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The original data collection complied with the ethical standards of the provincial education authority and was conducted under its mandate for routine student welfare assessment. The Scientific Research Ethics Committee of Hefei Normal University reviewed and approved the secondary-analysis protocol on 7 November 2025 (Approval No. 2025LLSC059).","order":1,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Before the original screening, parents or legal guardians were informed of the screening and could opt their child out under the provincial education authority\u2019s passive-consent procedure. Students then viewed an electronic informed-consent notice explaining the assessment, confidentiality and data use, the voluntary nature of participation, and their right to refuse or withdraw at any time without adverse consequences. They could enter the assessment only after selecting the agreement checkbox and clicking \u201cEnter Assessment\u201d; this constituted affirmative electronic student assent. The committee waived the requirement for additional individual informed consent for the approved retrospective analysis of fully anonymized records, which involved no direct participant contact or new data collection.","order":2,"name":"Ethics","label":"Consent","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"111"}}