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Bud is a co\u2010designed, self\u2010guided mobile app developed as an upstream suicide\u2010prevention intervention targeting transdiagnostic mechanisms related to suicide risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate the effectiveness, acceptability, engagement, and safety of Bud compared with an active and structured psychoeducational comparator.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>\n                      A two\u2010arm, parallel\u2010group randomized controlled trial was conducted with international students in Australia. Participants were randomized 1:1 to Bud (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009156) or psychoeducational fact sheets (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009156), completing assessments at baseline, 2\u2009weeks and 4\u2009weeks. The primary outcome was psychological distress (K10). Secondary outcomes included help\u2010seeking intentions, interpersonal risk processes, emotion regulation, suicidal ideation, and mental health literacy. Analyses used intention\u2010to\u2010treat mixed\u2010effects models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Contrary to the hypotheses, psychological distress decreased from baseline to 4\u2009weeks (Bud: \u22122.23; Comparator: \u22122.15), with no group\u2009\u00d7\u2009time interaction (\n                      <jats:italic>F<\/jats:italic>\n                      (2,342.45)\u2009=\u20090.43,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.652); emotion regulation and suicidal ideation showed similar patterns across groups, and other secondary outcomes remained stable across groups. As expected, Bud was rated as enjoyable, worthwhile, and usable. Engagement was moderate (median 10 activities), and no iatrogenic effects occurred.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Bud was feasible, acceptable, and safe but did not outperform an active psychoeducational comparator over 4\u2009weeks.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Trial Registration:<\/jats:bold>\n                      ClinicalTrials.gov identifier: ACTRN12625000584437.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/sltb.70125","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T09:35:36Z","timestamp":1782984936000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Randomized Controlled Trial With an Internal Pilot of a Co\u2010Designed App Targeting Upstream Suicide\u2010Related Risk and Protective Factors Among International Students"],"prefix":"10.1111","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2700-5285","authenticated-orcid":false,"given":"Samuel","family":"McKay","sequence":"first","affiliation":[{"name":"Orygen  Parkville Australia"},{"name":"School of Psychological Sciences Monash University  Melbourne Australia"},{"name":"Centre for Youth Mental Health The University of Melbourne  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Ng","sequence":"additional","affiliation":[{"name":"Orygen  Parkville Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Nicholas","sequence":"additional","affiliation":[{"name":"Orygen  Parkville Australia"},{"name":"School of Psychological Sciences Monash University  Melbourne 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