Wei Li, Xuerong Liu, Qianyu Zhang, Xiaobing Tian, Xianyong An, Jidong Ren, Xiaodi Han, Jingyu Lei, Chang Shen, Yanyan Li, Ji Chen, Lei Xia, Jingxuan Zhang, Yi Wu, Jie Gong, Hai Lan, Yan Wu, Zhengzhi Feng, Zhiyi Chen
{"title":"在代表性不足的儿童/青少年中，初级心理保健系统对降低自杀意念风险的影响：一项观察性、多中心、以人群为基础的纵向研究。","authors":"Wei Li, Xuerong Liu, Qianyu Zhang, Xiaobing Tian, Xianyong An, Jidong Ren, Xiaodi Han, Jingyu Lei, Chang Shen, Yanyan Li, Ji Chen, Lei Xia, Jingxuan Zhang, Yi Wu, Jie Gong, Hai Lan, Yan Wu, Zhengzhi Feng, Zhiyi Chen","doi":"10.1186/s13034-025-00914-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Establishing a primary psychological healthcare system to prevent suicide was eagerly advocated. Such system was developed as a low-cost healthcare framework integrating family, school, and hospitals to provide early psychological screening and intervention. However, it remains unclear whether such a policy-driven and low-cost healthcare system could be practical, especially with equal benefits for underrepresented children/adolescents. We aimed to examine the real-world practical effects of the primary psychological healthcare system in preventing suicide ideation among children/adolescents, particularly underprivileged ones.</p><p><strong>Methods: </strong>The study was conducted using an observational, multi-center, population-based, and longitudinal design. A total of 19,140 children and adolescents were sampled from lower- and middle-income areas in Nanchong, western China, with the majority for being underprivileged and underrepresented. They were followed up for one year. The primary outcome was the incidence of reported severe suicide ideation after implementing the primary psychological healthcare system at the 0.5-year and 1-year follow-ups, compared to baseline. Subgroup analysis was conducted to examine the equal benefits of the system for underrepresented children/adolescents.</p><p><strong>Results: </strong>The risks of suicide ideation for children/adolescents included in the system were found to be significantly lower compared to those not included at 0.5-year (adjusted relative risk [aRR] 0.28, 95%CI 0.23-0.33; p < 0.001) and 1-year follow-ups (aRR 0.28, 95% CI 0.23-0.33; p < 0.001). The effects were also observed among underrepresented children/adolescents, including \"left-behind\" children/adolescents, \"single-parent\" children/adolescents and children/adolescents in especially difficult circumstances (CEDC, all p<sub>corrected</sub> < 0.001). The effects in \"left-behind\" children/adolescents, CEDC, and \"single-parent\" children/adolescents were found to be non-inferior to the typically developing cohort at non-inferiority thresholds of 30%, 35%, and 45%, respectively (all p<sub>corrected</sub> < 0.05).</p><p><strong>Conclusions: </strong>The primary psychological healthcare system was effective in reducing suicide ideation risks among children/adolescents over a period of at least 1 year. However, certain underprivileged groups, such as orphans and unattended children, did not experience the same level of benefits, highlighting the need for targeted improvements.</p>","PeriodicalId":9934,"journal":{"name":"Child and Adolescent Psychiatry and Mental Health","volume":"19 1","pages":"56"},"PeriodicalIF":3.4000,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085056/pdf/","citationCount":"0","resultStr":"{\"title\":\"The real-world evidence to the effects of primary psychological healthcare system in diluting risks of suicide ideation in underrepresented children/adolescents: an observational, multi-center, population-based, and longitudinal study.\",\"authors\":\"Wei Li, Xuerong Liu, Qianyu Zhang, Xiaobing Tian, Xianyong An, Jidong Ren, Xiaodi Han, Jingyu Lei, Chang Shen, Yanyan Li, Ji Chen, Lei Xia, Jingxuan Zhang, Yi Wu, Jie Gong, Hai Lan, Yan Wu, Zhengzhi Feng, Zhiyi Chen\",\"doi\":\"10.1186/s13034-025-00914-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Establishing a primary psychological healthcare system to prevent suicide was eagerly advocated. Such system was developed as a low-cost healthcare framework integrating family, school, and hospitals to provide early psychological screening and intervention. However, it remains unclear whether such a policy-driven and low-cost healthcare system could be practical, especially with equal benefits for underrepresented children/adolescents. We aimed to examine the real-world practical effects of the primary psychological healthcare system in preventing suicide ideation among children/adolescents, particularly underprivileged ones.</p><p><strong>Methods: </strong>The study was conducted using an observational, multi-center, population-based, and longitudinal design. A total of 19,140 children and adolescents were sampled from lower- and middle-income areas in Nanchong, western China, with the majority for being underprivileged and underrepresented. They were followed up for one year. The primary outcome was the incidence of reported severe suicide ideation after implementing the primary psychological healthcare system at the 0.5-year and 1-year follow-ups, compared to baseline. Subgroup analysis was conducted to examine the equal benefits of the system for underrepresented children/adolescents.