Objective <p>Suicidal ideation is a pressing mental health issue among medical students worldwide, but there has been limited investigation into this phenomenon among medical students. Identifying the associated risk factors is essential for creating targeted prevention strategies. This study aims to assess the prevalence of suicidal ideation and to identify the risk factors associated with it among medical students.</p> Methods <p>This cross-sectional study surveyed 705 medical students at Islamic Azad University, Mashhad Medical Sciences, in 2023–2024. Participants completed demographic and psychometric questionnaires including the Beck Scale for Suicidal Ideation. Data were analyzed using descriptive statistics, non-parametric tests, and multivariate models to identify independent risk factors for suicidal ideation, with significance set at <i>p</i> &lt; 0.05.</p> Results <p>Approximately 78.3% of participants reported experiencing suicidal thoughts, while 18.6% demonstrated a readiness for suicide, and 3.1% expressed suicidal intent. Multivariate analysis revealed significant independent associations with a history of drug use, prior psychiatric disorders, recent relationship breakups, and academic probation (all <i>p</i> &lt; 0.001). In contrast, age, gender, educational level, and place of residence did not show any significant associations.</p> Conclusion <p>Suicidal ideation is alarmingly prevalent among medical students. Key risk factors such as substance use, psychiatric disorders, relationship breakdowns, and academic challenges necessitate immediate intervention. It is essential to implement systematic psychological screening programs, ensure accessible mental health services, develop academic support initiatives, and promote institutional efforts to destigmatize seeking help within medical education settings.</p>