Uncovering the mechanism linking education expectation and suicide ideation among students in tertiary education: The mediating role of academic burnout, psychache, and hopelessness

PLOS One | https://doi.org/10.1371/journal.pone.0337831 December 18, 2025 15 / 16 30. Tao VYK, Hong Y. When academic achievement is an obligation. J Cross-Cultural Psychol. 2013;45(1):110–36. https://doi. org/10.1177/0022022113490072 31. Crystal DS, Chen C, Fuligni AJ, Stevenson HW, Hsu C-C, Ko H-J, et al. Psychological maladjustment and academic achievement: a cross-cultural study of Japanese, Chinese, and American High School Students. Child Develop. 1994;65(3):738. https://doi.org/10.2307/1131415 32. Salmela-Aro K, Read S. Study engagement and burnout profiles among Finnish higher education students. Burnout Res. 2017;7:21–8. https://doi. org/10.1016/j.burn.2017.11.001 33. May RW, Bauer KN, Fincham FD. School burnout: diminished academic and cognitive performance. Learn Indiv Diff. 2015;42:126–31. https://doi. org/10.1016/j.lindif.2015.07.015 34. Madigan DJ, Curran T. Does burnout affect academic achievement? A meta-analysis of over 100,000 students. Educ Psychol Rev. 2020;33(2):387–405. https://doi.org/10.1007/s10648-020-09533-1 35. Fitzpatrick SJ, River J. Beyond the medical model: future directions for suicide intervention services. Int J Health Serv. 2018;48(1):189–203. https:// doi.org/10.1177/0020731417716086 PMID: 28649928 36. Galán F, Ríos-Santos J-V, Polo J, Rios-Carrasco B, Bullón P. Burnout, depression and suicidal ideation in dental students. Med Oral Patol Oral Cir Bucal. 2014;19(3):e206-11. https://doi.org/10.4317/medoral.19281 PMID: 24121916

37. Rahmati Z. The study of academic burnout in students with high and low level of self-efficacy. Procedia - Soc Behav Sci. 2015;171:49–55. https:// doi.org/10.1016/j.sbspro.2015.01.087 38. Karasek RA. Job demands, job decision latitude, and mental strain: implications for job redesign. Admin Sci Quart. 1979;24(2):285. https://doi. org/10.2307/2392498 39. Bahar N, Ismail WSW, Hussain N, Haniff J, Bujang MA, Hamid AM, et al. Suicide among the youth in Malaysia: What do we know?. Asia Pac Psy- chiatry. 2015;7(2):223–9. https://doi.org/10.1111/appy.12162 PMID: 25367507 40. Yu JH, Chae SJ, Chang KH. The relationship among self-efficacy, perfectionism and academic burnout in medical school students. Korean J Med Educ. 2016;28(1):49–55. https://doi.org/10.3946/kjme.2016.9 PMID: 26838568 41. Kim S, Kim H, Park EH, Kim B, Lee SM, Kim B. Applying the demand–control–support model on burnout in students: a meta‐analysis. Psychol Schools. 2021;58(11):2130–47. https://doi.org/10.1002/pits.22581 42. Klonsky ED, May AM. The Three-Step Theory (3ST): a new theory of suicide rooted in the “Ideation-to-Action” Framework. Inter J Cogn Ther. 2015;8(2):114–29. https://doi.org/10.1521/ijct.2015.8.2.114 43. Agarwal A. CogEpiCrim - The M-Theory of Suicidology. Center for Open Science; 2020. https://doi.org/10.31234/osf.io/j5n28 44. Zareian B, Klonsky ED. Connectedness and suicide. Alternatives to Suicide. Elsevier. 2020. p. 135–58. https://doi.org/10.1016/ b978-0-12-814297-4.00007-8

45. Dundes L, Cho E, Kwak S. The duty to succeed: honor versus happiness in college and career choices of East Asian students in the United States. Pastoral Care in Education. 2009;27(2):135–56. https://doi.org/10.1080/02643940902898960 46. Wolf EJ, Harrington KM, Clark SL, Miller MW. Sample size requirements for structural equation models: an evaluation of power, bias, and solution propriety. Educ Psychol Meas. 2013;76(6):913–34. https://doi.org/10.1177/0013164413495237 PMID: 25705052 47. Holden RR, Mehta K, Cunningham EJ, McLeod LD. Development and preliminary validation of a scale of psychache. Canadian J Behav Sci / Revue canadienne des sciences du comportement. 2001;33(4):224–32. https://doi.org/10.1037/h0087144 48. Bolland JM, McCallum DM, Lian B, Bailey CJ, Rowan P. Hopelessness and violence among inner-city youths. Matern Child Health J. 2001;5(4):237–44. https://doi.org/10.1023/a:1013028805470 PMID: 11822525 49. Salmela-Aro K, Kiuru N, Leskinen E, Nurmi J-E. School Burnout Inventory (SBI). European J Psychol Assess. 2009;25(1):48–57. https://doi. org/10.1027/1015-5759.25.1.48 50. Rudd MD. The prevalence of suicidal ideation among college students. Suicide Life Threat Behav. 1989;19(2):173–83. https://doi.org/10.1111/ j.1943-278x.1989.tb01031.x PMID: 2749860 51. Luxton DD, Rudd MD, Reger MA, Gahm GA. A psychometric study of the Suicide Ideation Scale. Arch Suicide Res. 2011;15(3):250–8. https://doi. org/10.1080/13811118.2011.589720 PMID: 21827314

52. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model A Multidiscip J. 1999;6(1):1–55. https://doi.org/10.1080/10705519909540118 53. Oishi S, Sullivan HW. The mediating role of parental expectations in culture and well-being. J Pers. 2005;73(5):1267–94. https://doi.org/10.1111/ j.1467-6494.2005.00349.x PMID: 16138873 54. Lu H, Nie P, Sousa-Poza A. The effect of parental educational expectations on adolescent subjective well-being and the moderating role of per- ceived academic pressure: longitudinal evidence for China. Child Ind Res. 2020;14(1):117–37. https://doi.org/10.1007/s12187-020-09750-8 55. Dyrbye LN, Thomas MR, Massie FS, Power DV, Eacker A, Harper W, et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008;149(5):334–41. https://doi.org/10.7326/0003-4819-149-5-200809020-00008 PMID: 18765703 56. Ijaz T, Ahmed S. Suicidal ideation and burnout among university students. In: Proceedings of the 44th International Academic Conference, Vienna, 2018. https://doi.org/10.20472/iac.2018.044.022