</p><p><strong>Results: </strong>The risks of suicide ideation for children/adolescents included in the system were found to be significantly lower compared to those not included at 0.5-year (adjusted relative risk [aRR] 0.28, 95%CI 0.23-0.33; p < 0.001) and 1-year follow-ups (aRR 0.28, 95% CI 0.23-0.33; p < 0.001). The effects were also observed among underrepresented children/adolescents, including \\\"left-behind\\\" children/adolescents, \\\"single-parent\\\" children/adolescents and children/adolescents in especially difficult circumstances (CEDC, all p<sub>corrected</sub> < 0.001). The effects in \\\"left-behind\\\" children/adolescents, CEDC, and \\\"single-parent\\\" children/adolescents were found to be non-inferior to the typically developing cohort at non-inferiority thresholds of 30%, 35%, and 45%, respectively (all p<sub>corrected</sub> < 0.05).</p><p><strong>Conclusions: </strong>The primary psychological healthcare system was effective in reducing suicide ideation risks among children/adolescents over a period of at least 1 year. However, certain underprivileged groups, such as orphans and unattended children, did not experience the same level of benefits, highlighting the need for targeted improvements.</p>\",\"PeriodicalId\":9934,\"journal\":{\"name\":\"Child and Adolescent Psychiatry and Mental Health\",\"volume\":\"19 1\",\"pages\":\"56\"},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2025-05-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085056/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Child and Adolescent Psychiatry and Mental Health\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13034-025-00914-4\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Child and Adolescent Psychiatry and Mental Health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13034-025-00914-4","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
The real-world evidence to the effects of primary psychological healthcare system in diluting risks of suicide ideation in underrepresented children/adolescents: an observational, multi-center, population-based, and longitudinal study.
Background: Establishing a primary psychological healthcare system to prevent suicide was eagerly advocated. Such system was developed as a low-cost healthcare framework integrating family, school, and hospitals to provide early psychological screening and intervention. However, it remains unclear whether such a policy-driven and low-cost healthcare system could be practical, especially with equal benefits for underrepresented children/adolescents. We aimed to examine the real-world practical effects of the primary psychological healthcare system in preventing suicide ideation among children/adolescents, particularly underprivileged ones.
Methods: The study was conducted using an observational, multi-center, population-based, and longitudinal design. A total of 19,140 children and adolescents were sampled from lower- and middle-income areas in Nanchong, western China, with the majority for being underprivileged and underrepresented. They were followed up for one year. The primary outcome was the incidence of reported severe suicide ideation after implementing the primary psychological healthcare system at the 0.5-year and 1-year follow-ups, compared to baseline. Subgroup analysis was conducted to examine the equal benefits of the system for underrepresented children/adolescents.
Results: The risks of suicide ideation for children/adolescents included in the system were found to be significantly lower compared to those not included at 0.5-year (adjusted relative risk [aRR] 0.28, 95%CI 0.23-0.33; p < 0.001) and 1-year follow-ups (aRR 0.28, 95% CI 0.23-0.33; p < 0.001). The effects were also observed among underrepresented children/adolescents, including "left-behind" children/adolescents, "single-parent" children/adolescents and children/adolescents in especially difficult circumstances (CEDC, all pcorrected < 0.001). The effects in "left-behind" children/adolescents, CEDC, and "single-parent" children/adolescents were found to be non-inferior to the typically developing cohort at non-inferiority thresholds of 30%, 35%, and 45%, respectively (all pcorrected < 0.05).
Conclusions: The primary psychological healthcare system was effective in reducing suicide ideation risks among children/adolescents over a period of at least 1 year. However, certain underprivileged groups, such as orphans and unattended children, did not experience the same level of benefits, highlighting the need for targeted improvements.
期刊介绍：
Child and Adolescent Psychiatry and Mental Health, the official journal of the International Association for Child and Adolescent Psychiatry and Allied Professions, is an open access, online journal that provides an international platform for rapid and comprehensive scientific communication on child and adolescent mental health across different cultural backgrounds. CAPMH serves as a scientifically rigorous and broadly open forum for both interdisciplinary and cross-cultural exchange of research information, involving psychiatrists, paediatricians, psychologists, neuroscientists, and allied disciplines. The journal focusses on improving the knowledge base for the diagnosis, prognosis and treatment of mental health conditions in children and adolescents, and aims to integrate basic science, clinical research and the practical implementation of research findings. In addition, aspects which are still underrepresented in the traditional journals such as neurobiology and neuropsychology of psychiatric disorders in childhood and adolescence are considered.
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