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Article History

Received: 16 January 2026

Accepted: 14 April 2026

First Online: 29 April 2026

Declarations

:

: This study was approved by the Ethics Committee of the Kyoto University Graduate School and Faculty of Medicine (Approval No. R5006; May 1, 2025). The ethical approval covers the use of anonymized survey datasets collected in 2014, 2015, 2016, 2019, and 2021 from students, teachers, and parents in public junior high schools in Nagoya. The data used in this study were collected through administrative surveys conducted by the Nagoya City Board of Education to evaluate and improve the school counseling system, and the present study represents a secondary analysis of these existing administrative data. The researchers were not involved in the original data collection. Because this study involved secondary analysis of anonymized survey data, it was determined not to fall under the category of ‘life sciences and medical research involving human subjects’ as defined by the Ethical Guidelines for Life Science and Medical Research Involving Human Subjects in Japan and was therefore considered outside the scope of these guidelines. Nevertheless, the study was conducted in accordance with the fundamental principles of the Declaration of Helsinki.

: Not applicable.

: AY is employed in the Department of Neurodevelopmental Medicine, Nagoya City University Graduate School of Medical Sciences, which is an endowment department supported by the City of Nagoya, and received medical fees from Gifu Hospital, instructor fees from Asamidori no Kai, a social welfare corporation, committee member fees from Snowm Co., Ltd, speaker’s fees from Aichi Education and Sports Foundation, Viatris Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Mental Care Association Japan, and other fees from the City of Nagoya. MS is employed in the Department of Neurodevelopmental Medicine, Nagoya City University Graduate School of Medical Sciences, which is an endowment department supported by the City of Nagoya, and has received a personal fee from SONY and Daiichi-Sankyo outside of the submitted work. YN has received grants from Japan Medical Association and Japan Cancer Society, and donations from Datack and Cancerscan, outside of the submitted work. HT is an Endowed Course Professor, supported by the City of Nagoya, in the Graduate School of Humanities and Social Sciences, Nagoya City University. The remaining author declares no conflicts of interest.