In the Depths of Night: Exploring Suicide Ideation among Nursing University Students through Sleep Quality and Irrational Thoughts

In the Depths of Night: Exploring Suicide Ideation among Nursing University Students through Sleep Quality and Irrational Thoughts | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article In the Depths of Night: Exploring Suicide Ideation among Nursing University Students through Sleep Quality and Irrational Thoughts Basma AbdElmajid Adly, Maha Ibrahim El Bayoumy Ali, Abdulqadir J. Nashwan, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7128255/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Suicide is one of the main preventable causes of mortality. Suicide Ideation through sleep quality issues and irrational thoughts represents a public health concern among university students who are a particularly high-risk group. Recognizing the connection between suicidal thoughts, sleep quality, and irrational thinking is vital. Sleep disturbances can significantly amplify irrational thoughts, which subsequently can deepen suicidal ideation. This creates a dangerous cycle that increases psychological vulnerability. This study aimed to assess suicide ideation among nursing university students through sleep quality and irrational thoughts. Method A correlational research design was employed, using a stratified sample of 370 participants from Cairo and Zagazig universities in Egypt. Four tools included the Personal Data Questionnaire, the Suicidal Ideation Attributes Scale (SIDAS), the Irrational Beliefs Inventory (IBI), and the Sleep Quality Scale (SQS). Results The results indicated that 41.2% of the sample under study were between the ages of 19 and 20, with a mean age of 19.7 ± 1.5 years, and 55.7% of the sample consisted of females. 78.1% of the sample exhibited moderate levels of irrational thinking, compared to 17.4% who had high levels and 82.6% who had moderate levels of suicidal thoughts. Additionally, 42.7% and 1.8% of participants, respectively, experienced moderate and severe sleep quality issues, while 55.4% of participants reported light sleep problems. There was a statistically significant correlation between nursing students' suicidal ideation and their irrational thoughts and sleep quality (P < 0.008, P < 0.04). Furthermore, there was no significant correlation (P < 0.17) between irrational thoughts and sleep quality. Conclusions This study indicates that most nursing students exhibited a moderate degree of suicidal ideation and irrational thoughts. Moreover, 55.4% of subjects experienced mild sleep quality issues. The findings indicate that a statistically significant correlation between suicide ideation and both irrational thoughts and sleep quality among nursing students. Hence, it is more crucial to encourage initiatives focused on mental health awareness and cognitive restructuring programs. Suicidal Ideation Irrational thoughts Sleep quality University students Wellbeing Introduction The chance of mental health issues among college students increases with the passage from the teenage years to adulthood, as well as the social, academic, and personal obligations at university [ 1 ]. Effective adjustment to these circumstances becomes essential for students' general well-being as well as their academic performance [ 2 ]. Suicide is a major global health issue. More than one out of every 100 deaths is due to suicide. Over 700,000 people worldwide are thought to lose their survives to suicide every year. Suicide is the 17th prominent cause of death globally and the fourth prominent cause of mortality among individuals aged 15 to 29 [ 3 ]. Nursing students are especially susceptible to mental health issues because of the particular strains connected to their clinical and academic training. Their likelihood of suicidal thoughts is significantly increased by the combined strain of emotional work, such as dealing with patient agony and death, and educational obligations [ 4 ]. The act of contemplating death or planning to take one's own life is known as suicidal ideation. From a broad wish for death without a specific strategy, intention, or action to active suicidal ideation, characterized by a comprehensive plan and a resolute determination to execute the suicidal ideation, can vary in intensity. Suicidal ideation is strongly correlated with both suicide attempts and fatalities, and it is a substantial risk factor for future suicide attempts [ 5 ]. Following the emergence of the COVID-19 pandemic, suicide ideation has increased significantly among college students. For instance, a meta-analysis of 113 studies across 31 nations revealed that around 20.6% of college students experienced suicidal ideation. [ 6 ]. Although suicidal ideation has been linked to academic stress and emotional strain among nursing students, recent studies highlight poor sleep quality as a potential contributing factor that may intensify negative thought patterns and reduce emotional resilience [ 7 ]. The term "sleep quality" denotes an individual's comprehensive contentment with multiple facets of their sleep experience. Sleep efficacy, sleep onset, sleep duration, and early awakening are the four primary markers used to evaluate sleep quality [ 8 ]. Young adults should strive for 7 to 9 hours of sleep each night. However, a minimum of 60% of college students get inadequate sleep, averaging merely seven hours per night. Previous studies have found that up to 75% of university students experience irregular sleep problems, and 15% report poor overall sleep quality [ 9 ]. One of the most important elements influencing a person's mental health outcomes is poor sleep quality. It might cause depression by upsetting the equilibrium of the hypothalamic-pituitary-adrenal axis. Additionally, getting too little sleep would impair one's capacity to regulate emotions, which would accelerate the onset of depression symptoms [ 10 ]. Furthermore, a lack of quality sleep would make someone feel more stressed, which could then result in more depressive symptoms. Additionally, inadequate sleep is linked with several adverse outcomes, including exhaustion, poor academic performance, and impaired daytime functioning [ 11 ]. Negative consequences of sleep deprivation encompass emotional instability, mood disorders, somnolence, forgetfulness, lethargy, fatigue, impaired academic performance, depression, stress, suicidal ideation, diminished immune response, reduced physical health, reduced psychomotor abilities, altered perception, heightened error rates, reduced interpersonal interactions, and substance use[ 12 ]. Additionally, the Substance Abuse and Mental Services Administration has identified sleep disorders as one of the top 10 suicide alert signs [ 13 ]. Over the past ten years, an increasing amount of research indicates that sleep disturbance is one of the key elements in the complex and multidimensional path leading to suicidal ideas and behaviors. The connection between sleep quality and suicidal ideation among university students highlights the need to explore underlying cognitive factors, such as irrational beliefs, that may contribute to them [ 14 ]. Irrational beliefs are persistent thoughts that control an individual's mind, shaping their interpretation of events, assigning denotation, and influencing the quality and intensity of behaviors and emotions. In simpler terms, irrational thoughts are wishes and goals that become crucial predilections, so that failing to meet them can result in anxiety and distress. These beliefs often conflict with reality, impose rigid 'musts' on individuals, disrupt their sense of balance, and hinder their ability to create order [ 15 ]. Negative thoughts that cause anxiety and tension are known as irrational beliefs. These ideas are centered on irrational thoughts that develop in the mind, upsetting equilibrium and resulting in unhealthy feelings and behaviors that endanger a person's life, mental health, and emotional stability. Consequently, it may be concluded that these beliefs are important and influential elements that impact an individual's health [ 16 ]. Additionally, some research has demonstrated a correlation between irrational beliefs and decreased life satisfaction, anxiety, and happiness [ 17 ]. It has also been investigated how illogical beliefs and suicidal thoughts are related. Quimbiul and Castro [ 18 ] investigated the irrational thoughts that lead people to attempt suicide in Ecuador. Suicide attempts can be influenced by feelings of helplessness, guilt, and hopelessness, according to their study of thirty patients who had attempted suicide. So, suicidal ideation is a significant predictor and risk factor for completed suicide and an increase in suicide rates. To prevent suicide, considerable efforts must be focused on decreasing suicidal ideation. To accomplish this, research is needed to explore the underlying mechanisms that contribute to the onset and persistence of suicidal ideation, as these can lead to suicide if not adequately addressed. In essence, it is crucial to investigate the factors closely linked to suicidal ideation and the specific connections between these factors and suicidal ideation to effectively manage the emergence of suicidal ideation, thereby preventing suicide. Among the various aspects related to suicidal ideation, sleep quality and irrational beliefs are particularly noteworthy due to their potential for modification [ 7 ]. Significance of the study Suicide ranks among the top five mental health concerns confronting college students globally. The WHO data published after 2019 indicates that over fifty percent of suicides are perpetrated by individuals under 45 years of age, especially those between 15 and 29 [ 19 ]. Suicidal conduct in kids impacts not only the individuals and their families but also has a wider societal effect. A significant amount of research indicates that the quality of sleep is crucial for optimal psychomotor performance and neurocognitive function, and maintaining physical and mental health [ 20 ]. Studies indicate a relationship between sleep issues and the occurrence of suicidal thoughts, suggesting that disrupted sleep may worsen emotional distress and cognitive difficulties. Additionally, irrational thoughts such as catastrophizing and perfectionism are recognized as cognitive distortions that increase the risk of suicidal ideation by impairing coping mechanisms and emotional regulation. Exploring the relation between these factors is crucial for evolving effective early intervention and support strategies within nursing education settings, such as sleep hygiene intervention and cognitive behavioral therapy sessions [ 21 ]. Moreover, previous research has suggested that suicidal ideation may serve as a risk factor for suicide completion. Besides, suicide has emerged as the third largest cause of mortality among adults in their prime, highlighting the urgent need for comprehensive prevention measures and risk assessment tools [ 22 ]. To bolster this understanding, we conducted research focusing on exploring suicide ideation through sleep quality and irrational thoughts among nursing university students. Aim of the study The study aimed to assess suicide ideation among nursing university students through sleep quality and irrational thoughts. Research questions : The main research questions that this study aims to address are: What is the level of suicide ideation, sleeping quality, and irrational thoughts among nursing university students? What is the correlation between suicide ideation, sleep quality, and irrational thoughts among nursing university students? What is the impact of sleep quality and irrational thoughts on suicidal ideation? Subjects and methods Design The present study utilized a correlational research design to attain its objectives. A correlational research methodology examines the relationships between variables. A correlation elucidates the magnitude and orientation of the relationship between two or more variables [ 23 ]. Setting This study was conducted among nursing students from Cairo and Zagazig universities in Egypt. The researcher selected the two nursing faculties, one in Cairo and one in Zagazig, due to the ease of accessibility and the researcher's affiliation with these institutions. Also, Cairo represents a more urban setting, while Zagazig is considered a rural area. Including both sites allows for a broader comparison of how contextual factors of lifestyles influence suicidal ideation, sleep quality, and irrational thought among nursing students. Study subjects Nursing students were selected using a stratified sampling method to achieve the study's aim. A sampling method known as stratified random sampling involves splitting a population into smaller subgroups, or strata [ 24 ]. According to Taherdoost [ 25 ], stratified random sampling, also known as stratification, creates strata based on traits or attributes that people have in common. The nursing students were divided into smaller subgroups, or strata, using a stratified sample. The sample size was 370 nursing students out of 9208 by using the formula for sample size calculation: n= \(\:\frac{{z}^{2}\text{*}p\text{*}(1-p)/{e}^{2}}{1+\:\frac{{z}^{2}\text{*}p\text{*}(1-p)}{{e}^{2}\text{*}N}}\) Where p is the estimated proportion in the population = 0.5 N population size = 9208 The margin of error = 5%=0.5 And z is the standard normal value with confidence level 95%=1.96 It was determined that the sample size was 370. To take into consideration any possible missing data, an additional nine students were included, bringing the total sample size to the required size. This approach ensured that the total sample size remained unaffected, even with incomplete responses, resulting in a total sample of 379 nursing students. Then the number of students selected from each university and each level was proportional to the proportion of students in that university and level in the entire population. The study sample from each university was (215) from Zagazig University out of (5129), and (164) from Cairo University out of (4079), and from each level was as follows (see Table 1 ): Table 1 Distribution of the study sample from Zagazig and Cairo Universities: Level Cairo Zagazig First 497/2881*164 = 28 1915/5129*215 = 80 Second 785/2881*164 = 45 831/5129*215 = 35 Third 835/2881*164 = 47 1249/5129*215 = 52 Forth 764/2881*164 = 44 1134/5129*215 = 48 Inclusion criteria : -An undergraduate student who studies at the Nursing Faculty, Cairo and Zagazig University, and has accepted to participate in the study. - Enrolled students from all academic years of the faculty to ensure representation across all levels of the study Exclusion criteria : -Free from mental and Psychiatric diseases. Tools of Data Collection : Data was collected using four Tools : First tool: Personal data questionnaire , developed by researchers, which incorporates items about nursing students, including age, gender, marital status, academic level, type of family, area of residence, living arrangement, name of university, availability of social support, and whether they are free from mental or psychiatric disease. Second tool: The Suicidal Ideation Attributes Scale (SIDAS) : van Spijker et al.