Objective To investigate the influence of different dimensions of health literacy on different stages of suicidal behavior among junior high school students and the gender differences, so as to provide a reference for the prevention and control of suicidal behavior.

Methods From May to June 2023, a multi-stage stratified cluster sampling method was used to select 7 360 junior high school students from three districts and counties in Chongqing city to conduct a survey on health literacy and suicidal behavior. Chi-square test, t-test, F-test, binary logistic regression, and multiple logistic regression were used for statistical analysis.

Results The reported rate of suicidal behavior among junior high school students in Chongqing city was 15.48%, with girls (18.66%) higher than boys (12.19%) (P < 0.01). The functional (154.19 ± 20.25), interactive (53.75 ± 9.22), and critical (42.00 ± 6.93) health literacy scores of students with positive suicidal behavior were all lower than those of students with negative suicidal behavior (156.60 ± 21.41), (56.26 ± 9.75), and (42.63 ± 7.10), respectively (all P < 0.01). Binary logistic regression analysis showed that interactive health literacy (OR = 0.98, 95%CI: 0.97–0.99) and critical health literacy (OR = 1.02, 95%CI: 1.00–1.03) were associated with suicidal behavior. Multiple logistic regression analysis showed that interactive health literacy was associated with suicidal ideation (OR = 0.98, 95%CI: 0.97–0.99) and suicide plan (OR = 0.96, 95%CI: 0.95–0.98), while critical health literacy was only associated with suicide plan (OR = 1.03, 95%CI: 1.00–1.06). Stratified analysis showed that interactive health literacy was significantly associated with suicidal ideation only in males (OR = 0.97, 95%CI: 0.95–0.98).

Conclusions Interactive health literacy is a influencing factor for suicidal ideation and suicide plan among junior high school students in Chongqing city, and there are gender differences.