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 primary psychological healthcare system to prevent suicide was eagerly advocated. However, it remains unclear whether such policy-driven and low-cost healthcare systems could be practical, especially with equal benefits for underrepresented children/adolescents. We aimed to examine the real-world practical effects of primary psychological healthcare system in preventing suicide ideation among children/adolescents, particularly underprivileged ones. Method and Findings The study employed an observational, multi-center, population-based and longitudinal design. 19,140 children/adolescents sampled from lower- and middle-income areas of western China (Nanchong) with 1-year followed-ups were included, of which majority to underrepresented underprivileged ones. The primary outcome was the incidence for reporting severe suicide ideation after practicing primary psychological healthcare system at 0.5-year and 1-year follow-ups, as contrasts to baseline. Subgroup analysis was conducted to examine the equal benefits of system for underrepresented children/adolescents. After instigating such system, the risks of reporting suicide ideation for included children/adolescents were found significantly lower compared with the control group at 0.5-year (adjust odds ratios [aOR] 0.28, 95%CI 0.23-0.33; p<0.001) and 1-year follow-ups (aOR 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 circumstance (CEDC, all pcorrected < 0.001). The effects in CEDC and “left-behind” children/adolescents were found non-inferior to typical developing cohort (all pcorrected < 0.01). Conclusions Primary psychological healthcare system was practically effective in reducing risks of suicide ideation in children/adolescents in 1-year, at least, but not yet with fully equal benefits for all the underprivileged ones. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study has been formally approved by the Institutional Review Board (IRB) of The Sixth People’s Hospital of Nanchong (IRB-2022.002). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All the follow-up data had been deposited into the Science Data Bank (ScienceDB, https://doi.org/10.57760/sciencedb.12150) for full accesses once being approved by the Data Regulation Office (CPHG-DRO). Form for applying the case-by-case approval could be found at the FigShare (https://doi.org/10.6084/m9.figshare.24297532.v1). All the analyses were implemented by the commercial software (i.e., SPSS, IBM.Inc.) and open-source R packages (e.g., MICE). All code used in R software had been deposited into the Open Science Framework (OSF, https://osf.io/e5h3a/) for full accesses.