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Participants | depressive disorder, DSM-5, Affective Disorders | MOS | The trial was advertised through pediatricians, social media platforms, and study flyers posted at specialty clinics at the University of California Los Angeles (UCLA) Semel Institute, Los Angeles, CA; the University of Colorado Anschutz Medical Campus in Aurora, CO; and the Stanford University Department of Psychiatry... | PMC10324335 |
Random Assignment to Psychosocial Interventions | Once eligible, children and families were randomly assigned to FFT-HR or enhanced usual care (EC) using a dynamic allocation procedure [ | PMC10324335 | ||
Interview-based Clinical Outcome Assessments | depression, hypo/mania, syndromal | RECURRENCES | Independent evaluators who were unaware of treatment assignments conducted interviews with the youth and at least one parent at the time of randomization (covering the 4 prior months), every 4 months in year 1, and then every 6 months for up to 4 years (median follow-up of 98 weeks, range 0-255 weeks). To quantify the ... | PMC10324335 |
Self-report Assessments | Ideation | To expand our understanding of the symptom and functional impact of psychosocial interventions, high-risk probands completed a battery of questionnaires at intake and at each 4-6 months follow-up: the 15-item Suicidal Ideation Questionnaire, Junior Version [ | PMC10324335 | |
Statistical Analyses: Comparisons of Treatment Groups for Symptomatic Outcomes | depression, hypo/mania | Details of the statistical modeling are described elsewhere [Using repeated measures mixed-effect models, we examined the main and interactive effects of treatment (FFT-HR versus EC) and study assessment visit (every 4 months in year 1 and every 6 months thereafter) as predictors of depression or hypo/mania (mean weekl... | PMC10324335 | |
Neuroimaging Hypotheses and Protocol | mood instability | CORTEX | We examined changes in neural functioning from before to after 4 months of psychosocial treatment using functional magnetic resonance imaging (fMRI). Youth were scanned only if they did not have MRI contraindications (Broadly, we hypothesized that intrinsic networks and neural network function subserving emotional cont... | PMC10324335 |
Neuroimaging Analyses | depression | Resting-state functional connectivity analyses aimed to examine changes in task-free correlational networks from pre- to post-treatment. We examined (a) default mode networks known for self-control and rumination during depression and (b) salience networks responsible for emotional expression. Group independent compone... | PMC10324335 | |
RESULTS | PMC10324335 | |||
Clinical Outcomes | hypo/mania, Depressive, bipolar I or II disorders, depressive symptoms | The sample characteristics are described in Table The FFT-HR and EC groups were matched in treatment duration (4 months) but not in the number of sessions (12 There was no evidence that the treatment delayed or prevented the onset of bipolar I or II disorders, which was observed in 18 of the 113 cases (15.9%) with at l... | PMC10324335 | |
Psychosocial Variables in the Pathway from Treatment to Symptomatic Outcomes | What psychosocial factors might explain the effects of FFT-HR on the symptomatic course of youth with high-risk phenotypes? In a recent article [We observed a similar pattern in a separate analysis [ | PMC10324335 | ||
Neuroimaging Results | What neural factors might explain the effects of FFT-HR (compared to EC) on the symptomatic course of youth with high-risk phenotypes? Out of 72 participants (out of a possible 83 at UCLA and Stanford) who received neuroimaging scans at baseline, 40 were scanned again after the 4-month interventions; usable resting sta... | PMC10324335 | ||
Neuroimaging, I: Changes in the Resting State | Depression | Examining interactions between the treatment group (FFT-HR, n=17 Adjusting for age, sex, and scanner site, post-minus pre-treatment changes in anterior DMN connectivity were significantly correlated with post-minus pre-treatment changes in Children’s Depression Rating Scale scores in the FFT-HR group (r= -0.71 p=0.006)... | PMC10324335 | |
Neuroimaging, II: Treatment-related Changes in Emotion Perception Using the Facial Expression Task | Twenty youth in FFT-HR and 20 in EC were included in the whole brain voxel-wise analysis of pre- to post-treatment neural changes during face emotion processing [ | PMC10324335 | ||
Neuroimaging, III: Changes in Neural Activity During a Problem-solving Task | mood instability | Analyses of neural activation during the problem-solving task were conducted with 16 subjects in the FFT-HR group and 20 in the EC group with useable data for this task. At the pre-treatment scan, results from a whole brain voxel-wise analysis, with family-wise error correction for multiple comparisons at the cluster l... | PMC10324335 | |
