Gatekeeper training enables teachers to identify and refer students at risk of suicide and can play a role in school-based prevention efforts. A cluster-randomized controlled trial in Chinese schools assessed the impact of the Life Gatekeeper Training Program (LGTP), a standardized one-day programme comprising eight sessions, delivered through a train-the-trainer cascade. School-based clusters were randomized 1:1 to either the LGTP intervention group (42 schools, n = 2,051; female, 1,536 (74.9 ChiCTR2200066142 . In a cluster-randomized trial including 84 schools in China, schools that received the Life Gatekeeper Training Program for suicide prevention saw significantly reduced suicide stigma and improved willingness of teachers to intervene, compared to schools without the training.

What is already known about this topic?:Childhood trauma represents a critical risk factor for substance use among young populations globally, presenting a substantial public health challenge. What is added by this report?:This comprehensive investigation elucidates the distinct associations between specific subtypes of childhood trauma and substance use behaviors within the Chinese youth population. The findings demonstrate significantly elevated risks for smoking, e-cigarette use, and alcohol consumption, particularly among individuals who have experienced severe or multiple forms of childhood trauma. What are the implications for public health practice?:Implementation of targeted interventions and support systems is essential for individuals with childhood trauma histories. Healthcare providers should emphasize early identification and trauma-informed care approaches. Policy frameworks promoting early intervention and sustained support mechanisms are crucial for reducing substance use behaviors and enhancing population health outcomes.

Short video addiction, a specific type of internet addiction, has emerged as a significant problem among youth today. The high prevalence of co-occurring mood problems, such as depressive symptoms, in individuals with short video addiction poses additional challenges for treatment. However, the extent to which these symptoms interact, predict each other, and further maintain the problems remains unclear. Therefore, this study employed cross-lagged panel network analysis to reveal the directional network structure between the co-occurrence of short video addiction and depressive symptoms in a sample of 1163 Chinese youth. The findings indicate that specific symptoms of addiction, namely ‘Tolerance’, and depressive symptoms such as ‘Anhedonia’, predicted the subsequent development of symptoms for each mental health issue. Furthermore, both the addiction problem ‘Conflict’ and emotional feelings such as ‘Sad mood’ may serve as bridge symptoms linking the co-occurrence of these two mental health issues. These findings contribute to a profound comprehension of the interrelationships and evolution of these conditions over time, revealing the underlying mechanisms behind the high relapse rates observed in addiction treatment strategies. In other words, the key symptoms and bridge symptoms identified in this study can be prioritized as targets for preventing and treating short video addiction in this particular population. By disrupting any interconnectedness between short video addiction and depressive symptoms, we can avoid the progression or escalation of co-occurring issues, leading to more effective and comprehensive treatment outcomes.

Gatekeeper training equips individuals with the skills to identify those exhibiting warning signs of suicide risk and refer them to appropriate services. However, enhancing gatekeepers' knowledge, efficacy, subsequent behaviors, and the broader implications of such interventions in school settings remain pressing concerns. To address these challenges, the Life Gatekeeper Training Program (LGTP) was developed. This 8-session program is designed to train school teachers in essential gatekeeper skills through case demonstrations, role-plays, and group discussions, by using a train-the-trainer model. A cluster randomized controlled trial, which randomly assigned 84 schools (including 223 trainers and 4,140 trainees) to intervention and waitlist control groups, was conducted from December 2022 to March 2024 to evaluate the 6- and 12-month outcomes of the LGTP in Yunfu, China. The primary outcomes were teachers' stigmatization, suicide literacy, perceived competence, and willingness to intervene. The secondary outcome measures were gatekeeper behaviors, including identifying students at risk, discussing potential suicide risk with them, or with their caregiver(s), and referring them to a mental health professional or a specialist clinic. The study was pre-registered with the Chinese Clinical Trial Registry, with a registration number of ChiCTR2200066142. Following the principle of intention to treat (ITT), the results of the generalized estimating equations showed LGTP intervention led to significant decreases in stigmatization (b = - 0.80, SE=0.04, P FDR 0.001), increases in suicide literacy (b = 0.98, SE=0.04, P FDR<0.001), perceived competence (b = 1.03, SE=0.04, P FDR<0.001), and willingness to intervene (b = 0.76, SE=0.04, P FDR<0.001) compared to the control group at post-intervention, and these effects were moderately maintained at the 6 and 12 months follow up. In addition, gatekeeper behavior outcomes (i.e., Identify risk students, Talk to the students, Talk to the parents, Refer to professional help) in the intervention group were significantly higher than those in the control group. The LGTP, a standardized program with a brief training format, demonstrated efficacy in increasing actual gatekeeper behaviors among school teachers in China. The delivery strategies of this program enabled rapid scalability to reach a large population within a short time frame, thereby offering opportunities to expand early intervention and prevention efforts.