[ 26 ] developed the Suicidal Ideation Attributes Scale (SIDAS), which had been validated as a brief online measurement of the intensity of suicidal ideation. Suicide plans and attempts were more closely linked to thinking frequency and controllability than to other characteristics evaluated. The SIDAS is a five-item scale that uses 10-point ratings to assess the following criteria over the last month: item 1: frequency; item 2: controllability; item 3: closeness to attempt; item 4: distress; and item 5: interference with everyday activities. A scale ranging from 0 (Never) to 10 (Always) is used to score each item. High risk of suicidal behavior was indicated by scores ≥ 21. The SIDAS appears to be a valid instrument for measuring the intensity of suicidal thoughts. The scale's internal consistency is high (α = .91) [ 26 ]. Third tool: The Irrational Beliefs Inventory (IBI) : The IBI-34 items developed by Koopmans et al.,[ 27 ], measured five factors: (6 items); Need for Approval, (8 items); Worrying, (6 items); Rigidity, (7 items); Emotional Irresponsibility, and (7 items); Problem Avoidance. Each item was answered by participants using a 5-point Likert-type scale, with 1 denoting "strongly disagree" and 5 denoting "strongly agree. Accordingly, higher scores reflect more irrational beliefs. The alpha for the 34 items of the IBI–34, developed by AL-Heeti, Hamid, and Alghorani [ 28 ], was 0.76. The subscales generally demonstrated acceptable internal consistency reliability, ranging from 0.71 to 0.76 [ 28 ]. Fourth tool: Sleep Quality Scale (SQS) , developed by Shahid et al. [ 29 ], which consists of 28 items. Daytime symptoms, recovery after sleep, problems initiating and maintaining sleep, difficulty waking, and sleep satisfaction are the six domains of sleep quality that are assessed by SQS. Scoring Using a four-point Likert-type scale (0 = “few,” 1 = “sometimes,” 2 = “often,” and 3 = “almost always”) respondents indicate how frequently they exhibit certain sleep behaviors. Scores on items belonging to factors 2 and 5 (restoration after sleep and satisfaction with sleep) are reversed before being tallied. Higher scores indicating more acute sleep problems. Total scores can range from 0 to 84. Test-retest reliability is .81and Internal consistency is .92 [ 29 ]. Procedure Following the official approval of Zagazig University's Faculty of Nursing's Research Ethics Committee, Data collection was conducted using an online questionnaire designed via Google Forms. The survey link was distributed to nursing students across all academic levels (first to fourth year) through the WhatsApp groups designated for each level. The researcher employed a sequential distribution technique: the link was first shared with students in one academic level, and once the required number of responses based on the calculated sample size for that level was obtained, the form was closed for that group. Subsequently, the link was shared with the next academic level, and the same process was repeated until the targeted number of participants was reached in each group. This approach ensured proportionate representation from all educational levels and controlled the number of responses according to the predetermined sample size. Participants who consented to engage completed the study tools through the Google Form after receiving a clear explanation of the study's aim and nature. They were guaranteed the confidentiality of their responses and informed of their right to withdraw at any time without consequence. The questionnaire remained available for two months, from early December 2024 to the end of January 2025, during which it was distributed sequentially to each academic level using a stratified sampling technique. On average, participants required approximately 15 to 30 minutes to complete the tools. Ethical considerations The study was conducted following the Declaration of Helsinki ethical guidelines. The study was formally approved by the Faculty of Nursing's Research Ethics Committee under code ID/ZU.Nur.REC#209 . After being fully informed about the purpose of the study, the students provided informed consent by submitting the completed study tools, and participation in the study was entirely voluntary. Explaining the goal and nature of the study, as well as ensuring that the material was kept private and that no one could access it without the students' consent, were among the ethical concerns. Participants in the study weren't exposed to any risks. Statistical design : IBM SPSS version 25.0 (Armonk, NY: IBM Corp.) was used for data entry and statistical analysis. Numbers and percentages were calculated for qualitative data, while means and standard deviations were calculated for quantitative data. Pearson's correlation was used to examine the relationships between variables. Regression analysis was used to study the impact of suicide ideation on irrational thoughts and sleep quality. All tests were considered significant if the p-value < 0.05. Results Table 2 shows that 41.2% of the sample under study were between the ages of 19 and 20, with a mean age of 19.7 ± 1.5, and 55.7% of the sample consisted of females. In terms of marital status, 95% of the participants were single, 76.3% lived in rural areas, and 77.6% belonged to a nuclear family. During the study years, 84.2% of the participants lived with their families, and 76.5% of them received social support. Furthermore, 28.8% of the sample under study was in their first year of school. Furthermore, 56.7% were affiliated with Zagazig University. Table 3 shows that the mean + SD of suicide ideation among nursing students was 11.97 + 9.83, with a mean/maximum score of 23.9. Additionally, the mean + SD of irrational thoughts and sleep quality were 113.75 + 15.84 and 40.54 + 11.35, with mean/maximum scores of 71.1 and 59.6, respectively. According to Table 4 , 17.4% of the sample under study exhibited a high level of suicidal ideation, whereas 82.6% had a moderate level, and 78.1% of the sample under study had moderate levels of irrational thoughts, whereas 18.2% and 3.7% had severe and mild levels, respectively. Additionally, 55.4% of participants had mild sleep quality problems while 42.7% and 1.8% had moderate and severe levels, respectively. Table 5 elucidates a statistically significant correlation between suicide ideation and both irrational thoughts and sleep quality among nursing students (P < 0.008, P < 0.04), respectively. Moreover, there is no statistically significant relationship between irrational thoughts and sleep quality (P < 0.17). As is apparent in Table 6 , irrational thoughts are significantly positively impact on suicidal ideation, while the level of suicidal ideation increased, irrational thoughts increased also and it indicated by (regression coefficient = 0.08, S. E = 0.03, t = 2.7, p = 0.007*) Table 2 Personal data of studied nursing students (n = 379) Personal data questionnaire No. % Age 17–18 87 23.0 19–20 156 41.2 21–22 136 35.8 Mean + SD = 19.7 ± 1.5 Gender Female 211 55.7 Male 168 44.3 Marital status Divorced 1 .3 Married 18 4.7 Single 360 95.0 University Cairo 164 43.3 Zagazig 215 56.7 Academic year First 109 28.8 Second 78 20.6 Third 107 28.2 Fourth 85 22.4 Family type Nuclear 294 77.6 Extended 54 14.2 Joint 31 8.2 Residence area Rural 289 76.3 Urban 90 23.7 Residence with : External/ University Housing 60 15.8 With Family 319 84.2 Social support No 89 23.5 Yes 290 76.5 Table 3 Descriptive statistics for study variables (suicide ideation, irrational thoughts, and sleep quality) (n = 379): Study variables Minimum score in the sample Maximum score in the sample Mean SD Mean percent (= mean/maximum score in sample) Suicide ideation 0 50 11.97 9.83 23.9 Irrational thoughts 36 160 113.75 15.84 71.1 Sleep quality 0 68 40.54 11.35 59.6 Table 4 Levels of irrational thoughts, sleep quality, and suicide ideation of studied students (n = 379): Levels Irrational thoughts Sleep quality Levels Suicide ideation No. % No. % No. % Mild 14 3.7 210 55.4 Low 313 82.6 Moderate 296 78.1 162 42.7 Severe 69 18.2 7 1.8 High 66 17.4 Table 5 Correlation between study variables among nursing students (n = 379): Scores Suicide ideation Irrational thoughts Sleep quality R p R p r P Suicide ideation 1 Irrational thoughts 0.14 0.008* 1 Sleep quality 0.10 0.04* 0.07 0.17 1 *Significant at p-value < 0.05 Table 6 Regression analysis for impact of irrational thoughts and Sleep quality on suicide ideation among nursing students (n = 379): In dependent variable Regression coefficient S. E t P Irrational thoughts 0.08 0.03 2.7 0.007* Sleep quality 0.06 0.04 1.5 0.11 *Significant at p-value < 0.05 Discussion In recent years, Egyptian society has witnessed a significant increase in suicide rates, especially among student populations [ 30 ]. Globally, a key objective outlined for 2030 is to shrink the suicide rate by one-third [ 31 ].In alignment with this priority, the present study aimed to explore the suicide ideation among nursing university students through sleep quality and irrational thoughts. The present study assessed the level of suicidal ideation among nursing students and its potential association with irrational thoughts and sleep quality. The finding revealed that nearly 17.4% of the students exhibited a high level of suicidal ideation, whereas 82.6% reported low levels. In terms of irrational thoughts, 78.1% of the sample under study had moderate levels of irrational thoughts. Additionally, 55.4% of participants had mild sleep quality problems while 42.7% had moderate levels. These findings highlight the need to consider both irrational thoughts and sleep quality as key factors when addressing suicidal ideation in nursing students. In alignment with our findings on suicide ideation, Jones et al. [ 32 ] reported that approximately one-fifth of students had suicidal ideation. Similarly, Slanitz et al. [ 33 ] found that the prevalence of suicidal ideation among nurses was 24.58%. On the same line, a research study conducted by Samutri [ 34 ] reported that 22.8% of nursing students were suicidal. Additionally, another study conducted by Tran et al. [ 35 ] revealed that 16.9% of the students experienced suicidal ideation. Moreover, the current research was corroborated by another study with Seedat et al. [ 36 ], which examined the prevalence of students who experienced suicidal ideation. Higher suicidal ideation was significantly higher for females than males (24.1% versus 17.8%; p = 0.011). Similarly, Kabbash et al. [ 37 ] revealed that the prevalence of both suicidal ideation and attempts among Egyptian university students was 25.3% and 12.3% respectively, reporting suicidal thoughts and suicide attempts. Also, our findings agree with those of Wen et al. [ 38 ], who found that 5.4% of students had suicidal thoughts overall. Furthermore, a recent study by Yang et al. [ 39 ] indicated that nursing students' suicide attempts ranged from 2.9 to 12.6%, while their suicide ideation ranged from 4.3 to 44.58%. The findings were also supported by [ 40 , 41 , 42 , 43 ], who showed that nursing students had lifetime suicidal thoughts. From the researcher’s point of view, the reported level of suicidal ideation among Egyptian nursing students may be attributed to the cumulative stressors associated with the demands of the nursing curriculum. The academic pressure, including frequent clinical areas with different departments and different diagnoses, and the anxiety related to educational failure, may also contribute to significantly poor sleep quality and irrational thoughts, which were evident among many nursing students. Additionally, most of the participants were female, characterized by emotional vulnerability and coping mechanisms, which could influence their psychological resilience and their access to a support system. Although a high number of students reported having social support, a notable number lacked it, which might further heighten their susceptibility to mental health challenges. Regarding the observed differences in percentages, these variations may be attributed to cultural factors, such as the distinction between rural and urban settings, as well as the unique characteristics of Egyptian culture compared to other countries. Notably, the higher prevalence rates reported in Egyptian studies could reflect cultural influences and the relatively limited advancement in psychiatric and mental health services in Egypt compared to more developed contexts. Similarly, a study by Al Badarneh et al. [ 44 ] revealed that students' psychological estrangement and irrational thinking were at a moderate level. This outcome is consistent with Yusefi et al. [ 45 ], who showed a moderate level of irrational beliefs, with a mean of 337.56 ± 22.37 out of 500. Similarly, an earlier study by Ham and You [ 46 ] found that the average score for illogical beliefs was 2.65 ± 0.45 out of 5 across the dimensions of irrational thoughts, indicating the extent of irrationality among nursing students. Furthermore, Al-Habies[ 47 ] who demonstrated an increase in irrationality among the study sample. Regarding irrational thinking among nursing students, the findings may be attributed to the negative psychological states, such as anxiety, that students experience in the university environment, which can distort their thinking patterns. Additionally, limited engagement in critical thinking within their academic, social, and cultural contexts may contribute to the persistence of irrational beliefs. A lack of skills in analysis, synthesis, and evaluation prevents students from effectively challenging these thoughts. Therefore, it is recommended that university authorities, particularly those responsible for student affairs, academic advising, and cultural development, work to create supportive conditions that help address students’ challenges and foster rational, critical thinking. According to this study, 55.4% of the participants had mild sleep quality issues. The mean + SD score for sleep quality was 40.54 ± 11.35, with a mean/maximum score of 59.6. This finding is consistent with that of Hammouda and el Rafey [ 48 ], who conducted interviews with 278 fourth-year medical students and obtained detailed information on their sleep quality, finding that 25.5% of the students had poor sleep. Additionally, Teh et al. [ 49 ], in an earlier survey, found that 54% of respondents experienced trouble sleeping, and 43.3% of them were only moderately active. Furthermore, Simponget al., [ 50 ] who stated that overall, poor sleep quality was reported by 48.5% of subjects (PSQI > 5). Age groups showed differences in the distribution of global PSQI values, with individuals aged 25 to 29 reporting higher rates of poor sleep quality. Similarly, Schmickler et al. [ 51 ] found that 48.7% of 1,684 college students were categorized as poor sleepers. This conclusion was also supported by both Gómez-Chiappe et al. [ 52 ] and Alimirzae [ 53 ], who found that 58.9% and 71%, respectively, of the participants had poor sleep quality. From the researchers' perspectives, sleep quality disturbance is related to various factors that nursing students commonly experience, including