Psychological symptoms and inadequate mental health literacy potentially increase the risks of suicidal behaviors in Chinese middle school students

Abstract Background Suicide is a major public health problem as the second leading cause of death for adolescent. Inadequate mental health literacy (MHL) and psychological symptoms are risk factors of suicidal behaviors. But so far, no study has examined the interactive role of MHL and psychological symptoms in suicidal behaviors. In this context, the purpose of this study was to examine the independent and interactive association of MHL and self-reported psychological symptoms with suicidal behaviors in Chinese middle school students. Methods A total of 16 853 middle school students were recruited from October 2020 to June 2021. Psychological symptoms, MHL and suicidal behaviors were measured by self-reported validated instruments. Logistic regression models were conducted to examine relations between them. Results The prevalence of suicidal ideation, suicidal plan and suicidal attempt were 31.3%, 16.3% and 7.5%, respectively, Inadequate MHL was significantly associated with suicidal ideation, suicidal plan and suicidal attempt [ OR (95% CI) was 1.100 (1.018–1.189), 1.246 (1.125–1.380), 1.739 (1.488–2.033)]. Psychological symptoms were significantly related with suicidal ideation, suicidal plan and suicidal attempt [ OR (95%CI) was 4.749 (4.268–5.284), 5.463 (5.069–6.283), 5.970 (5.236–6.806)]. Furthermore, psychological symptoms and inadequate MHL were interactively associated with increased risks of suicidal behaviors. Conclusions These finding indicated that Chinese middle school students having psychological symptoms and inadequate MHL are at risk of exhibiting suicidal behaviors. Enhancing MHL and attenuating the severity of psychological symptoms should be considered and involved in the development of early intervention programs for suicide.