The aim of this study is to compare ecologically-valid measure (the Cambridge Prospective Memory Test, CAMPROMPT) and laboratory measure (eye-tracking paradigm) in assessing prospective memory (PM) in individuals with schizophrenia spectrum disorders (SSDs). In addition, eye-tracking indices are used to examine the relationship between PM and other cognitive domains in SSDs patients. Initially, the study sample was formed by 32 SSDs patients and 32 healthy control subjects (HCs) who were matched in sociodemographic profile and the performance on CAMPROMPT. An eye-tracking paradigm was employed to examine the differences in PM accuracy and key cognitive processes (e.g., cue monitoring) between the two groups. Additional 31 patients were then recruited to investigate the relationship between PM cue monitoring, other cognitive functions, and the severity of clinical symptoms within the SSDs group. The monitoring of PM cue was reflected in total fixation time and total fixation counts for distractor words. Cognitive functions were assessed using the Chinese version of the MATRICS Consensus Cognitive Battery (MCCB). The Positive and Negative Syndrome Scale (PANSS) was applied to assess psychopathology. SSDs patients exhibited fewer total fixation counts for distractor words and lower PM accuracy compared to HCs, even though they were priori matched on CAMPROMPT. Correlation analysis within the SSDs group (63 cases) indicated a negative correlation between PM accuracy and PANSS total score, and a positive correlation with working memory and attention/vigilance. Regression analysis within the SSDs group revealed that higher visual learning and lower PANSS total scores independently predicted more total fixation counts on distractor words. Impairment in cue monitoring is a critical factor in the PM deficits in SSDs. The eye-tracking laboratory paradigm has advantages over the ecologically-valid measurement in identifying the failure of cue detection, making it a more sensitive tool for PM deficits in patients with SSDs.

Abstract Background With suicide as a leading cause of death, the issue of children and adolescent suicide risks is in the spotlight today. To empower teachers in primary and secondary schools to serve as gatekeepers and to ensure the safety of children and adolescents, the systematically tailored and localized Life Gatekeeper suicide prevention program was designed for Chinese schools. Objective With the ultimate goal of preventing child and adolescent suicide, we aim to outline a research protocol for examining outcomes of the recently created standardized school-based Life Gatekeeper program in reducing teachers’ stigma, increasing their knowledge, willingness to intervene, and perceived competence. Methods Participants will be recruited from eligible primary and secondary schools. Cluster sampling will be used to randomly assign each school to either the intervention group or the control group. The primary outcomes are stigma against suicide, suicide literacy, perceived competence, and willingness to intervene with suicidal individuals, which will be measured using the Stigma of Suicide Scale, the Literacy of Suicide Scale, and the Willingness to Intervene Against Suicide Questionnaire, respectively. Measurements will be taken at four time points, including pre-intervention, immediately after the intervention, 6-month follow-up, and 1-year follow-up. Conclusions The current study features innovative implementation in the real world, by using a randomized controlled trial design to examine the effectiveness of a school-based gatekeeper program among primary and secondary school teachers, following a sequence of defined and refined steps. The research will also investigate the viability of a school-based gatekeeper program for primary and secondary school teachers that could be quickly and inexpensively implemented in a large number of schools.

The study aimed to investigate the cognitive processing of prospective memory (PM) in patients with schizophrenia spectrum disorders (SSDs) by using an eye-tracking paradigm. In addition, the facilitating effects of prosocial intention (the desire to help others) on PM in SSDs were also examined. In phase 1, 26 patients (group1) and 25 healthy controls (HCs) were compared in an eye-tracking PM paradigm in terms of the PM accuracy and eye-tracking indices. In phase 2, 21 more patients (group2) were recruited, and a prosocial intention was introduced in the eye-tracking PM paradigm. Their PM accuracy and eye-tracking indices were compared with those in group1. The PM cue monitoring was indicated by the total fixation counts and fixation time on distractor words. In phase 1, group1 showed lower PM accuracy, fewer fixation counts and less fixation time on distractor words than HCs. In phase 2, group2 (with prosocial intention) performed significantly better than group1 (with typical instruction) on both PM accuracy and fixation time on distractor words. In both groups of SSDs, the PM accuracy was significantly correlated with both the fixation counts and the fixation time of distractor words. After controlling for the cue monitoring indices, the difference in PM accuracy remained significant between group1 and HCs but disappeared between group1 and group2. The cue monitoring deficit contributes to the PM impairment in SSDs. The facilitating effect of prosocial intention disappears after the control of cue monitoring, also indicating its critical role in PM.

Non-suicidal self-injury behavior (NSSI) is a serious public health concern that requires immediate attention. Despite the high prevalence of NSSI among the Chinese population, there is a significant gap in research on the comprehensive picture of this field. Therefore, a scoping review was conducted to investigate the prevalence, methods, risk factors, and preventive intervention programs related to NSSI in China. The review found that the estimated lifetime prevalence of NSSI among Chinese youth population is alarmingly high at 24.7% (N = 1,088,433). Common methods of NSSI include scratching, hitting, and biting. Additionally, the review synthesized 249 risk factors based on the biopsychosocial-ecological framework, highlighting the urgent need for intervention. However, only 12 empirical studies focus on NSSI prevention or intervention programs were included. These findings underscore the necessity for more clinical practices and larger studies to identify effective interventions and ultimately alleviate the burden of NSSI on the Chinese population. Funding:This review was supported by Humanity and Social Science Youth foundation of Ministry of Education (22YJCZH018), Science and Technology Innovation 2030 (STI2030-Major Projects:2021ZD0200702), National Natural Science Foundation of China (81825009), and Shuimu Tsinghua Scholar. No funding agencies were involved in the data collection, data analysis, and writing of this paper.