multiple academic and psychosocial stressors. The heavy coursework and irregular study schedules, another contributing factor, as well as the demand for clinical placements, frequently disrupt healthy sleep patterns. Moreover, the demographic data of the nursing students revealed that many of them are single, which can exacerbate feelings of stress and further impact their sleep quality. Additionally, the pressure to seek part-time work alongside their studies adds another layer of strain that may interfere with their consistent sleep routines. These challenges may be more pronounced among students from rural areas compared to those from urban settings, as rural students often face additional barriers, including limited access to education, longer travel times, and greater financial or family responsibilities. One of the most significant findings that emerged and is directly relevant to answering the research questions is that a statistically significant correlation between suicide ideation and both irrational thoughts and sleep quality among nursing students after suicidal ideation, showed a substantial positive impact on nursing students through irrational thoughts. As levels of suicidal ideation increased, there was a corresponding rise in the severity of irrational thought and sleep quality issues. Similarly, a study by Tian et al. [ 54 ] discovered that among college students, a lower quality of sleep was associated with a higher level of suicide ideation (whether it be active, passive, or total) one month later. In line with earlier research by Slanitz et al. [ 55 ], the study validated the potential connection between poor sleep quality and elevated suicidal thoughts and could help identify suicidal behavior early. The current study was supported by another study by Wu et al. [ 56 ], which discovered that sleep quality, which is mediated independently by perceived social support and resilience, indirectly predicts suicide ideation in major depressed adolescents. Furthermore, another study by Landa Blanco et al. [ 57 ] found that sleep quality is a factor linked to fewer suicidal thoughts. Similarly, Mohseni et al. [ 58 ] demonstrated a positive and significant correlation (r = 0.05) between suicidal thoughts and irrational beliefs. From the researcher’s perspective, the strong positive association between suicidal ideation, irrational thoughts, and poor sleep quality can be interpreted through the psychosocial pressures faced by nursing students. As students who exhibited more severe irrational thought patterns have a relation to their sleep quality, and without social support, prevention, and critical thinking, resilience will affect suicidal ideation levels, suggesting a cyclic relationship in which suicidal ideation may contribute to both irrational thoughts and poor sleep quality. This association is particularly related to the characteristics of the studied sample, as the majority of participants were young, female, single, and residing in rural areas in Egypt, all of which may reflect limited life experience, reduced access to mental health resources, and potential stigma around expressing emotional distress if anyone exhibited. Another contribution related to our result is that 55.4% of the participants had mild sleep disturbance, which did not show a significant impact on suicidal ideation. This may explain why there was no significant association between sleep quality and irrational thoughts. This finding explained that although nursing students are exposed to considerable academic and clinical pressures, they are still able to cope with irrational thoughts to some extent. However, they remain at high risk of developing more severe problems in the absence of adequate health assurance and without effective, integrated programs to promote their overall health and well-being. Additionally, this study can be considered as addressing the first level of prevention, as it identifies high-risk variables among nursing students. It also lays the way for future research to explore potential predictors and other related problems that may affect nursing students’ mental health and well-being. Limitation The first study's limitation is its cross-sectional design, which collects data at a single point in time, thereby limiting the ability to establish causal correlations among variables. This design does not account for changes over time or the direction of influence. The second limitation concerns the study’s focus on Egyptian nursing students only. Cultural differences can vary significantly affect student’s perception and experiences, thought pattern, sleep quality and overall mental wellbeing; consequently, executing a comparative cross-sectional survey across varied cultural contexts may yield significant insights and improve the generalizability of results. The third, utilizing online platforms for data collecting, may add selection bias by potentially rejecting students with restricted or no internet access, which may affect the generalizability of the findings. Conclusion This study highlights that the majority of nursing students had a moderate level of suicidal ideation and irrational thoughts. Additionally, 55.4% of participants had mild sleep quality problems. The results also show that irrational thoughts and sleep quality are significantly positively impacted by suicidal ideation. In contrast, the level of suicidal ideation increased, irrational thoughts and sleep quality problems increased. Findings from this study indicate that a statistically significant correlation exists between suicide ideation and both irrational thoughts and sleep quality among nursing students. Moreover, there is no statistically significant relation between irrational thoughts and sleep quality. Recommendations It is essential to implement communication campaigns that address irrational thinking, raise awareness of irrational beliefs, and strengthen the role of parents as social support systems. Encourage initiatives focused on Mental Health Awareness and Cognitive Restructuring Programs. Creating efficient methods for the early identification of sleep disturbance and suicide risk, as well as the application of interventions (such as stress management workshops, time management training, mindfulness programs, and easier access to psychological support services). Incorporate Sleep Hygiene Training into Nursing Curricula. Equipping students with the necessary skills to cope with psychological and emotional challenges is essential. Additionally, establishing more extensive support networks, such as community resources and support groups, is also recommended to provide social and emotional support. Declarations Ethics Approval and Consent for Publication Ethics approval and consent to participate. The study was conducted following the Declaration of Helsinki ethical guidelines. Primary approval was obtained by the Research Ethics Committee at Zagazig University's Faculty of Nursing under code ID/ZU.Nur.REC#209 . Participation in the study was voluntary and based on obtaining participants’ informed consent through their submission of the completed study tools. The ethical considerations include explaining the purpose and nature of the study to ensure that the information remains confidential and is not accessible to others. The study posed no risk to the participants. Clinical trial number : not applicable Consent for publication : Not applicable Availability of data and materials : The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests : The authors declare no competing interests Funding : No. Authors’ Contributions B.A.A.: Writing – review & editing. L.A.A.: Conceived and designed the study, and M.I.E.: Performed the statistical analyses, Methodology, and Formal analysis; L.A.A and B.A.A.: Edited and drafted the paper; B.A.A., M.I.E., and L.A.A.: Participated in data collection. A.J.N.: critical review and final editing. All authors provided input regarding the manuscript and approved the final version. Acknowledgement: The researchers would like to express their gratitude to all the students who participated in the study. References The Lancet. (2022) : An age of uncertainty: mental health in young people 400:539. doi: 10.1016/S0140-6736(22)01572-0. [DOI] [PubMed] [Google Scholar] Gueldner, B. A., Feuerborn, L. L., & Merrell, K. W. (2020). Social and emotional learning in the classroom: Promoting mental health and academic success (2nd ed.). The Guilford Press. WHO (2021): Suicide. Available at https://www.who.int/news-room/fact-sheets/detail/suicide. Accessed July 2023 Accessed on 15/6/2025. Xue, J., Dong, P., Sentian, Y. et al. (2025). The impact of self-regulatory fatigue on suicidal ideation in nursing students: the mediating role of experiential avoidance and the moderating role of negative life events. BMC Psychol 13, 287 https://doi.org/10.1186/s40359-025-02589-0 Harmer, B., Lee, S., Rizvi, A.& Saadabadi ,A. (2025). Suicidal Ideation. 2024 Apr 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 33351435. Du, W., Jia , Y.J., Hu, F.H., Ge, M.W., Cheng, Y.J., Qu, X., et al. .(2023): Prevalence of suicidal ideation and correlated risk factors during the COVID-19 pandemic: a meta-analysis of 113 studies from 31 countries. J Psychiatr Res. 2023;166:147–68.e18749445344211. http://dx.doi.org/10.2174/0118749445344211240903094824 Liu,Y., Chen,J., Chen,K., Liu, J., Wang,W.(2023).The associations between academic stress and depression among college students: A moderated chain mediation model of negative affect, sleep quality, and social support. Acta Psychologica Volume 239, September 2023, 104014. https://doi.org/10.1016/j.actpsy.2023.104014 Wang, X. Y., Wan, Y. H., and Hu, H. L. (2023). The correlation between behavioral problems and sleep quality in preschool children. Chin. J. Health Educ. 39, 771–776. Mbous, Y.P.V, Nili, M., Mohamed, R., Dwibedi, N .(2022): Psychosocial Correlates of Insomnia Among College Students. Prev Chronic Dis. 2022 Sep 15;19:E60. doi: 10.5888/pcd19.220060. PMID: 36108290; PMCID: PMC9480843 Carpi, M., Cianfarani,C.,& Vestri, A.(2022). Sleep quality and its associations with physical and mental health-related quality of life among university students: A cross-sectional study International Journal of Environmental Research and Public Health, 19 (5) (2022), p. 2874, 10.3390/ijerph19052874 Zhang, C.C., Xiao, S.J., Lin, H., Shi, L., Zheng, X., Xue, Y.Q., …, Xue, B.L.(2018). The association between sleep quality and psychological distress among older Chinese adults: a moderated mediation model BMC Geriatrics, 22 (35) (2022), pp. 1-10, 10.1186/s12877-021-02711-y Negussie, B.B., Emeri, M.S., Reta, E.Y., Shiferaw, B.Z.(2021): Sleep deprivation and associated factors among students of the Institute of Health in Jimma University, Southwest Ethiopia. Front Nurs. 2021;8(3):303–11. Substance Abuse and Mental Health Services Administration (SAMHSA). Suicide and suicidal behavior. Accessed June 7, 2025. Russell, K., Allan, S., Beattie, L., Bohan, J., MacMahon, K., Rasmussen, S.(2019): Sleep problem, suicide and self-harm in university students: A systematic review. Sleep Med Rev. 2019 Apr;44:58-69. doi: 10.1016/j.smrv.2018.12.008. Epub 2019 Jan 23. PMID: 30721844. Modarres, M., Abunasri, M., Alhani, F., Ebrahimi , E.(2022): The Effectiveness of Implementing Family-Centered Empowerment, Model on Irrational Thoughts of Iranian Infertile Women: A Randomized Clinical Trial. Journal of Caring Sciences.;11(4):224. doi: 10.34172/jcs.2022.22. Afshahr S(2016). Comparison of the spiritual health and irrational beliefs of male and female undergraduate, masters and Ph. D student in Kashan. Res Relig Health 2016; 2(3): 25-34. Bahremand, M., Saeidi, M., Komasi , S. (2015).Non-coronary patients with severe chest pain show more irrational beliefs compared to patients with mild pain. Korean J Fam Med 2015; 36(4): 180-5. Quimbiulco, M., & Castro, A. (2017). Aspectos psicosociales y creencias irracionales en pacientes con intento de suicidio atendidos en el servicio de salud mental del Hospital Carlos Andrade Marín. [Tesis de Licenciatura, Universidad Central del Ecuador]. Repositorio digital de la Universidad Central del Ecuador. Retrieved from http://www.dspace.uce.edu.ec/handle/25000/15257 Farahat, R.A., Shaheen N., Abdelazeem , B. .(2022): Suicide in Egypt: Should it Be prevented or disregarded? Ann Med Surg (Lond). 2022 Aug 25;81:104496. doi: 10.1016/j.amsu.2022.104496. PMID: 36060436; PMCID: PMC9433602. Giri, P., Baviskar, M, Phalke, D. (2013).Study of sleep habits and sleep problems among medical students of Pravara Institute of Medical Sciences Loni, Western Maharashtra, India. Ann Med Health Sci Res. 2013;3:51–4. doi: 10.4103/2141-9248.109488. [DOI] [PMC free article] [PubMed] [Google Scholar] Alfonsi, V., Scarpelli, S., D’Atri, A., Stella, G., & De Gennaro, L. (2020). Later School Start Time: The Impact of Sleep on Academic Performance and Health in the Adolescent Population. International Journal of Environmental Research and Public Health, 17(7), 2574. https://doi.org/10.3390/ijerph17072574 Cathleen, F., Ivano Kalaij, A. G., Soelaeman, M. F., & Raharja, S. L. (2023). Suicidal Ideation as a Risk Factor of Suicide in Asian Countries: A Systematic Review and Meta-Analysis of Case-Control Studies . Journal Of The Indonesian Medical Association, 73(3), 113 - 123. https://doi.org/10.47830/jinma-vol.73.3-2023-990 Bhandari, P.( 2023).Correlational Research | When & How to Use. Scribbr. Retrieved January 13, 2025, from https://www.scribbr.com/methodology/correlational-research Ahn, C., Heo, M., & Zhang, S. (2014): Sample size calculations for clustered and longitudinal outcomes in clinical research. CRC Press. 1st Edition,2014. https://doi.org/10.1201/b17822 Taherdoost, H. (2016): Sampling Methods in Research Methodology; How to Choose a Sampling Technique for Research, International Journal of AcademicResearch in Management (IJARM) Vol. 5, No. 2, 2016, Page: 18-27, ISSN: 2296-1747. https://doi.org/10.2139/ssrn.3205035 van Spijker, B.A., Batterham, P.J., Calear, A.L., Farrer, L., Christensen, H., Reynolds, J., et al,(2014):The suicidal ideation attributes scale (SIDAS): community-based validation study of a new scale for the measurement of suicidal ideation. Suicide Life Threat Behav. 2014; 44:408–19 Koopmans, P. C., Sanderman, R., Timmerman, I., & Emmelkamp, P. M. G. (1994). The Irrational Beliefs Inventory (IBI): Development and psychometric evaluation. European Journal of Psychological Assessment, 10(1), 15 Alyahya, K.I., Alrefaei, R.M., Almadhyani, L.F., AlQuwayz, S.S., AlOmairini MI, Alsayed FA, Alasmari YS. (2023): The Prevalence and Correlation of Suicidal Ideation Among Nurses in King Saud University Medical City. Cureus. 2023 Sep 7;15(9):e44859. doi: 10.7759/cureus.44859. PMID: 37809273; PMCID: PMC10560092. Shahid,A., et al.( 2012). STOP, THAT and One Hundred Other Sleep Scales. © Springer Science Business Media, LLC 2012. DOI 10.1007/978-1-4419-9893-4_85. Hilali, S. (2022) :About the phenomenon of suicide in Egypt. https://en.eipss-eg.org/wp-content/uploads/2022/03/About-the-phenomenon-of-suicide-in-Egypt-.pdf. Accessed june 2025 Suicide worldwide in 2019 Global Health Estimates (n.d.). https://iris.who.int/bitstream/handle/10665/341728/9789240026643-eng.pdf?sequence=1. Accessed june 2025 Jones LB, Vereschagin M, Wang AY, et al. (2022).Suicidal Ideation Amongst University Students During the COVID-19 Pandemic: Time Trends and Risk Factors. The Canadian Journal of Psychiatry. 