DISCUSSION | ideation, ideation/behavior, mood instability, rigidity, depressive, hypo/mania, depressive symptoms, depression, Depression | CORTEX | In this article, we have presented clinical, psychosocial, and neuroimaging results from one of the first randomized trials of a psychosocial intervention in the early stages of BD. Following phenomenological research on offspring of parents with BD [Our results suggest that in high-risk youth, a brief family psychoedu... | PMC10324335 |
Study Limitations | primary and comorbid | First, the sample sizes for the neuroimaging analyses were modest. Nonetheless, we found robust and consistent results across resting and task-based fMRI after correcting for multiple comparisons and adjusting for neuroimaging site, age, and sex. Second, high-risk youth were clinically heterogeneous, and were on a vari... | PMC10324335 | |
CONCLUSION | ideation, manic, ’s mood swings, bipolar illness, mania, depressive, hypomania, depression | DISORDER | What have we learned about high-risk states in BD? First, working with families of high-risk youth on their understanding of the child’s mood swings and their ability to communicate and solve problems may be associated with a more favorable trajectory of mood symptoms and reductions in suicidal ideation and behavior. T... | PMC10324335 |
ACKNOWLEDGEMENTS | The authors wish to thank the teams of diagnostic assessors, treating psychiatrists and psychologists, research assistants, and methodology consultants who provided assistance to this study. | PMC10324335 | ||
LIST OF ABBREVIATIONS | Specified Bipolar Disorder, bipolar disorder | ANTERIOR, CORTEX | Anterior Default Mode NetworkBipolar DisorderChildren’s Affective Lability ScaleConflict Behavior QuestionnaireDorsolateral Prefrontal CortexEnhanced CareFamily-Focused Therapy for High-Risk YouthOther Specified Bipolar Disorder (formerly bipolar disorder, not otherwise specified)Psychiatric Status Ratings from Adolesc... | PMC10324335 |
ETHICS APPROVAL AND CONSENT TO PARTICIPATE | The study was conducted in accordance with the Declaration of Helsinki Ethical Principles for Medical Research Involving Human Subjects. The study was approved by the Medical Institutional Review Boards of the University of California, Los Angeles Semel Institute, University of Colorado Anschutz Medical Campus, and Sta... | PMC10324335 | ||
HUMAN AND ANIMAL RIGHTS | No animals/humans were used for studies that are the basis of this research. | PMC10324335 | ||
CONSENT FOR PUBLICATION | Not applicable. | PMC10324335 | ||
AVAILABILITY OF DATA AND MATERIALS | Not applicable. | PMC10324335 | ||
FUNDING | Financial support for this study was provided by US National Institute of Mental Health (NIMH) grants R01-MH093676, R01-MH093666, R34-MH117200, and R01-MH123575. The funding sources had no role in the design or conduct of the study; the collection, management, analysis and interpretation of data; preparation, review, o... | PMC10324335 | ||
CONFLICT OF INTEREST | Johnson and Johnson, Alkermes, and Neumora | BRAIN | Dr. Miklowitz receives research support from the National Institute of Mental Health (NIMH), the Danny Alberts Foundation, Attias Family Foundation, Carl and Roberta Deutsch Foundation, Kayne Family Foundation, AIM for Youth Metal Health, and Max Gray Fund; and book royalties from Guilford Press and John Wiley and Sons... | PMC10324335 |
Subject terms | cardiometabolic diseases, metabolic syndrome, fasting blood glucose | METABOLIC SYNDROME | Low-education women, a substantially older population, are subject to increased risks of metabolic syndrome and consequent cardiometabolic diseases; early detection and effective management were urgently needed. Ninety-nine women with metabolic syndrome, age 61 and education ≤ 6 years, from four community units were ra... | PMC10293226 |
Introduction | cardiometabolic diseases like heart disease, stroke, impaired fasting blood glucose, abdominal obesity, MetS, Metabolic syndrome | CARDIOVASCULAR DISEASE, STROKE, ELEVATED TRIGLYCERIDES, METABOLIC SYNDROME, HIGH BLOOD PRESSURE, METABOLIC SYNDROME | Metabolic syndrome (MetS), a condition caused by the presence of a cluster of risk factors—abdominal obesity (large waist circumference) and two or more other risks, elevated triglycerides, high blood pressure, impaired fasting blood glucose, or low high-density lipoprotein cholesterol (HDL-C), increases the chance of ... | PMC10293226 |
Aims and hypotheses | METABOLIC SYNDROME | This study aimed to examine the efficacy of a multidimensional self-management intervention on low-education women with metabolic syndrome. We hypothesized that the intervention would improve individual-level health-promotion behaviors—physical activity and healthy diet, and metabolic syndrome and its related biomarker... | PMC10293226 | |
