= 1.02, 95% CI [0.69, 1.36]), with substantial heterogeneity. Attitudes, knowledge, and confidence gains were sustained at 12 months, whereas competence gains were not sustained at 6 months. Controlled studies were sparse. Only one repeated-measures study assessed community-level outcomes and found no significant reduction in suicide attempts. Evidence for sustained behavior change and population-level impact remains limited.
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Lyu et al. (2026) studied this question.
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