2022;68(7):531-546. doi:10.1177/07067437221140375 Slanitz, C., Fuchshuber, J., Fink, A., Unterrainer , H.F. (2024): Anxious and depressive symptoms mediate the influence of sleep quality on suicidality in young adults. Front Public Health. 2024 Jan 11;12:1322069. doi: 10.3389/fpubh.2024.1322069. PMID: 38282761; PMCID: PMC10808692. SAMUTRI, ERNI (2023):Prevalence and predictors of suicidality among nursing students in Indonesia. KontAKt / Journal of nursing and social sciences related to health and illness Tran Thi Thuy, H., Pham, Thi. M., Cap, Minh .D.(2024). Suicidal ideation and its associated factors among high school adolescents in Haiphong, Vietnam: 10.55131/jphd/2024/220201. J Public Hlth Dev [internet]. 2024 May 31 [cited 2025 Feb. 25];22(2):1-12. available from: https://he01.tci-thaijo.org/index.php/AIHD-MU/article/view/267515 Seedat , S., Sengwayo, M., Gani, S., Mashego, L., Ochayon, J., Shepard , A., Vergie , C., Masango, M., Makuapane, L.P., Wagner, F., , R.G.(2025). Prevalence and determinants of suicidal ideation among South African Health Sciences students at the onset of the COVID-19 pandemic. Front Psychiatry. 2025 Mar 19;16:1492620. doi: 10.3389/fpsyt.2025.1492620. PMID: 40177592; PMCID: PMC11962656. Kabbash, I.A., Salama, B., Mohammad, M.A. et al.(2023). Perception and experiences of suicide among university students in Egypt. Middle East Curr Psychiatry 30, 87 (2023). https://doi.org/10.1186/s43045-023-00358-6 Wen, L.y., Zhang, L., Zhu, Lj. et al. (2024).Depression and suicidal ideation among Chinese college students during the COVID-19 pandemic: the mediating roles of chronotype and sleep quality. BMC Psychiatry 24, 583 .https://doi.org/10.1186/s12888-024-06027-0 Yang, X., Hu, D., Li, L., Rezak, R.(2025). Factors of suicide-related behaviors based on stress-vulnerability model and prevention strategies among nurses: a scoping review. Front Psychol. 2025 Jan 20;16:1483904. doi: 10.3389/fpsyg.2025.1483904. PMID: 39901970; PMCID: PMC11788286. Atreya, A., Nepal, S., Menezes, R.G., Marhatta, A., Ghimire, S., Shah, P. (2023): Suicidal Ideation Among Medical and Nursing Students. J Nepal Health Res Counc. 2023 Jul 20;20(4):852-858. doi: 10.33314/jnhrc.v20i4.4147. PMID: 37489667. Xue, J., Dong, P., Sentian, Y., Wenzheng , F., Yuhuan, Z., Dong, C., Xuanye, H., Hongyanjun , L.(2025): The impact of self-regulatory fatigue on suicidal ideation in nursing students: the mediating role of experiential avoidance and the moderating role of negative life events. BMC Psychol. 2025 Mar 21;13(1):287. doi: 10.1186/s40359-025-02589-0. PMID: 40119484; PMCID: PMC11929291. Herawati, K., & Gayatri, D. (2019). The correlation between sleep quality and levels of stress among students in Universitas Indonesia. Enfermeria Clinica, 29, 357-361. https://doi.org/10.1016/j.enfcli.2019.04.044 Çetin, N., Uslu, E., Kendirkıran , G..(2024): Evaluation of suicide in nursing students from the perspective of meaning of life and hope. J Nursology. 2024;27(2):111-119. Al Badarneh, M. T., Al Azzam, A. A. A., Yassien, B. B., & Al Khasawneh, A. A. (2023). The Level of Psychological Alienation and Its Relationship with the Prevalence of Irrational Thoughts among a Sample of Syrian Students in Jordan. 42(200), 19-169. doi: 10.21608/jsrep.2023.324611 Yusefi , A., Atashbahar, O., Bahmaei, J., Askarpour , H., Bordbar, S.(2024): Examining Irrational Beliefs and their Association with the Quality of Life of Students: Evidence from a Cross-Sectional Study. Open Public Health J, 2024; 17: e18749445344211. http://dx.doi.org/10.2174/0118749445344211240903094824 Ham, E-.M., You, M. J. .(2017): Role of Irrational Beliefs and Anger Rumination on Nurses’ Anger Expression Styles. Workplace Health & Safety. 2017;66(5):223-232.doi:10.1177/2165079917737090 Al-Habies , F. (2022). Irrational Beliefs among Sciences and Human Sciences Students at Isra University. Dirasat: Human and Social Sciences, 49(2), 573–582. https://doi.org/10.35516/hum.v49i2.1815 Hammouda, M.& el rafey, D. (2024): sleep quality and association with academic performance among fourth year medical students at zagazig university. Zagazig University Medical Journal, 2024; (76-82): -. doi: 10.21608/zumj.2021.56954.2071 Teh, Shu & M., Saat & A., Hanawi & S., Chan & H., Hanafiah & R., Aznan & C, Joan & S., Ahmad & H, Zulkefli. (2020). Sleep Quality among University Students: Associations between Demographic Factors and Physical Activity Level. International Journal Of Pharmaceutical Research And Allied Sciences. 57-65. Simpong, D.L., Bockarie, A., Kumah , A.B., Atta-Owusu, A.B., Eshun , M., Frimpong, B.A., Bachella , B., Osei, GN. .(2024): Poor sleep quality remains a major challenge among tertiary education students in Ghana: A cross-sectional study in a Ghanaian University. IBRO Neurosci Rep. 2024 Dec 31;18:130-134. doi: 10.1016/j.ibneur.2024.12.014. PMID: 39877590; PMCID: PMC11773084. Schmickler, J.M., Blaschke , S., Robbins, R., Mess., F. .(2019): Determinants of Sleep Quality: A Cross-Sectional Study in University Students. Int J Environ Res Public Health. 2023 Jan 23;20(3):2019. doi: 10.3390/ijerph20032019. PMID: 36767422; PMCID: PMC9915447. Gómez-Chiappe , N., Lara-Monsalve , P.A., Gómez A.M., Gómez DC, González J.C., González L., Gutiérrez-Prieto J.E., Jaimes-Reyes M.A., González LD, Castillo J.S. .(2020): Poor sleep quality and associated factors in university students in Bogotá D.C., Colombia. Sleep Sci. 2020 Apr-Jun;13(2):125-130. doi: 10.5935/1984-0063.20190141. PMID: 32742583; PMCID: PMC7384535. Alimirzae, R., Azzizadeh, Forouzi, M., Abazari F, Haghdoost .(2014): A.. Prevalence of quality of sleeping and its determinants among Students of Kerman Razi School of nursing and midwifery. Asian J. Nur. Edu. and Research 4(1): Jan.-March 2014; Page 76-80. Tian, M., Lin, L., Liu, Y. et al.(2024): The relationship between sleep quality and suicidal ideation in college students: the longitudinal mediating role of negative affect and the neural basis of this relationship. Curr Psychol 43, 29385–29398 (2024). https://doi.org/10.1007/s12144-024-06574-5 Slanitz, C., Fuchshuber, J., Fink A, Unterrainer H.F. (2024): Anxious and depressive symptoms mediate the influence of sleep quality on suicidality in young adults. Front Public Health. 2024 Jan 11;12:1322069. doi: 10.3389/fpubh.2024.1322069. PMID: 38282761; PMCID: PMC10808692. Wu, Y., Guo , Z., Zhang, D., Wang, Y., Wang S.(2024): Sleep Quality and Suicidal Ideation in Adolescent Depression: A Chain Mediation Effect of Perceived Social Support and Resilience. Clin Psychol Psychother. 2024 Mar-Apr;31(2):e2990. doi: 10.1002/cpp.2990. PMID: 38659274. Landa Blanco, Miguel & Romero, Karol & Caballero, Ivin & Gálvez-Pineda, Ernesto & Fúnes-Henríquez, María & Romero, Rina. (2024). Exploring suicide ideation in university students: sleep quality, social media, self-esteem, and barriers to seeking psychological help. Frontiers in Psychiatry. 15. 10.3389/fpsyt.2024.1352889 Mohseni, S. , Mirgol, A. and Moradi, J. (2023). Predicting suicidal ideation based on irrational beliefs and rumination of students (psychology and educational sciences) Payame Noor. Horizon of Medical Education Development, 14(2), 77-65. doi: 10.22038/hmed.2022.58230.1156 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7128255","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":500550809,"identity":"2f1847d7-0183-4041-a6f9-2e52c446a8f9","order_by":0,"name":"Basma AbdElmajid Adly","email":"","orcid":"","institution":"Zagazig University","correspondingAuthor":false,"prefix":"","firstName":"Basma","middleName":"AbdElmajid","lastName":"Adly","suffix":""},{"id":500550814,"identity":"92b43b28-60e6-4861-99a6-446f1c1ad434","order_by":1,"name":"Maha Ibrahim El Bayoumy Ali","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABF0lEQVRIie3QMUvDQBTA8RcCnZ7c+gpSv8KTQGhRyFdRBLsE7dSpQ0CMi+gacPEj6DdIOLBLbNcbMnTq1KGTdGjFuxtLTteC9yeES8jvXhIAn+8A4xLtGYCCTK/6KOz9jpsM9ghhN/uDJJaAIfaaLP+VxNPPag2j5la83N2/wYSOo2nNsB5LEOK1ndQ3V3rn5aBoqlzBB2FcpxwUMwndYtFOypQ1kQzqUpOOJgo5PMolsCpbCc9X0caQE0u+CaNCk50miYuoNLZT2JAgJ2R9hIGZIjIHWcV9/S18askTIdXXo+pxNkRS7X+M52mkYNtwTw2XCr7OE/Eg3xeb8VlPPLe/mCnc7i/Mswh04SSuhHuKz+fz/at+ACZ5YvM0lnBkAAAAAElFTkSuQmCC","orcid":"","institution":"Cairo University","correspondingAuthor":true,"prefix":"","firstName":"Maha","middleName":"Ibrahim El Bayoumy","lastName":"Ali","suffix":""},{"id":500550815,"identity":"cf9215da-e58b-4c26-9313-360b491d2286","order_by":2,"name":"Abdulqadir J. 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Effective adjustment to these circumstances becomes essential for students' general well-being as well as their academic performance [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Suicide is a major global health issue. More than one out of every 100 deaths is due to suicide. Over 700,000 people worldwide are thought to lose their survives to suicide every year. Suicide is the 17th prominent cause of death globally and the fourth prominent cause of mortality among individuals aged 15 to 29 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNursing students are especially susceptible to mental health issues because of the particular strains connected to their clinical and academic training. Their likelihood of suicidal thoughts is significantly increased by the combined strain of emotional work, such as dealing with patient agony and death, and educational obligations [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The act of contemplating death or planning to take one's own life is known as suicidal ideation. From a broad wish for death without a specific strategy, intention, or action to active suicidal ideation, characterized by a comprehensive plan and a resolute determination to execute the suicidal ideation, can vary in intensity. Suicidal ideation is strongly correlated with both suicide attempts and fatalities, and it is a substantial risk factor for future suicide attempts [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Following the emergence of the COVID-19 pandemic, suicide ideation has increased significantly among college students. For instance, a meta-analysis of 113 studies across 31 nations revealed that around 20.6% of college students experienced suicidal ideation. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough suicidal ideation has been linked to academic stress and emotional strain among nursing students, recent studies highlight poor sleep quality as a potential contributing factor that may intensify negative thought patterns and reduce emotional resilience [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The term \"sleep quality\" denotes an individual's comprehensive contentment with multiple facets of their sleep experience. Sleep efficacy, sleep onset, sleep duration, and early awakening are the four primary markers used to evaluate sleep quality [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Young adults should strive for 7 to 9 hours of sleep each night. However, a minimum of 60% of college students get inadequate sleep, averaging merely seven hours per night. Previous studies have found that up to 75% of university students experience irregular sleep problems, and 15% report poor overall sleep quality [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOne of the most important elements influencing a person's mental health outcomes is poor sleep quality. It might cause depression by upsetting the equilibrium of the hypothalamic-pituitary-adrenal axis. Additionally, getting too little sleep would impair one's capacity to regulate emotions, which would accelerate the onset of depression symptoms [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Furthermore, a lack of quality sleep would make someone feel more stressed, which could then result in more depressive symptoms. Additionally, inadequate sleep is linked with several adverse outcomes, including exhaustion, poor academic performance, and impaired daytime functioning [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNegative consequences of sleep deprivation encompass emotional instability, mood disorders, somnolence, forgetfulness, lethargy, fatigue, impaired academic performance, depression, stress, suicidal ideation, diminished immune response, reduced physical health, reduced psychomotor abilities, altered perception, heightened error rates, reduced interpersonal interactions, and substance use[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Additionally, the Substance Abuse and Mental Services Administration has identified sleep disorders as one of the top 10 suicide alert signs [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Over the past ten years, an increasing amount of research indicates that sleep disturbance is one of the key elements in the complex and multidimensional path leading to suicidal ideas and behaviors. The connection between sleep quality and suicidal ideation among university students highlights the need to explore underlying cognitive factors, such as irrational beliefs, that may contribute to them [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIrrational beliefs are persistent thoughts that control an individual's mind, shaping their interpretation of events, assigning denotation, and influencing the quality and intensity of behaviors and emotions. In simpler terms, irrational thoughts are wishes and goals that become crucial predilections, so that failing to meet them can result in anxiety and distress. These beliefs often conflict with reality, impose rigid 'musts' on individuals, disrupt their sense of balance, and hinder their ability to create order [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Negative thoughts that cause anxiety and tension are known as irrational beliefs. These ideas are centered on irrational thoughts that develop in the mind, upsetting equilibrium and resulting in unhealthy feelings and behaviors that endanger a person's life, mental health, and emotional stability. Consequently, it may be concluded that these beliefs are important and influential elements that impact an individual's health [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Additionally, some research has demonstrated a correlation between irrational beliefs and decreased life satisfaction, anxiety, and happiness [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIt has also been investigated how illogical beliefs and suicidal thoughts are related. Quimbiul and Castro [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] investigated the irrational thoughts that lead people to attempt suicide in Ecuador. Suicide attempts can be influenced by feelings of helplessness, guilt, and hopelessness, according to their study of thirty patients who had attempted suicide. So, suicidal ideation is a significant predictor and risk factor for completed suicide and an increase in suicide rates. To prevent suicide, considerable efforts must be focused on decreasing suicidal ideation.