Perceived social support and suicide ideation in Chinese rural left-behind children: A possible mediating role of depression

•Perceived social support was in general inversely associated with SI in LBC.•Support from relatives living together showed the strongest association with SI.•It is possible that social support-SI association was largely mediated by depression.•Suicide intervention measures on improving social support could be considered. Psychologically distressed rural Chinese left-behind children (LBC) are at an increased risk of suicide. However, within this population, suicide and potential associated factors are severely under-discussed. This study primarily aims to explore the association between perceived social support and suicide ideation (SI), and to discuss the possible mediating role of depression in this association. A population representative sampling survey was carried out with 2,898 LBC in southwest China. Relevant information was collected by means of face-to-face interviews. Binary and ordinal logistic regression models were employed to screen factors associated with perceived social support, depression and SI. Path analysis was applied to estimate the direct and indirect associations between social support and SI. Multivariate logistic regression models revealed that, among the four sources, perceived social support from relatives living together, friends, and parents, but not teachers, was inversely associated with SI in LBC. Moreover, depression and SI were strongly associated with each other: Compared with non-depressed LBC, depressed LBC were 6.76 (95%CI: 3.85, 11.87) times more likely to report prominent SI. Path analysis revealed that it is possible that the association between perceived social support and SI was almost entirely mediated by depression. Perceived social support from relatives living together, friends, and parents may be a protective factor against SI among rural Chinese LBC. Intervention strategies and measures that are targeted towards improving social support, especially cultivating closeness between LBC and their grandparents, could be effective in reducing SI in LBC.