Background: Post-traumatic stress disorder (PTSD) is highly prevalent in the individuals at clinical-high risk for psychosis (CHR). The aim of this study was to examine the efficacy and safety of Eye Movement Desensitization and Reprocessing (EMDR) in individuals at CHR with comorbid PTSD or subthreshold PTSD in a randomized controlled trial. Methods: Fifty-seven individuals at CHR with PTSD or subthreshold PTSD formed the study sample. The eligible participants were randomly assigned to a 12 weeks EMDR treatment (N = 28) or a waiting list condition (WL, N = 29). The structured interview for psychosis risk syndrome (SIPS), the clinician administered post-traumatic stress disorder scale (CAPS) and a battery of self-rating inventories covering depressive, anxiety and suicidal symptoms were administered. Results: Twenty-six participants in the EMDR group and all the participants in the WL group completed the study. The analyses of covariance revealed greater reduction of the mean scores on CAPS (F = 23.2, Partial 72 = 0.3, P < 0.001), SIPS positive scales (F = 17.8, Partial 72 = 0.25, P < 0.001) and all the self-rating inventories in the EMDR group than in the WL group. Participants in the EMDR group were more likely to achieve remission of CHR compared to those in the WL group at endpoint (60.7 % vs. 31 %, P = 0.025). Conclusions: EMDR treatment not only effectively improved traumatic symptoms, but also significantly reduced the attenuated psychotic symptoms and resulted in a higher remission rate of CHR. This study highlighted the necessity of adding a trauma-focused component to the present approach of early intervention in psychosis.

To combat the pressing issue of contemporary suicide rates, an effective Life Gatekeeper training program was developed to educate school teachers in identifying and intervening with at-risk students. Two single-arm sequential studies evaluated the program's effectiveness, spanning implementation science stages from design to refinement. The initial study employed face-to-face training (FTF), followed by a standardized video-based 'Train-the-trainer' (TTT) approach. In Study 1, post-intervention and one-month follow-up results showed improved suicide literacy, reduced stigma, and increased willingness to intervene among gatekeepers. The revised TTT program (study 2) also yielded reduced stigmatization and improved intervention competence. In addition, six out of twenty teachers exhibited gatekeeper behaviors. In conclusion, both delivery methods proved effective, particularly the practical application of the TTT version, although further research is warranted to examine long-term effectiveness of the program.

Review question / Objective: What are the frequency and methods of non-suicidal self-injury behaviors in China?What are the risk factors of non-suicidal self-injury behaviors in China from a biopsychosocial-ecological approach?What are the prevention and intervention programs that target nonsuicidal self-injury in China?Background: Non-suicidal-self-injury (NSSI) behavior is the deliberate, self-inflicted destruction of body tissues without any suicidal intent and for purposes.Common examples include cutting, burning, scratching, and hitting.NSSI has become a severe public health problem nowadays, causing significant burdens for mental health and potentially leading to subsequent suicidality.

Objectives Both bullying and psychosis-like experiences (PLEs) have gained much attention in recent years, but their interactions are not fully unraveled. The aim of the current study was to validate the Chinese version of Bullying Scale for Adults (C-BSA), and to investigate whether past bullying experiences independently predict the presence of PLEs in university students. Methods The validity and reliability of the C-BSA were determined in two independent samples. A battery of psychological inventories was also administered to assess the presence of PLEs, maltreatment history in the family, and current depression and anxiety, including the 15-item positive subscale of the community assessment of psychic experiences (CAPE-p15), the Chinese version of the Childhood Trauma Questionnaire (CTQ), Self-Rating Depression Scale (SDS), and Self-Rating Anxiety Scale (SAS). Results In the construction sample ( N = 629), a Cronbach's α of 0.921 indicated a good internal consistency of C-BSA. The exploratory factor analysis (EFA) yielded a four-factor model and a three-factor model, and both were verified by using the confirmatory factorial analysis (CFA) in the validation sample ( N = 629). The total scores of C-BSA were significantly correlated with that of CTQ, CAPE-p15, SDS, and SAS. Multivariate logistic regression revealed that bullying was associated with 2.0 or 3.7 times of risk for the presence of PLEs (numbers of bullying types < = 3 or > 3, respectively) after controlling for CTQ, SDS, and SAS scores. Conclusions C-BSA has shown good psychometric properties in college students. The contribution of past bullying experiences to the present PLEs seems to be independent of other childhood trauma, current depression, and anxiety.