\u003c/p\u003e\u003cp\u003eTo accomplish this, research is needed to explore the underlying mechanisms that contribute to the onset and persistence of suicidal ideation, as these can lead to suicide if not adequately addressed. In essence, it is crucial to investigate the factors closely linked to suicidal ideation and the specific connections between these factors and suicidal ideation to effectively manage the emergence of suicidal ideation, thereby preventing suicide. Among the various aspects related to suicidal ideation, sleep quality and irrational beliefs are particularly noteworthy due to their potential for modification [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eSignificance of the study\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSuicide ranks among the top five mental health concerns confronting college students globally. The WHO data published after 2019 indicates that over fifty percent of suicides are perpetrated by individuals under 45 years of age, especially those between 15 and 29 [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Suicidal conduct in kids impacts not only the individuals and their families but also has a wider societal effect. A significant amount of research indicates that the quality of sleep is crucial for optimal psychomotor performance and neurocognitive function, and maintaining physical and mental health [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eStudies indicate a relationship between sleep issues and the occurrence of suicidal thoughts, suggesting that disrupted sleep may worsen emotional distress and cognitive difficulties. Additionally, irrational thoughts such as catastrophizing and perfectionism are recognized as cognitive distortions that increase the risk of suicidal ideation by impairing coping mechanisms and emotional regulation. Exploring the relation between these factors is crucial for evolving effective early intervention and support strategies within nursing education settings, such as sleep hygiene intervention and cognitive behavioral therapy sessions [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMoreover, previous research has suggested that suicidal ideation may serve as a risk factor for suicide completion. Besides, suicide has emerged as the third largest cause of mortality among adults in their prime, highlighting the urgent need for comprehensive prevention measures and risk assessment tools [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. To bolster this understanding, we conducted research focusing on exploring suicide ideation through sleep quality and irrational thoughts among nursing university students.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAim of the study\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study aimed to assess suicide ideation among nursing university students through sleep quality and irrational thoughts.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResearch questions\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eThe main research questions that this study aims to address are:\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWhat is the level of suicide ideation, sleeping quality, and irrational thoughts among nursing university students?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWhat is the correlation between suicide ideation, sleep quality, and irrational thoughts among nursing university students?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWhat is the impact of sleep quality and irrational thoughts on suicidal ideation?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Subjects and methods","content":"\u003cp\u003e\u003cstrong\u003eDesign\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study utilized a correlational research design to attain its objectives. A correlational research methodology examines the relationships between variables. A correlation elucidates the magnitude and orientation of the relationship between two or more variables [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted among nursing students from Cairo and Zagazig universities in Egypt. The researcher selected the two nursing faculties, one in Cairo and one in Zagazig, due to the ease of accessibility and the researcher\u0026apos;s affiliation with these institutions. Also, Cairo represents a more urban setting, while Zagazig is considered a rural area. Including both sites allows for a broader comparison of how contextual factors of lifestyles influence suicidal ideation, sleep quality, and irrational thought among nursing students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy subjects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNursing students were selected using a stratified sampling method to achieve the study\u0026apos;s aim. A sampling method known as stratified random sampling involves splitting a population into smaller subgroups, or strata [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e]. According to Taherdoost [\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e], stratified random sampling, also known as stratification, creates strata based on traits or attributes that people have in common. The nursing students were divided into smaller subgroups, or strata, using a stratified sample. The sample size was 370 nursing students out of 9208 by using the formula for sample size calculation:\u003c/p\u003e\n\u003cp\u003en=\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\frac{{z}^{2}\\text{*}p\\text{*}(1-p)/{e}^{2}}{1+\\:\\frac{{z}^{2}\\text{*}p\\text{*}(1-p)}{{e}^{2}\\text{*}N}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eWhere p is the estimated proportion in the population\u0026thinsp;=\u0026thinsp;0.5\u003c/p\u003e\n\u003cp\u003eN population size\u0026thinsp;=\u0026thinsp;9208\u003c/p\u003e\n\u003cp\u003eThe margin of error\u0026thinsp;=\u0026thinsp;5%=0.5\u003c/p\u003e\n\u003cp\u003eAnd z is the standard normal value with confidence level 95%=1.96\u003c/p\u003e\n\u003cp\u003eIt was determined that the sample size was 370. To take into consideration any possible missing data, an additional nine students were included, bringing the total sample size to the required size. This approach ensured that the total sample size remained unaffected, even with incomplete responses, resulting in a total sample of 379 nursing students. Then the number of students selected from each university and each level was proportional to the proportion of students in that university and level in the entire population. The study sample from each university was (215) from Zagazig University out of (5129), and (164) from Cairo University out of (4079), and from each level was as follows (see Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e):\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDistribution of the study sample from Zagazig and Cairo Universities:\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLevel\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCairo\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eZagazig\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFirst\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e497/2881*164\u0026thinsp;=\u0026thinsp;\u003cstrong\u003e28\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1915/5129*215\u0026thinsp;=\u0026thinsp;\u003cstrong\u003e80\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecond\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e785/2881*164\u0026thinsp;=\u0026thinsp;\u003cstrong\u003e45\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e831/5129*215\u0026thinsp;=\u0026thinsp;\u003cstrong\u003e35\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThird\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e835/2881*164\u0026thinsp;=\u0026thinsp;\u003cstrong\u003e47\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1249/5129*215\u0026thinsp;=\u0026thinsp;\u003cstrong\u003e52\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eForth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e764/2881*164\u0026thinsp;=\u0026thinsp;\u003cstrong\u003e44\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1134/5129*215\u0026thinsp;=\u0026thinsp;\u003cstrong\u003e48\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e-An undergraduate student who studies at the Nursing Faculty, Cairo and Zagazig University, and has accepted to participate in the study.\u003c/p\u003e\n\u003cp\u003e- Enrolled students from all academic years of the faculty to ensure representation across all levels of the study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e-Free from mental and Psychiatric diseases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTools of Data Collection\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData was collected using four Tools\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFirst tool: Personal data questionnaire\u003c/strong\u003e, developed by researchers, which incorporates items about nursing students, including age, gender, marital status, academic level, type of family, area of residence, living arrangement, name of university, availability of social support, and whether they are free from mental or psychiatric disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSecond tool: The Suicidal Ideation Attributes Scale (SIDAS)\u003c/strong\u003e: van Spijker et al.[\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e] developed the Suicidal Ideation Attributes Scale (SIDAS), which had been validated as a brief online measurement of the intensity of suicidal ideation. Suicide plans and attempts were more closely linked to thinking frequency and controllability than to other characteristics evaluated. The SIDAS is a five-item scale that uses 10-point ratings to assess the following criteria over the last month: item 1: frequency; item 2: controllability; item 3: closeness to attempt; item 4: distress; and item 5: interference with everyday activities. A scale ranging from 0 (Never) to 10 (Always) is used to score each item. High risk of suicidal behavior was indicated by scores\u0026thinsp;\u0026ge;\u0026thinsp;21. The SIDAS appears to be a valid instrument for measuring the intensity of suicidal thoughts. The scale\u0026apos;s internal consistency is high (\u0026alpha;\u0026thinsp;=\u0026thinsp;.91) [\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThird tool: The Irrational Beliefs Inventory (IBI)\u003c/strong\u003e: The IBI-34 items developed by Koopmans et al.,[\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e], measured five factors: (6 items); Need for Approval, (8 items); Worrying, (6 items); Rigidity, (7 items); Emotional Irresponsibility, and (7 items); Problem Avoidance. Each item was answered by participants using a 5-point Likert-type scale, with 1 denoting \u0026quot;strongly disagree\u0026quot; and 5 denoting \u0026quot;strongly agree. Accordingly, higher scores reflect more irrational beliefs. The alpha for the 34 items of the IBI\u0026ndash;34, developed by AL-Heeti, Hamid, and Alghorani [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e], was 0.76. The subscales generally demonstrated acceptable internal consistency reliability, ranging from 0.71 to 0.76 [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFourth tool: Sleep Quality Scale (SQS)\u003c/strong\u003e, developed by Shahid et al. [\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e], which consists of 28 items. Daytime symptoms, recovery after sleep, problems initiating and maintaining sleep, difficulty waking, and sleep satisfaction are the six domains of sleep quality that are assessed by SQS. Scoring Using a four-point Likert-type scale (0 = \u0026ldquo;few,\u0026rdquo; 1 = \u0026ldquo;sometimes,\u0026rdquo; 2 = \u0026ldquo;often,\u0026rdquo; and 3 = \u0026ldquo;almost always\u0026rdquo;) respondents indicate how frequently they exhibit certain sleep behaviors. Scores on items belonging to factors 2 and 5 (restoration after sleep and satisfaction with sleep) are reversed before being tallied. Higher scores indicating more acute sleep problems. Total scores can range from 0 to 84. Test-retest reliability is .81and Internal consistency is .92 [\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u003cstrong\u003eProcedure\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eFollowing the official approval of Zagazig University\u0026apos;s Faculty of Nursing\u0026apos;s Research Ethics Committee, Data collection was conducted using an online questionnaire designed via Google Forms. The survey link was distributed to nursing students across all academic levels (first to fourth year) through the WhatsApp groups designated for each level. The researcher employed a sequential distribution technique: the link was first shared with students in one academic level, and once the required number of responses based on the calculated sample size for that level was obtained, the form was closed for that group. Subsequently, the link was shared with the next academic level, and the same process was repeated until the targeted number of participants was reached in each group. This approach ensured proportionate representation from all educational levels and controlled the number of responses according to the predetermined sample size. Participants who consented to engage completed the study tools through the Google Form after receiving a clear explanation of the study\u0026apos;s aim and nature. They were guaranteed the confidentiality of their responses and informed of their right to withdraw at any time without consequence. The questionnaire remained available for two months, from early December 2024 to the end of January 2025, during which it was distributed sequentially to each academic level using a stratified sampling technique. On average, participants required approximately 15 to 30 minutes to complete the tools.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted following the Declaration of Helsinki ethical guidelines. The study was formally approved by the Faculty of Nursing\u0026apos;s Research Ethics Committee under code \u003cstrong\u003eID/ZU.Nur.REC#209\u003c/strong\u003e. After being fully informed about the purpose of the study, the students provided informed consent by submitting the completed study tools, and participation in the study was entirely voluntary. Explaining the goal and nature of the study, as well as ensuring that the material was kept private and that no one could access it without the students\u0026apos; consent, were among the ethical concerns. Participants in the study weren\u0026apos;t exposed to any risks.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical design\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eIBM SPSS version 25.0 (Armonk, NY: IBM Corp.) was used for data entry and statistical analysis. Numbers and percentages were calculated for qualitative data, while means and standard deviations were calculated for quantitative data. Pearson\u0026apos;s correlation was used to examine the relationships between variables. Regression analysis was used to study the impact of suicide ideation on irrational thoughts and sleep quality. All tests were considered significant if the p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows that 41.2% of the sample under study were between the ages of 19 and 20, with a mean age of 19.