SNs' MHL and suicide literacy are currently insufficient in Japan, and developing evidence-based training to improve these competencies is essential to strengthen school health services and promote better adolescent mental health and lower suicide risk.
One-third of school nurses incorrectly believed that psychotic symptoms could be managed by careful listening alone.
Many school nurses hesitated to ask students about suicide plans even when suicide risk was evident.
Over half of school nurses lacked confidence in providing mental health education to students.
School nurses' mental health literacy and suicide literacy were found to be currently insufficient in Japan.
Evidence-based training was identified as essential to improve school nurses' mental health and suicide literacy competencies.
This research surveyed 337 school nurses working in Japanese middle and high schools to assess how well they understand mental health conditions and suicide risk — a set of competencies called 'mental health literacy' and 'suicide literacy.' The study found significant gaps: about one-third of school nurses wrongly believed that serious psychiatric symptoms (like those seen in psychosis) could be handled simply by listening carefully to a student, without referral to specialized care. Additionally, many nurses were reluctant to directly ask students about suicide plans even when warning signs were clearly present, and more than half did not feel confident enough to provide mental health education to students. These findings matter because school nurses are often the first point of contact for adolescents experiencing mental health crises or suicidal thoughts. If they lack accurate knowledge, hold unhelpful attitudes, or feel uncertain about how to respond, students in need may not receive timely or appropriate support. The hesitancy to ask directly about suicide is particularly notable, as research generally supports that asking about suicidal thoughts does not increase risk and can be a critical step in connecting students to help. This research suggests that school nurse training programs in Japan — and potentially in other countries with similar school health systems — need to be updated with evidence-based content that addresses not only factual knowledge about mental health and suicide, but also practical skills and confidence in intervention. Strengthening these competencies in school nurses could be an important step toward improving mental health outcomes and reducing suicide risk among adolescents.
Yukawa A, Kusaka S, Yamaguchi S, Arai T, Sawamura F, Togo F, et al.. (2026). Mental health and suicide literacy among school nurses in Japan: A cross-sectional study.. PloS one. https://doi.org/10.1371/journal.pone.0334488