Objective: To identify protective and risk factors in the relationship between destructive leadership, organizational dimensions, and suicidal ideation in public health workers in Chile. Methods: A cross-sectional study. A survey was administered to 1,855 public hospital workers from three regions in Chile between January and May 2023. Sampling was probabilistic, stratified by sex and professional category. Using logistic regression models segmented by sex, the association between leadership styles (laissez-faire, tyrannical, and constructive), mental health (suicidal ideation), and organizational dimensions (work harassment, emotional demands, role conflict, work vulnerability, conflict management climate) was analyzed. Results: 6.42% of the sample presented suicidal ideation; 32.94% reported laissez-faire leadership; 13.42%, tyrannical leadership; and 85.93%, constructive leadership. The adjusted models showed us that men exposed to laissez-faire leadership [ORa = 2.52 (95 % CI: 1.34-5.76)] and tyrannical leadership [ORa = 2.80 (95 % CI: 1.33-5.87)] are almost three times more likely to present suicidal ideation than those not exposed. A favorable conflict management climate is a protective factor for suicidal ideation for the total sample of workers [ORa = 0.58 (95 % CI: 0.34-0.98)]. Conclusion: Destructive leadership is a risk factor for suicidal ideation in men. Work harassment and emotional demands also act as risk factors for suicidal ideation in men and women, and work vulnerability is a risk factor only in women. A favorable conflict management climate constitutes a protective factor for mental health in organizations and a possible avenue for intervention.