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5, and 55.7% of the sample consisted of females. In terms of marital status, 95% of the participants were single, 76.3% lived in rural areas, and 77.6% belonged to a nuclear family. During the study years, 84.2% of the participants lived with their families, and 76.5% of them received social support. Furthermore, 28.8% of the sample under study was in their first year of school. Furthermore, 56.7% were affiliated with Zagazig University.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows that the mean\u0026thinsp;+\u0026thinsp;SD of suicide ideation among nursing students was 11.97\u0026thinsp;+\u0026thinsp;9.83, with a mean/maximum score of 23.9. Additionally, the mean\u0026thinsp;+\u0026thinsp;SD of irrational thoughts and sleep quality were 113.75\u0026thinsp;+\u0026thinsp;15.84 and 40.54\u0026thinsp;+\u0026thinsp;11.35, with mean/maximum scores of 71.1 and 59.6, respectively.\u003c/p\u003e\u003cp\u003eAccording to Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, 17.4% of the sample under study exhibited a high level of suicidal ideation, whereas 82.6% had a moderate level, and 78.1% of the sample under study had moderate levels of irrational thoughts, whereas 18.2% and 3.7% had severe and mild levels, respectively. Additionally, 55.4% of participants had mild sleep quality problems while 42.7% and 1.8% had moderate and severe levels, respectively.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e elucidates a statistically significant correlation between suicide ideation and both irrational thoughts and sleep quality among nursing students (P\u0026thinsp;\u0026lt;\u0026thinsp;0.008, P\u0026thinsp;\u0026lt;\u0026thinsp;0.04), respectively. Moreover, there is no statistically significant relationship between irrational thoughts and sleep quality (P\u0026thinsp;\u0026lt;\u0026thinsp;0.17).\u003c/p\u003e\u003cp\u003eAs is apparent in Table \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, irrational thoughts are significantly positively impact on suicidal ideation, while the level of suicidal ideation increased, irrational thoughts increased also and it indicated by (regression coefficient\u0026thinsp;=\u0026thinsp;0.08, S. E\u0026thinsp;=\u0026thinsp;0.03, t\u0026thinsp;=\u0026thinsp;2.7, p\u0026thinsp;=\u0026thinsp;0.007*)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePersonal data of studied nursing students (n\u0026thinsp;=\u0026thinsp;379)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePersonal data questionnaire\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17\u0026ndash;18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e19\u0026ndash;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e156\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u0026ndash;22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMean\u0026thinsp;+\u0026thinsp;SD\u0026thinsp;=\u0026thinsp;19.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e211\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e360\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eUniversity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCairo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e164\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZagazig\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e215\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAcademic year\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFirst\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e109\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecond\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThird\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFourth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily type\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNuclear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e294\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtended\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJoint\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eResidence area\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e289\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eResidence with\u003c/b\u003e:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExternal/ University Housing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWith Family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e319\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSocial support\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e290\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive statistics for study variables (suicide ideation, irrational thoughts, and sleep quality) (n\u0026thinsp;=\u0026thinsp;379):\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy variables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMinimum score in the sample\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMaximum score in the sample\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMean percent\u003c/p\u003e\u003cp\u003e(=\u0026thinsp;mean/maximum score in sample)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSuicide ideation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e23.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIrrational thoughts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e160\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e113.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e15.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e71.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSleep quality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e40.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e11.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e59.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLevels of irrational thoughts, sleep quality, and suicide ideation of studied students (n\u0026thinsp;=\u0026thinsp;379):\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eLevels\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eIrrational thoughts\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eSleep quality\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLevels\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eSuicide ideation\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNo.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMild\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e55.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e313\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e82.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e296\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e78.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e162\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e42.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSevere\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eHigh\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e17.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelation between study variables among nursing students (n\u0026thinsp;=\u0026thinsp;379):\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eScores\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eSuicide ideation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eIrrational thoughts\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eSleep quality\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSuicide ideation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIrrational thoughts\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.008*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSleep quality\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.04*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e*Significant at p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRegression analysis for impact of irrational thoughts and Sleep quality on suicide ideation among nursing students (n\u0026thinsp;=\u0026thinsp;379):\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIn dependent variable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRegression coefficient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eS. E\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIrrational thoughts\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.007*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSleep quality\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003e*Significant at p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn recent years, Egyptian society has witnessed a significant increase in suicide rates, especially among student populations [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Globally, a key objective outlined for 2030 is to shrink the suicide rate by one-third [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].In alignment with this priority, the present study aimed to explore the suicide ideation among nursing university students through sleep quality and irrational thoughts. The present study assessed the level of suicidal ideation among nursing students and its potential association with irrational thoughts and sleep quality. The finding revealed that nearly 17.4% of the students exhibited a high level of suicidal ideation, whereas 82.6% reported low levels. In terms of irrational thoughts, 78.1% of the sample under study had moderate levels of irrational thoughts. Additionally, 55.4% of participants had mild sleep quality problems while 42.7% had moderate levels. These findings highlight the need to consider both irrational thoughts and sleep quality as key factors when addressing suicidal ideation in nursing students.\u003c/p\u003e\u003cp\u003eIn alignment with our findings on suicide ideation, Jones et al. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] reported that approximately one-fifth of students had suicidal ideation. Similarly, Slanitz et al. [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] found that the prevalence of suicidal ideation among nurses was 24.58%. On the same line, a research study conducted by Samutri [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] reported that 22.8% of nursing students were suicidal. Additionally, another study conducted by Tran et al. [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] revealed that 16.9% of the students experienced suicidal ideation. Moreover, the current research was corroborated by another study with Seedat et al. [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], which examined the prevalence of students who experienced suicidal ideation. Higher suicidal ideation was significantly higher for females than males (24.1% versus 17.8%; p\u0026thinsp;=\u0026thinsp;0.011). Similarly, Kabbash et al. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] revealed that the prevalence of both suicidal ideation and attempts among Egyptian university students was 25.3% and 12.3% respectively, reporting suicidal thoughts and suicide attempts. Also, our findings agree with those of Wen et al. [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], who found that 5.4% of students had suicidal thoughts overall. Furthermore, a recent study by Yang et al. [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] indicated that nursing students' suicide attempts ranged from 2.9 to 12.6%, while their suicide ideation ranged from 4.3 to 44.58%. The findings were also supported by [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], who showed that nursing students had lifetime suicidal thoughts.\u003c/p\u003e\u003cp\u003eFrom the researcher\u0026rsquo;s point of view, the reported level of suicidal ideation among Egyptian nursing students may be attributed to the cumulative stressors associated with the demands of the nursing curriculum. The academic pressure, including frequent clinical areas with different departments and different diagnoses, and the anxiety related to educational failure, may also contribute to significantly poor sleep quality and irrational thoughts, which were evident among many nursing students. Additionally, most of the participants were female, characterized by emotional vulnerability and coping mechanisms, which could influence their psychological resilience and their access to a support system. Although a high number of students reported having social support, a notable number lacked it, which might further heighten their susceptibility to mental health challenges. Regarding the observed differences in percentages, these variations may be attributed to cultural factors, such as the distinction between rural and urban settings, as well as the unique characteristics of Egyptian culture compared to other countries. Notably, the higher prevalence rates reported in Egyptian studies could reflect cultural influences and the relatively limited advancement in psychiatric and mental health services in Egypt compared to more developed contexts.\u003c/p\u003e\u003cp\u003eSimilarly, a study by Al Badarneh et al. [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e] revealed that students' psychological estrangement and irrational thinking were at a moderate level. This outcome is consistent with Yusefi et al. [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], who showed a moderate level of irrational beliefs, with a mean of 337.56\u0026thinsp;\u0026plusmn;\u0026thinsp;22.37 out of 500. Similarly, an earlier study by Ham and You [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e] found that the average score for illogical beliefs was 2.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45 out of 5 across the dimensions of irrational thoughts, indicating the extent of irrationality among nursing students. Furthermore, Al-Habies[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e] who demonstrated an increase in irrationality among the study sample.\u003c/p\u003e\u003cp\u003eRegarding irrational thinking among nursing students, the findings may be attributed to the negative psychological states, such as anxiety, that students experience in the university environment, which can distort their thinking patterns. Additionally, limited engagement in critical thinking within their academic, social, and cultural contexts may contribute to the persistence of irrational beliefs. A lack of skills in analysis, synthesis, and evaluation prevents students from effectively challenging these thoughts. Therefore, it is recommended that university authorities, particularly those responsible for student affairs, academic advising, and cultural development, work to create supportive conditions that help address students\u0026rsquo; challenges and foster rational, critical thinking.