Association between health literacy and suicide-related behaviors in middle school students: The mediating role of depressive symptoms

Abstract

Background The health literacy level is closely related to mental health. Depressive symptoms are one of the most common mental health problems and are strongly associated with suicide-related behaviors among middle school students. The purpose of this study was to examine the mediating role of depressive symptoms in the relationship between health literacy and suicide-related behaviors in middle school students. Method A total of 7182 middle school students were included in this analysis. A paper-based self-administered questionnaire was used to collect data in May 2023. Multiple linear regression and multivariate logistic regression models were applied to analyse the association between health literacy, depressive symptoms and suicide-related behaviors. The Monte Carlo method was used to determine whether depressive symptoms mediated the relationship between health literacy and suicide-related behaviors. Results The prevalence of suicidal ideation, planning, and attempts in the past 12 months among middle school students was 26.62%, 9.27%, and 4.55%, respectively. Health literacy levels exhibited a significant and negative correlation with depressive symptoms, suicidal ideation, suicide planning, and suicide attempts, whereas depressive symptoms was correlated significantly and positively with three suicide-related behaviors. Mediation analysis showed that depressive symptoms mediated the relationship between health literacy and suicidal ideation, suicide planning, and suicide attempts, with mediating effect sizes of 47.5%, 43.0% and 41.8%, respectively. Conclusion Depressive and anxiety symptoms mediate the relationship between health literacy and suicide-related behaviors. Comprehensive health literacy improvement programs may be useful in preventing depression and suicide-related behaviors.