cultural pressure to appear resilient. Due to the cross-sectional design, the present study cannot support causal inferences regarding the relationships observed. Future research must employ longitudinal or experimental designs to establish directionality.

Abbreviations

WHO

World Health Organization

KGAI

Kernis-Goldman Authenticity Inventory

BSSI

Beck Scale for Suicide Ideation

GHQ

General Health Questionnaire

CVI

Content Validity Index

CI

Confidence Interval

CFA

Confirmatory Factor Analysis

CFI

Comparative Fit Index

TLI

Tucker-Lewis Index

RMSEA

Root Mean Square Error of Approximation

SDR

Socially Desirable Response

Authors’ contributions

Author FD was the project leader. FD, SRA, and NH designed the protocol of the study. SRA and MN, participated in data collection. Authors FD and NH participated analysed the data and interpreted the results. Author FD wrote the draft for the introduction. All co-authors edited and revised the manuscript. All authors approved the final manuscript.

Funding

The study is funded by the Iranshahr University of Medical Sciences. The funding institution did not play a part in designing, conducting the study, managing, collecting and analyzing data and making the decision to submit the report of publication.

Data availability

The data that support the results of this study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the ethics committee of Iranshahr University of Medical Sciences with the ethical code IR.IRSHUMS.REC.1403.025. Obtaining informed consent from the participants and assuring them of their anonymity and data confidentiality were other ethical considerations. The participants were free to withdraw from the study at any stage of the research.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.