\u003c/p\u003e\u003cp\u003eAccording to this study, 55.4% of the participants had mild sleep quality issues. The mean\u0026thinsp;+\u0026thinsp;SD score for sleep quality was 40.54\u0026thinsp;\u0026plusmn;\u0026thinsp;11.35, with a mean/maximum score of 59.6. This finding is consistent with that of Hammouda and el Rafey [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], who conducted interviews with 278 fourth-year medical students and obtained detailed information on their sleep quality, finding that 25.5% of the students had poor sleep. Additionally, Teh et al. [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e], in an earlier survey, found that 54% of respondents experienced trouble sleeping, and 43.3% of them were only moderately active. Furthermore, Simponget al., [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e] who stated that overall, poor sleep quality was reported by 48.5% of subjects (PSQI\u0026thinsp;\u0026gt;\u0026thinsp;5). Age groups showed differences in the distribution of global PSQI values, with individuals aged 25 to 29 reporting higher rates of poor sleep quality. Similarly, Schmickler et al. [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e] found that 48.7% of 1,684 college students were categorized as poor sleepers. This conclusion was also supported by both G\u0026oacute;mez-Chiappe et al. [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e] and Alimirzae [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e], who found that 58.9% and 71%, respectively, of the participants had poor sleep quality.\u003c/p\u003e\u003cp\u003eFrom the researchers' perspectives, sleep quality disturbance is related to various factors that nursing students commonly experience, including multiple academic and psychosocial stressors. The heavy coursework and irregular study schedules, another contributing factor, as well as the demand for clinical placements, frequently disrupt healthy sleep patterns. Moreover, the demographic data of the nursing students revealed that many of them are single, which can exacerbate feelings of stress and further impact their sleep quality. Additionally, the pressure to seek part-time work alongside their studies adds another layer of strain that may interfere with their consistent sleep routines. These challenges may be more pronounced among students from rural areas compared to those from urban settings, as rural students often face additional barriers, including limited access to education, longer travel times, and greater financial or family responsibilities.\u003c/p\u003e\u003cp\u003eOne of the most significant findings that emerged and is directly relevant to answering the research questions is that a statistically significant correlation between suicide ideation and both irrational thoughts and sleep quality among nursing students after suicidal ideation, showed a substantial positive impact on nursing students through irrational thoughts. As levels of suicidal ideation increased, there was a corresponding rise in the severity of irrational thought and sleep quality issues. Similarly, a study by Tian et al. [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e] discovered that among college students, a lower quality of sleep was associated with a higher level of suicide ideation (whether it be active, passive, or total) one month later. In line with earlier research by Slanitz et al. [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e], the study validated the potential connection between poor sleep quality and elevated suicidal thoughts and could help identify suicidal behavior early. The current study was supported by another study by Wu et al. [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e], which discovered that sleep quality, which is mediated independently by perceived social support and resilience, indirectly predicts suicide ideation in major depressed adolescents. Furthermore, another study by Landa Blanco et al. [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e] found that sleep quality is a factor linked to fewer suicidal thoughts. Similarly, Mohseni et al. [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e] demonstrated a positive and significant correlation (r\u0026thinsp;=\u0026thinsp;0.05) between suicidal thoughts and irrational beliefs.\u003c/p\u003e\u003cp\u003eFrom the researcher\u0026rsquo;s perspective, the strong positive association between suicidal ideation, irrational thoughts, and poor sleep quality can be interpreted through the psychosocial pressures faced by nursing students. As students who exhibited more severe irrational thought patterns have a relation to their sleep quality, and without social support, prevention, and critical thinking, resilience will affect suicidal ideation levels, suggesting a cyclic relationship in which suicidal ideation may contribute to both irrational thoughts and poor sleep quality. This association is particularly related to the characteristics of the studied sample, as the majority of participants were young, female, single, and residing in rural areas in Egypt, all of which may reflect limited life experience, reduced access to mental health resources, and potential stigma around expressing emotional distress if anyone exhibited.\u003c/p\u003e\u003cp\u003eAnother contribution related to our result is that 55.4% of the participants had mild sleep disturbance, which did not show a significant impact on suicidal ideation. This may explain why there was no significant association between sleep quality and irrational thoughts. This finding explained that although nursing students are exposed to considerable academic and clinical pressures, they are still able to cope with irrational thoughts to some extent. However, they remain at high risk of developing more severe problems in the absence of adequate health assurance and without effective, integrated programs to promote their overall health and well-being. Additionally, this study can be considered as addressing the first level of prevention, as it identifies high-risk variables among nursing students. It also lays the way for future research to explore potential predictors and other related problems that may affect nursing students\u0026rsquo; mental health and well-being.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe first study's limitation is its cross-sectional design, which collects data at a single point in time, thereby limiting the ability to establish causal correlations among variables. This design does not account for changes over time or the direction of influence. The second limitation concerns the study\u0026rsquo;s focus on Egyptian nursing students only. Cultural differences can vary significantly affect student\u0026rsquo;s perception and experiences, thought pattern, sleep quality and overall mental wellbeing; consequently, executing a comparative cross-sectional survey across varied cultural contexts may yield significant insights and improve the generalizability of results. The third, utilizing online platforms for data collecting, may add selection bias by potentially rejecting students with restricted or no internet access, which may affect the generalizability of the findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights that the majority of nursing students had a moderate level of suicidal ideation and irrational thoughts. Additionally, 55.4% of participants had mild sleep quality problems. The results also show that irrational thoughts and sleep quality are significantly positively impacted by suicidal ideation. In contrast, the level of suicidal ideation increased, irrational thoughts and sleep quality problems increased. Findings from this study indicate that a statistically significant correlation exists between suicide ideation and both irrational thoughts and sleep quality among nursing students. Moreover, there is no statistically significant relation between irrational thoughts and sleep quality.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRecommendations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIt is essential to implement communication campaigns that address irrational thinking, raise awareness of irrational beliefs, and strengthen the role of parents as social support systems. Encourage initiatives focused on Mental Health Awareness and Cognitive Restructuring Programs. Creating efficient methods for the early identification of sleep disturbance and suicide risk, as well as the application of interventions (such as stress management workshops, time management training, mindfulness programs, and easier access to psychological support services). Incorporate Sleep Hygiene Training into Nursing Curricula. Equipping students with the necessary skills to cope with psychological and emotional challenges is essential. Additionally, establishing more extensive support networks, such as community resources and support groups, is also recommended to provide social and emotional support.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate.\u003c/strong\u003e The study was conducted following the Declaration of Helsinki ethical guidelines. Primary approval was obtained by the Research Ethics Committee at Zagazig University\u0026apos;s Faculty of Nursing under code ID/ZU.Nur.REC#209\u003cstrong\u003e.\u003c/strong\u003e Participation in the study was voluntary and based on obtaining participants\u0026rsquo; informed consent through their submission of the completed study tools. The ethical considerations include explaining the purpose and nature of the study to ensure that the information remains confidential and is not accessible to others. The study posed no risk to the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: not applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: The authors declare no competing interests\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: No.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eB.A.A.: Writing \u0026ndash; review \u0026amp; editing. L.A.A.: Conceived and designed the study, and M.I.E.: Performed the statistical analyses, Methodology, and Formal analysis; L.A.A and B.A.A.: Edited and drafted the paper; B.A.A., M.I.E., and L.A.A.: Participated in data collection. A.J.N.: critical review and final editing. All authors provided input regarding the manuscript and approved the final version.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u003c/strong\u003e The researchers would like to express their gratitude to all the students who participated in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eThe Lancet. (2022) : An age of uncertainty: mental health in young people 400:539. doi: 10.1016/S0140-6736(22)01572-0. [DOI] [PubMed] [Google Scholar]\u003c/li\u003e\n \u003cli\u003eGueldner, B. A., Feuerborn, L. L., \u0026amp; Merrell, K. W. (2020). Social and emotional learning in the classroom: Promoting mental health and academic success (2nd ed.). The Guilford Press.\u003c/li\u003e\n \u003cli\u003eWHO (2021): Suicide. Available at https://www.who.int/news-room/fact-sheets/detail/suicide. Accessed July 2023 Accessed on 15/6/2025.\u003c/li\u003e\n \u003cli\u003eXue, J., Dong, P., Sentian, Y. et al. (2025). The impact of self-regulatory fatigue on suicidal ideation in nursing students: the mediating role of experiential avoidance and the moderating role of negative life events. BMC Psychol 13, 287 https://doi.org/10.1186/s40359-025-02589-0\u003c/li\u003e\n \u003cli\u003eHarmer, B., Lee, S., Rizvi, A.\u0026amp; Saadabadi ,A. (2025). Suicidal Ideation. 2024 Apr 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan\u0026ndash;. PMID: 33351435.\u003c/li\u003e\n \u003cli\u003eDu, W., Jia , Y.J., Hu, F.H., Ge, M.W., Cheng, Y.J., Qu, X., et al. .(2023): Prevalence of suicidal ideation and correlated risk factors during the COVID-19 pandemic: a meta-analysis of 113 studies from 31 countries. J Psychiatr Res. 2023;166:147\u0026ndash;68.e18749445344211. http://dx.doi.org/10.2174/0118749445344211240903094824\u003c/li\u003e\n \u003cli\u003eLiu,Y., Chen,J., Chen,K., Liu, J., Wang,W.(2023).The associations between academic stress and depression among college students: A moderated chain mediation model of negative affect, sleep quality, and social support. Acta Psychologica Volume 239, September 2023, 104014. https://doi.org/10.1016/j.actpsy.2023.104014\u003c/li\u003e\n \u003cli\u003eWang, X. Y., Wan, Y. H., and Hu, H. L. (2023). The correlation between behavioral problems and sleep quality in preschool children. Chin. J. Health Educ. 39, 771\u0026ndash;776.\u003c/li\u003e\n \u003cli\u003eMbous, Y.P.V, Nili, M., Mohamed, R., Dwibedi, N .(2022): Psychosocial Correlates of Insomnia Among College Students. Prev Chronic Dis. 2022 Sep 15;19:E60. doi: 10.5888/pcd19.220060. PMID: 36108290; PMCID: PMC9480843\u003c/li\u003e\n \u003cli\u003eCarpi, M., Cianfarani,C.,\u0026amp; Vestri, A.(2022). Sleep quality and its associations with physical and mental health-related quality of life among university students: A cross-sectional study International Journal of Environmental Research and Public Health, 19 (5) (2022), p. 2874, 10.3390/ijerph19052874\u003c/li\u003e\n \u003cli\u003eZhang, C.C., Xiao, S.J., Lin, H., Shi, L., Zheng, X., Xue, Y.Q., \u0026hellip;, Xue, B.L.(2018). The association between sleep quality and psychological distress among older Chinese adults: a moderated mediation model BMC Geriatrics, 22 (35) (2022), pp. 1-10, 10.1186/s12877-021-02711-y\u003c/li\u003e\n \u003cli\u003eNegussie, B.B., Emeri, M.S., Reta, E.Y., Shiferaw, B.Z.(2021): Sleep deprivation and associated factors among students of the Institute of Health in Jimma University, Southwest Ethiopia. Front Nurs. 2021;8(3):303\u0026ndash;11.\u003c/li\u003e\n \u003cli\u003eSubstance Abuse and Mental Health Services Administration (SAMHSA). Suicide and suicidal behavior. Accessed June 7, 2025.\u003c/li\u003e\n \u003cli\u003eRussell, K., Allan, S., Beattie, L., Bohan, J., MacMahon, K., Rasmussen, S.(2019): Sleep problem, suicide and self-harm in university students: A systematic review. Sleep Med Rev. 2019 Apr;44:58-69. doi: 10.1016/j.smrv.2018.12.008. Epub 2019 Jan 23. PMID: 30721844.\u003c/li\u003e\n \u003cli\u003eModarres, M., Abunasri, M., Alhani, F., Ebrahimi , E.(2022): The Effectiveness of Implementing Family-Centered Empowerment, Model on Irrational Thoughts of Iranian Infertile Women: A Randomized Clinical Trial. Journal of Caring Sciences.;11(4):224. doi: 10.34172/jcs.2022.22.\u003c/li\u003e\n \u003cli\u003eAfshahr S(2016). Comparison of the spiritual health and irrational beliefs of male and female undergraduate, masters and Ph. D student in Kashan. Res Relig Health 2016; 2(3): 25-34.\u003c/li\u003e\n \u003cli\u003eBahremand, M., Saeidi, M., Komasi , S. (2015).Non-coronary patients with severe chest pain show more irrational beliefs compared to patients with mild pain. Korean J Fam Med 2015; 36(4): 180-5.\u003c/li\u003e\n \u003cli\u003eQuimbiulco, M., \u0026amp; Castro, A. (2017). Aspectos psicosociales y creencias irracionales en pacientes con intento de suicidio atendidos en el servicio de salud mental del Hospital Carlos Andrade Mar\u0026iacute;n. [Tesis de Licenciatura, Universidad Central del Ecuador]. Repositorio digital de la Universidad Central del Ecuador. Retrieved from http://www.dspace.uce.edu.ec/handle/25000/15257\u003c/li\u003e\n \u003cli\u003eFarahat, R.A., Shaheen N., Abdelazeem , B. .(2022): Suicide in Egypt: Should it Be prevented or disregarded? Ann Med Surg (Lond). 2022 Aug 25;81:104496. doi: 10.1016/j.amsu.2022.104496. PMID: 36060436; PMCID: PMC9433602.