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.