Methods | PMC10293226 | |||
Design | metabolic syndrome | METABOLIC SYNDROME, RECRUITMENT | This study was an 18-month two-arm parallel cluster randomized controlled trial with a 1:1 allocation ratio. Recruitment period was from September to October 2017 and follow-up period was from November 2017 to April 2019. The intervention arm received a self-management program, while the attention-control arm received ... | PMC10293226 |
Participants and setting | cognitive impairment, abdominal adiposity, dementia, hearing and visual acuity difficulties | METABOLIC SYNDROME | Potential participants were recruited from four conveniently chosen communities in northern Taiwan. With an estimated median distance of 8.35 km (range 7.2–9.7 km), contamination, spill-over of intervention effects to the control, was considered minimal as communications or acquaintance between the intervention and con... | PMC10293226 |
Recruitment and randomization | metabolic syndrome | METABOLIC SYNDROME | One-hundred and sixty women were screened initially, 55 without metabolic syndrome were excluded, two declined. The four community units with 103 women were randomly assigned to either the intervention or control arm by drawing lots enclosed in sealed opaque envelopes. Each arm consisted of two community units. Two par... | PMC10293226 |
The self-management program | The intervention consisted of five dimensions—lifestyle modification, goal setting, coaching and peer support, problem-solving, and self-monitoring. | PMC10293226 | ||
Lifestyle modification | We applied three of the five World Health Organization’s Key Actions for Health Promotion | PMC10293226 | ||
Providing supportive environments and accessible resources | We worked with the intervention community managers to identify vicinity sites, such as community-based activity centers, for administering exercise classes, nutrition courses, and related physical and clinical assessments. | PMC10293226 | ||
Providing simple exercise skills and group course | We offered daytime community health volunteer-supervised aerobic exercise classes for 40 min a day, 5 days a week, throughout the 18-month intervention. Exercise specialists designed the exercises, which composed of three parts—warm-up, main activity (aerobics), and cool down (stretching). Additional supervised 40-min ... | PMC10293226 | ||
Providing nutrition courses and simple healthy meal plans | To implement the dietary guidelines | PMC10293226 | ||
Goal setting | The goal was to engage in moderate to vigorous exercise 30 min or more per day, five days or more per week, and to adhere to the 2018 Taiwan’s Daily Food Guide | PMC10293226 | ||
Coaching and peer support | metabolic syndrome | METABOLIC SYNDROME | One nurse investigator, one trained community health volunteer, and 6–7 participants formed a peer support group. Each group took a 12-hour course provided by the research team and the metabolic syndrome experts to learn about exercise, healthy diet, behavior change, communication skills, and methods of physical measur... | PMC10293226 |
Problem-solving | The most common problem encountered was the concern of the safety commuting to exercise sites on rainy days. The community health volunteers and the participants conferred to reach feasible alternatives, such as following the exercise videos shown on YouTube or digital video discs. | PMC10293226 | ||
Self-monitoring | fasting blood glucose | The intervention participants were encouraged to visit nearby support sites monthly to monitor their body weight, body mass index, waist circumference, blood pressure, and fasting blood glucose. To monitor and reinforce healthy activities, each participant kept a health passport containing personal measurements recorde... | PMC10293226 | |
Data collection | To obtain accurate and quality data from low- or no-literacy participants, trained investigators used fact-to-face interviews to ensure complete cooperative responses, capture verbal and non-verbal cues, and control interactions. There were neither missing data in demographic characteristics, medical history, lifestyle... | PMC10293226 | ||
Participant characteristics | DISEASES | Participant characteristics included demographic data—age, employment, education, and marital status; medical history—diseases and medicine use; smoking and drinking. | PMC10293226 | |
Biomarkers of metabolic syndrome | We followed the World Health Organization’s Physical Measurements Guideline | PMC10293226 | ||
Leisure-time physical activity | Leisure-time physical activity (LTPA) was assessed using two questions modified from studies of Gionet and Godin | PMC10293226 | ||
Healthy diet behaviors | Participants were asked six questions based on Daily Food Guide of the Taiwan Health Promotion Administration, Ministry of Health and Welfare | PMC10293226 | ||
