Background: University students have specific risk factors for suicide, necessitating targeted prevention programs. This longitudinal study evaluated the efficacy of the Crisis-management, Anti-stigma, Mental health literacy Program for University Students (CAMPUS) for reduction of risk factors and promotion of preventative behaviors. Methods: A total of 136 medical students attended the CAMPUS as a required course at the University of Tsukuba. The CAMPUS consisted of a lecture and two group sessions covering mental health literacy, self-stigma, and gatekeeper efficacy (e.g., identifying and helping at-risk individuals). The students were asked to role-play based on a movie about gatekeepers and scripts about self stigma and suicide-related issues. Participants completed questionnaires on suicidal behavior, depression, help-seeking intentions, self-efficacy as gatekeepers, self-concealment, and self-acceptance. Results: A total of 121 students completed the questionnaires pre- and post-program, and 107 students also responded 6 months later. Higher-risk students demonstrated significantly reduced suicide risk 6 months post-program compared to before the program. In addition, gatekeeper self-efficacy, help-seeking intentions for formal resources, and self-acceptance were improved in both low and higher-risk students 6 month after the program. Limitations: The CAMPUS program was delivered as a mandatory requirement to a group with high scholastic abilities and relatively low suicide risk. Further studies are required to assess its suitability for the general university student population. Conclusions: The CAMPUS proved effective at reducing risk factors for suicide and promoting preventative behaviors among university students.

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