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Then, the audios were permanently deleted to give the participants the highest level of confidentiality, considering the sensitive nature of the mental health disclosures. A multi-level support system was established to ensure participant safety. All participants were informed of available mental health services. Based on PHQ-9 scores, participants with moderate to moderately severe depression (score 10\u201319) were referred to school counselors. Participants with severe depression (scores \u2265 20) or a history of suicide attempt were provided referral information to the psychiatric clinic at Woldia Comprehensive Specialized Hospital for specialized care. While participants had elevated depression scores, none disclosed active suicide plans or imminent risk during interviews.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}],"article-number":"7272"}}