Data analysis | METABOLIC SYNDROME | We used the Statistical Package for Social Sciences (SPSS) software version 27.0 (International Business Machines Corporation, Armonk, NY, USA). All statistical tests were two-sided with 0.05 levels of statistical significance (α). Descriptive analysis included means, standard deviations, and frequency distribution (pe... | PMC10293226 | |
Ethics approval and consent to participate | We followed the declaration of Helsinki. The ethical committee of a medical center in Taiwan approved this study on February 15, 2017 (No. 201602059A3). All participants were assured that their anonymity and confidentiality would be preserved and that they could withdraw from the study at any time and for any reason. S... | PMC10293226 | ||
Results | PMC10293226 | |||
Effects of the self-management intervention | Table | PMC10293226 | ||
Acknowledgements | The authors thank all the participating subjects, the community managers, and the community health volunteers. Special acknowledgment is extended to Miss Kuan-Ying Kao, the study’s research assistant. | PMC10293226 | ||
Author contributions | S.H.C., Y.Y.C., and W.J.J. designed and conducted the study. S.H.C. and Y.Y.C. analyzed and interpreted the data and prepared the first draft. W.J.J. produced figures and tables. J.P.M.W. analyzed and interpreted the data and substantially revised the manuscript. All authors critically reviewed and approved the revised... | PMC10293226 | ||
Funding | This study was supported by the Ministry of Science and Technology (MOST 107-2314-B-255-006, MOST 109-2314-B-255-002, and MOST 110-2314-B-255-007) and Chang Gung University of Science and Technology (ZRRPF3L0011 and ZRRPF3M0051), Taiwan. The funding source did not involve any parts of the study, including its design, ... | PMC10293226 | ||
Data availability | The datasets generated and analyzed in the current study are not publicly available due to the identity information contained in the data. Deleting this information can obtain them from the corresponding author upon reasonable request. | PMC10293226 | ||
Competing interests | The authors declare no competing interests. | PMC10293226 | ||
References | PMC10293226 | |||
Subject terms | BRAIN | Brain dopamine may regulate the ability to maintain and manipulate sequential information online. However, the precise role of dopamine remains unclear. This pharmacological fMRI study examined whether and how the dopamine D2/3 receptor agonist pramipexole modulates fronto-subthalamic or fronto-striatal pathways during... | PMC10066371 | |
Introduction | CORTEX, BRAIN | Brain dopamine is known to regulate visuospatial working memory [In visuospatial working memory, the dual-state theory of prefrontal dopamine function [Distinct roles of D1 We have put forward a fronto-basal ganglia model for sequential working memory [We hypothesize that activation of D2/3 receptors regulates sequenti... | PMC10066371 | |
Materials and methods | The study was approved by the ethics committee of the University of Lübeck following the Declaration of Helsinki. All participants signed written informed consent before participating in this study. | PMC10066371 | ||
Participants | excessive head motion (mean total displacement, neurological or psychiatric disease | We only recruited male volunteers to avoid problems that could arise with unknown pregnancies in female volunteers. Twenty-six healthy men participated (mean age 26.0 ± 4.1 years, range 20–38 years). They were right-handed and had normal or corrected-to-normal vision. None of them had a history of neurological or psych... | PMC10066371 | |
Study design | nausea | This study had a double-blind, randomized crossover design. Participants received pramipexole and placebo in separate sessions at least seven days apart (mean interval 40.4 ± 34.2 days). At each session, they received 10-mg domperidone in a non-blind fashion to antagonize nausea and other potential side effects induced... | PMC10066371 | |
Digit ordering task | All participants conducted the digit ordering task during fMRI scanning (Fig. | PMC10066371 | ||
Analysis of task performance | We controlled behavioral data quality by monitoring premature (reaction time, RT, shorter than 0.1 s) and inattentive responses (RT longer than 3 SDs above the individual mean). Participants made no premature response and very few inattentive responses (pramipexole: 1.1%, placebo: 1.5%). The inattentive responses were ... | PMC10066371 | ||
Acquisition of MRI and fMRI data | BRAIN | Brain imaging data were acquired on a Siemens Magnetom Skyra 3 T MRI scanner with a 64-channel head coil. Structural T1-weighted images used a magnetization-prepared rapid gradient-echo sequence (208 sequential sagittal slices, repetition time 2300 ms, echo time 2.43 ms, inversion time 1100 ms, flip angle 8°, field of ... | PMC10066371 | |