\u003c/li\u003e\n \u003cli\u003eGiri, P., Baviskar, M, Phalke, D. (2013).Study of sleep habits and sleep problems among medical students of Pravara Institute of Medical Sciences Loni, Western Maharashtra, India. Ann Med Health Sci Res. 2013;3:51\u0026ndash;4. doi: 10.4103/2141-9248.109488. [DOI] [PMC free article] [PubMed] [Google Scholar]\u003c/li\u003e\n \u003cli\u003eAlfonsi, V., Scarpelli, S., D\u0026rsquo;Atri, A., Stella, G., \u0026amp; De Gennaro, L. (2020). Later School Start Time: The Impact of Sleep on Academic Performance and Health in the Adolescent Population. International Journal of Environmental Research and Public Health, 17(7), 2574. https://doi.org/10.3390/ijerph17072574\u003c/li\u003e\n \u003cli\u003eCathleen, F., Ivano Kalaij, A. G., Soelaeman, M. F., \u0026amp; Raharja, S. L. (2023). Suicidal Ideation as a Risk Factor of Suicide in Asian Countries: A Systematic Review and Meta-Analysis of Case-Control Studies . Journal Of The Indonesian Medical Association, 73(3), 113 - 123. https://doi.org/10.47830/jinma-vol.73.3-2023-990\u003c/li\u003e\n \u003cli\u003eBhandari, P.( 2023).Correlational Research | When \u0026amp; How to Use. Scribbr. Retrieved January 13, 2025, from https://www.scribbr.com/methodology/correlational-research\u003c/li\u003e\n \u003cli\u003eAhn, C., Heo, M., \u0026amp; Zhang, S. (2014): Sample size calculations for clustered and longitudinal outcomes in clinical research. CRC Press. 1st Edition,2014. https://doi.org/10.1201/b17822\u003c/li\u003e\n \u003cli\u003eTaherdoost, H. (2016): Sampling Methods in Research Methodology; How to Choose a Sampling Technique for Research, International Journal of AcademicResearch in Management (IJARM) Vol. 5, No. 2, 2016, Page: 18-27, ISSN: 2296-1747. https://doi.org/10.2139/ssrn.3205035\u003c/li\u003e\n \u003cli\u003evan Spijker, B.A., Batterham, P.J., Calear, A.L., Farrer, L., Christensen, H., Reynolds, J., et al,(2014):The suicidal ideation attributes scale (SIDAS): community-based validation study of a new scale for the measurement of suicidal ideation. Suicide Life Threat Behav. 2014; 44:408\u0026ndash;19\u003c/li\u003e\n \u003cli\u003eKoopmans, P. C., Sanderman, R., Timmerman, I., \u0026amp; Emmelkamp, P. M. G. (1994). The Irrational Beliefs Inventory (IBI): Development and psychometric evaluation. European Journal of Psychological Assessment, 10(1), 15\u003c/li\u003e\n \u003cli\u003eAlyahya, K.I., Alrefaei, R.M., Almadhyani, L.F., AlQuwayz, S.S., AlOmairini MI, Alsayed FA, Alasmari YS. (2023): The Prevalence and Correlation of Suicidal Ideation Among Nurses in King Saud University Medical City. Cureus. 2023 Sep 7;15(9):e44859. doi: 10.7759/cureus.44859. PMID: 37809273; PMCID: PMC10560092.\u003c/li\u003e\n \u003cli\u003eShahid,A., et al.( 2012). STOP, THAT and One Hundred Other Sleep Scales. \u0026copy; Springer Science Business Media, LLC 2012. DOI 10.1007/978-1-4419-9893-4_85.\u003c/li\u003e\n \u003cli\u003eHilali, S. (2022) :About the phenomenon of suicide in Egypt. https://en.eipss-eg.org/wp-content/uploads/2022/03/About-the-phenomenon-of-suicide-in-Egypt-.pdf. Accessed june 2025\u003c/li\u003e\n \u003cli\u003eSuicide worldwide in 2019 Global Health Estimates (n.d.). https://iris.who.int/bitstream/handle/10665/341728/9789240026643-eng.pdf?sequence=1. Accessed june 2025\u003c/li\u003e\n \u003cli\u003eJones LB, Vereschagin M, Wang AY, et al. (2022).Suicidal Ideation Amongst University Students During the COVID-19 Pandemic: Time Trends and Risk Factors. The Canadian Journal of Psychiatry. 2022;68(7):531-546. doi:10.1177/07067437221140375\u003c/li\u003e\n \u003cli\u003eSlanitz, C., Fuchshuber, J., Fink, A., Unterrainer , H.F. (2024): Anxious and depressive symptoms mediate the influence of sleep quality on suicidality in young adults. Front Public Health. 2024 Jan 11;12:1322069. doi: 10.3389/fpubh.2024.1322069. PMID: 38282761; PMCID: PMC10808692.\u003c/li\u003e\n \u003cli\u003eSAMUTRI, ERNI (2023):Prevalence and predictors of suicidality among nursing students in Indonesia. KontAKt / Journal of nursing and social sciences related to health and illness\u003c/li\u003e\n \u003cli\u003eTran Thi Thuy, H., Pham, Thi. M., Cap, Minh .D.(2024). Suicidal ideation and its associated factors among high school adolescents in Haiphong, Vietnam: 10.55131/jphd/2024/220201. J Public Hlth Dev [internet]. 2024 May 31 [cited 2025 Feb. 25];22(2):1-12. available from: https://he01.tci-thaijo.org/index.php/AIHD-MU/article/view/267515\u003c/li\u003e\n \u003cli\u003eSeedat , S., Sengwayo, M., Gani, S., Mashego, L., Ochayon, J., Shepard , A., Vergie , C., Masango, M., Makuapane, L.P., Wagner, F., , R.G.(2025). Prevalence and determinants of suicidal ideation among South African Health Sciences students at the onset of the COVID-19 pandemic. Front Psychiatry. 2025 Mar 19;16:1492620. doi: 10.3389/fpsyt.2025.1492620. PMID: 40177592; PMCID: PMC11962656.\u003c/li\u003e\n \u003cli\u003eKabbash, I.A., Salama, B., Mohammad, M.A. et al.(2023). Perception and experiences of suicide among university students in Egypt. Middle East Curr Psychiatry 30, 87 (2023). https://doi.org/10.1186/s43045-023-00358-6\u003c/li\u003e\n \u003cli\u003eWen, L.y., Zhang, L., Zhu, Lj. et al. (2024).Depression and suicidal ideation among Chinese college students during the COVID-19 pandemic: the mediating roles of chronotype and sleep quality. BMC Psychiatry 24, 583 .https://doi.org/10.1186/s12888-024-06027-0\u003c/li\u003e\n \u003cli\u003eYang, X., Hu, D., Li, L., Rezak, R.(2025). Factors of suicide-related behaviors based on stress-vulnerability model and prevention strategies among nurses: a scoping review. Front Psychol. 2025 Jan 20;16:1483904. doi: 10.3389/fpsyg.2025.1483904. PMID: 39901970; PMCID: PMC11788286.\u003c/li\u003e\n \u003cli\u003eAtreya, A., Nepal, S., Menezes, R.G., Marhatta, A., Ghimire, S., Shah, P. (2023): Suicidal Ideation Among Medical and Nursing Students. J Nepal Health Res Counc. 2023 Jul 20;20(4):852-858. doi: 10.33314/jnhrc.v20i4.4147. PMID: 37489667.\u003c/li\u003e\n \u003cli\u003eXue, J., Dong, P., Sentian, Y., Wenzheng , F., Yuhuan, Z., Dong, C., Xuanye, H., Hongyanjun , L.(2025): The impact of self-regulatory fatigue on suicidal ideation in nursing students: the mediating role of experiential avoidance and the moderating role of negative life events. BMC Psychol. 2025 Mar 21;13(1):287. doi: 10.1186/s40359-025-02589-0. PMID: 40119484; PMCID: PMC11929291.\u003c/li\u003e\n \u003cli\u003eHerawati, K., \u0026amp; Gayatri, D. (2019). The correlation between sleep quality and levels of stress among students in Universitas Indonesia. Enfermeria Clinica, 29, 357-361. https://doi.org/10.1016/j.enfcli.2019.04.044\u003c/li\u003e\n \u003cli\u003e\u0026Ccedil;etin, N., Uslu, E., Kendirkıran , G..(2024): Evaluation of suicide in nursing students from the perspective of meaning of life and hope. J Nursology. 2024;27(2):111-119.\u003c/li\u003e\n \u003cli\u003eAl Badarneh, M. T., Al Azzam, A. A. A., Yassien, B. B., \u0026amp; Al Khasawneh, A. A. (2023). The Level of Psychological Alienation and Its Relationship with the Prevalence of Irrational Thoughts among a Sample of Syrian Students in Jordan. 42(200), 19-169. doi: 10.21608/jsrep.2023.324611\u003c/li\u003e\n \u003cli\u003eYusefi , A., Atashbahar, O., Bahmaei, J., Askarpour , H., Bordbar, S.(2024): Examining Irrational Beliefs and their Association with the Quality of Life of Students: Evidence from a Cross-Sectional Study. Open Public Health J, 2024; 17: e18749445344211. http://dx.doi.org/10.2174/0118749445344211240903094824\u003c/li\u003e\n \u003cli\u003eHam, E-.M., You, M. J. .(2017): Role of Irrational Beliefs and Anger Rumination on Nurses\u0026rsquo; Anger Expression Styles. Workplace Health \u0026amp; Safety. 2017;66(5):223-232.doi:10.1177/2165079917737090\u003c/li\u003e\n \u003cli\u003eAl-Habies , F. (2022). Irrational Beliefs among Sciences and Human Sciences Students at Isra University. Dirasat: Human and Social Sciences, 49(2), 573\u0026ndash;582. https://doi.org/10.35516/hum.v49i2.1815\u003c/li\u003e\n \u003cli\u003eHammouda, M.\u0026amp; el rafey, D. (2024): sleep quality and association with academic performance among fourth year medical students at zagazig university. Zagazig University Medical Journal, 2024; (76-82): -. doi: 10.21608/zumj.2021.56954.2071\u003c/li\u003e\n \u003cli\u003eTeh, Shu \u0026amp; M., Saat \u0026amp; A., Hanawi \u0026amp; S., Chan \u0026amp; H., Hanafiah \u0026amp; R., Aznan \u0026amp; C, Joan \u0026amp; S., Ahmad \u0026amp; H, Zulkefli. (2020). Sleep Quality among University Students: Associations between Demographic Factors and Physical Activity Level. International Journal Of Pharmaceutical Research And Allied Sciences. 57-65.\u003c/li\u003e\n \u003cli\u003eSimpong, D.L., Bockarie, A., Kumah , A.B., Atta-Owusu, A.B., Eshun , M., Frimpong, B.A., Bachella , B., Osei, GN. .(2024): Poor sleep quality remains a major challenge among tertiary education students in Ghana: A cross-sectional study in a Ghanaian University. IBRO Neurosci Rep. 2024 Dec 31;18:130-134. doi: 10.1016/j.ibneur.2024.12.014. PMID: 39877590; PMCID: PMC11773084.\u003c/li\u003e\n \u003cli\u003eSchmickler, J.M., Blaschke , S., Robbins, R., Mess., F. .(2019): Determinants of Sleep Quality: A Cross-Sectional Study in University Students. Int J Environ Res Public Health. 2023 Jan 23;20(3):2019. doi: 10.3390/ijerph20032019. PMID: 36767422; PMCID: PMC9915447.\u003c/li\u003e\n \u003cli\u003eG\u0026oacute;mez-Chiappe , N., Lara-Monsalve , P.A., G\u0026oacute;mez A.M., G\u0026oacute;mez DC, Gonz\u0026aacute;lez J.C., Gonz\u0026aacute;lez L., Guti\u0026eacute;rrez-Prieto J.E., Jaimes-Reyes M.A., Gonz\u0026aacute;lez LD, Castillo J.S. .(2020): Poor sleep quality and associated factors in university students in Bogot\u0026aacute; D.C., Colombia. Sleep Sci. 2020 Apr-Jun;13(2):125-130. doi: 10.5935/1984-0063.20190141. PMID: 32742583; PMCID: PMC7384535.\u003c/li\u003e\n \u003cli\u003eAlimirzae, R., Azzizadeh, Forouzi, M., Abazari F, Haghdoost .(2014): A.. Prevalence of quality of sleeping and its determinants among Students of Kerman Razi School of nursing and midwifery. Asian J. Nur. Edu. and Research 4(1): Jan.-March 2014; Page 76-80.\u003c/li\u003e\n \u003cli\u003eTian, M., Lin, L., Liu, Y. et al.(2024): The relationship between sleep quality and suicidal ideation in college students: the longitudinal mediating role of negative affect and the neural basis of this relationship. Curr Psychol 43, 29385\u0026ndash;29398 (2024). https://doi.org/10.1007/s12144-024-06574-5\u003c/li\u003e\n \u003cli\u003eSlanitz, C., Fuchshuber, J., Fink A, Unterrainer H.F. (2024): Anxious and depressive symptoms mediate the influence of sleep quality on suicidality in young adults. Front Public Health. 2024 Jan 11;12:1322069. doi: 10.3389/fpubh.2024.1322069. PMID: 38282761; PMCID: PMC10808692.\u003c/li\u003e\n \u003cli\u003eWu, Y., Guo , Z., Zhang, D., Wang, Y., Wang S.(2024): Sleep Quality and Suicidal Ideation in Adolescent Depression: A Chain Mediation Effect of Perceived Social Support and Resilience. Clin Psychol Psychother. 2024 Mar-Apr;31(2):e2990. doi: 10.1002/cpp.2990. PMID: 38659274.\u003c/li\u003e\n \u003cli\u003eLanda Blanco, Miguel \u0026amp; Romero, Karol \u0026amp; Caballero, Ivin \u0026amp; G\u0026aacute;lvez-Pineda, Ernesto \u0026amp; F\u0026uacute;nes-Henr\u0026iacute;quez, Mar\u0026iacute;a \u0026amp; Romero, Rina. (2024). Exploring suicide ideation in university students: sleep quality, social media, self-esteem, and barriers to seeking psychological help. Frontiers in Psychiatry. 15. 10.3389/fpsyt.2024.1352889\u003c/li\u003e\n \u003cli\u003eMohseni, S. , Mirgol, A. and Moradi, J. (2023). Predicting suicidal ideation based on irrational beliefs and rumination of students (psychology and educational sciences) Payame Noor. Horizon of Medical Education Development, 14(2), 77-65. doi: 10.22038/hmed.2022.58230.1156\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Suicidal Ideation, Irrational thoughts, Sleep quality, University students, Wellbeing","lastPublishedDoi":"10.21203/rs.3.rs-7128255/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7128255/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eSuicide is one of the main preventable causes of mortality. Suicide Ideation through sleep quality issues and irrational thoughts represents a public health concern among university students who are a particularly high-risk group. Recognizing the connection between suicidal thoughts, sleep quality, and irrational thinking is vital. Sleep disturbances can significantly amplify irrational thoughts, which subsequently can deepen suicidal ideation. This creates a dangerous cycle that increases psychological vulnerability. This study aimed to assess suicide ideation among nursing university students through sleep quality and irrational thoughts.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eA correlational research design was employed, using a stratified sample of 370 participants from Cairo and Zagazig universities in Egypt. Four tools included the Personal Data Questionnaire, the Suicidal Ideation Attributes Scale (SIDAS), the Irrational Beliefs Inventory (IBI), and the Sleep Quality Scale (SQS).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe results indicated that 41.2% of the sample under study were between the ages of 19 and 20, with a mean age of 19.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 years, and 55.7% of the sample consisted of females. 78.1% of the sample exhibited moderate levels of irrational thinking, compared to 17.4% who had high levels and 82.6% who had moderate levels of suicidal thoughts. Additionally, 42.7% and 1.8% of participants, respectively, experienced moderate and severe sleep quality issues, while 55.4% of participants reported light sleep problems. There was a statistically significant correlation between nursing students' suicidal ideation and their irrational thoughts and sleep quality (P\u0026thinsp;\u0026lt;\u0026thinsp;0.008, P\u0026thinsp;\u0026lt;\u0026thinsp;0.04). Furthermore, there was no significant correlation (P\u0026thinsp;\u0026lt;\u0026thinsp;0.17) between irrational thoughts and sleep quality.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThis study indicates that most nursing students exhibited a moderate degree of suicidal ideation and irrational thoughts. Moreover, 55.4% of subjects experienced mild sleep quality issues. The findings indicate that a statistically significant correlation between suicide ideation and both irrational thoughts and sleep quality among nursing students. Hence, it is more crucial to encourage initiatives focused on mental health awareness and cognitive restructuring programs.\u003c/p\u003e","manuscriptTitle":"In the Depths of Night: Exploring Suicide Ideation among Nursing University Students through Sleep Quality and Irrational Thoughts","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-20 09:29:07","doi":"10.21203/rs.3.rs-7128255/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"88130a8e-4394-4cfd-add7-4c4ff2ae37fa","owner":[],"postedDate":"August 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-09T15:23:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-20 09:29:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7128255","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7128255","identity":"rs-7128255","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}