Preprocessing and analysis of fMRI data | REGRESSION | fMRI data were processed using SPM12 (v7771, We controlled fMRI data quality by monitoring the scan-to-scan total displacement (mean total displacement <1.5 mm) [First, we replicated the manipulation-related regional activation. The general linear model convolved a design matrix with a canonical hemodynamic response fu... | PMC10066371 | |
Results | PMC10066371 | |||
Pramipexole impaired task performance | sleepiness | Pramipexole impaired digit ordering task performance (Fig. The pramipexole effect on RT persisted across serial positions and experimental blocks (Fig. The pramipexole effect on RT was unlikely due to sleepiness or other side effects of the drug. Participants responded equally fast in an independent decision-making tas... | PMC10066371 | |
Relationships between task performance and fronto-subthalamic pathway | Figure | PMC10066371 | ||
Pramipexole reduced prefrontal activity pattern similarity | Figure | PMC10066371 | ||
Pramipexole enhanced fronto-subthalamic functional connectivity | Pramipexole enhanced the functional connectivity between the left dlPFC and left STN (paired | PMC10066371 | ||
Discussion | PD | BRAIN | Brain dopamine may regulate sequential working memory. Dopamine deficiency in PD leads to difficulties in diverse sequencing tasks that rely on the persistent maintenance and flexible manipulation of sequential information [A single oral dose of the D2/3 receptor agonist pramipexole led to less accurate and slower resp... | PMC10066371 |
Fronto-basal ganglia loops and sequential working memory | In the fronto-basal ganglia model for sequential working memory [This study confirmed the role of the fronto-subthalamic pathway in sequential working memory. The relationship between D2-receptor modulated STN activity and sequential working memory is non-linear: both insufficient and excessive STN activity impairs seq... | PMC10066371 | ||
Non-linear relationships between STN and sequential working memory. | The non-linear relationship is presented as a quadratic function for simplicity. Other non-linear functions are possible [ | PMC10066371 | ||
D2/3 transmission in the fronto-subthalamic pathway | CORTEX | A novel finding is that D2 receptor activation can downregulate the maintenance-related STN and dlPFC activity and dlPFC activity pattern similarity but upregulate the manipulation-related STN and dlPFC activity and fronto-subthalamic functional connectivity. Although the STN and frontal cortex have a much lower densit... | PMC10066371 | |
D2 transmission and sequential working memory | sleepiness, behavioral deficits | A second novel finding is that D2 receptor activation can negatively affect sequential working memory. Pramipexole can impair sequence maintenance by inhibiting maintenance-related STN activity and impair sequence manipulation by enhancing manipulation-related STN activity. Another possibility is that pramipexole slowe... | PMC10066371 | |
D2 transmission in the fronto-striatal pathway | PD | A third finding is that D2 receptor activation can downregulate the striatal activity for maintaining (but not manipulating) sequences. This finding is compatible with our previous results. First, the striatum is hypo-activated in PD patients medicated with D2/3 receptor agonists and levodopa [D2 receptors are abundant... | PMC10066371 | |
Limitations | A major limitation is that female volunteers were excluded, and women might respond differently to pramipexole during sequential working memory. As there are concerns about giving pramipexole to women of childbearing age [ | PMC10066371 | ||
Conclusions | This study shows that D2 receptor activation could modulate the fronto-subthalamic pathway during sequential working memory. The D2/3 receptor agonist pramipexole downregulated the maintenance-related STN and dlPFC activity, increasing reaction times for maintaining sequences. In contrast, pramipexole upregulated the m... | PMC10066371 | ||
Supplementary information | The online version contains supplementary material available at 10.1038/s41386-022-01494-z. | PMC10066371 | ||
Author contributions | MH, NB | NB, TFM, and ZY designed the study. MH, EM, and AK collected the data. ZY analyzed the data. ZY and TFM wrote the original draft of the manuscript. MH, EM, AK, and NB reviewed and edited the manuscript. All authors approved the submitted version. | PMC10066371 | |
Funding | This work was supported by the German Research Foundation (MU 1311/20-1) and the National Natural Science Foundation of China (31961133025) and the Innovation of Science and Technology 2030 (2021ZD0203600). | PMC10066371 | ||
Competing interests | The authors declare no competing interests. | PMC10066371 | ||
References | PMC10066371 | |||
1. Introduction | NSSI, Non-suicidal self-injury, death | Background: Non-suicidal self-injury (NSSI) is a common mental health problem, with a 19% lifetime prevalence in Australian adolescents and 12% in adults. Though rates of professional help-seeking for NSSI are low, disclosure to family and friends is more common, providing opportunities for them to encourage profession... | PMC9963380 | |
2. Materials and Methods | PMC9963380 | |||
2.1. Intervention | The Why people engage in NSSI;How to talk to someone about their NSSI;How to help the person stay safe;How to connect someone to appropriate professional help;How to assess for suicidal thoughts and behaviours. | PMC9963380 | ||
2.2. Procedures | A member of the research team contacted instructors who were delivering the Course attendees were invited to complete three surveys: one before the course (pre-course; completed on paper or online via the survey software Survey Monkey [ | PMC9963380 | ||
2.3. Measures | NSSI | In the pre-course survey, participants were asked to provide demographic information, outline any personal and professional experience with NSSI, indicate whether they had participated in any previous training related to mental health or NSSI, and the reason for attending the course. These questions were adapted from a... | PMC9963380 | |
2.3.1. Knowledge about NSSI | NSSI | At each time point, participants were presented with 16 true or false questions about NSSI that were based on the course content. They were asked to respond with “Disagree”, “Agree”, or “Don’t know” (the latter was coded as an incorrect response). Knowledge scores were calculated as the percentage of correct answers (p... | PMC9963380 | |
2.3.2. Stigmatising Attitudes and Social Distance | NSSI, bruising | HEAT, SCRATCHES | At each time point, participants were presented with a vignette that depicted Alicia, an 18-year-old girl who is described as “your niece”, showing warning signs for NSSI, such as “bruising and scratches on her arms and legs” and “wearing her winter clothes in spite of the heat” (see | PMC9963380 |
2.3.3. Confidence in Intended Helping in Response to the Alicia Vignette | Participants were asked how confident they were in their ability to help Alicia on a 5-point Likert scale from “Not at all confident” (a score of 1) to “Extremely confident” (a score of 5). | PMC9963380 | ||
2.3.4. Quality of Intended Helping Behaviours in Response to the Alicia Vignette | At each time point, participants were asked to rate how likely they would be to take 18 actions to support Alicia using a 5-point Likert scale from “Very unlikely” (a score of 1) to “Very likely” (a score of 5). Ten actions contrary to the course teachings and underlying guidelines [ | PMC9963380 | ||
2.3.5. Confidence in and Quality of Actual Helping Behaviours | NSSI, non-suicidal self-injury | In the pre-course and six-month follow-up surveys, participants were asked: “In the past 6 months, have you had contact with someone who you thought might be engaging in non-suicidal self-injury?” Those who answered “Yes” were asked how many people they assisted. They were then asked to provide the age range, gender, a... | PMC9963380 | |
2.3.6. Course Satisfaction | In the post-course survey, participants were asked to provide information about course satisfaction, including how new, understandable, and relevant the information in the course was; how well it was presented; and how much they liked the course materials. A 5-point Likert scale was used for each question. Participants... | PMC9963380 | ||
2.4. Statistical Analysis | REGRESSION | Data were analysed using linear and logistic mixed models. Mixed models retain all available data and provide an intention-to-treat estimate of change under the assumption of missingness at random. Models included a fixed effect of time and a random effect of participants to adjust for the correlation of responses with... | PMC9963380 | |
3. Results | PMC9963380 | |||
3.1. Participant Demographics | Between 2018 and 2021, 153 course attendees from 15 courses were approached to participate in the evaluation and 147 (96.1%) consented to participate. Of the 147 participants, 137 (93.2%) provided at least some data at the post-course survey and 72 (49%) provided at least some data at six-month follow-up. Missingness a... | PMC9963380 | ||
3.2. Knowledge about NSSI | NSSI | Mean knowledge about NSSI at pre-course was moderate (see | PMC9963380 | |
3.3. Social Distance | Mean social distance scores were low at pre-course (m = 1.90, SD = 0.70; see | PMC9963380 | ||
3.4. Stigma | Stigmatising attitudes at pre-course were low (m = 1.67, SD = 0.55) and decreased at post-course and follow-up (see | PMC9963380 |
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