Characterisation of a university student sample with a lifetime history of non-suicidal self-injury: mixed-methods analysis of stress factors, coping mechanisms and reasons for self-injury

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Background Non-suicidal self-injury (NSSI) displays an alarmingly high prevalence rate among university students, placing them at high risk for adverse long-term outcomes, including suicide. Aims This study aimed to achieve a better understanding of factors contributing to NSSI in university student populations by examining reasons for NSSI and histories of stressful events and coping strategies. Method A total of 185 university students with a lifetime history of NSSI were assessed for depressive symptoms and NSSI characteristics. They completed three questionnaires on NSSI reasons, stressful events and coping strategies during childhood and adolescence. Each questionnaire included an ‘others’ option combined with an open-ended response box. After descriptive analysis of the closed questions, these open-ended responses were qualitatively categorised and analysed as predictors of depression severity and NSSI continuation from adolescence into adulthood. Results Qualitative analysis identified eight, five and ten categories from the open-ended responses for NSSI reasons, stressful events and coping strategies, respectively, with substantial to almost perfect interrater reliability. Two qualitative reason categories, one stressful event category and two coping strategy categories significantly predicted depression severity ( β = 0.21–0.23). Participants reporting events in the stressful events category ‘Traumatisation and experiences of violence’ were three times more likely to continue NSSI into adulthood ( f 2 = 0.07). Conclusions This study demonstrates the value of mixed-methods approaches. Stable qualitative categories highlight the need to capture individual variations in NSSI-related factors. It emphasises trauma-related stressors due to their influence on depression severity and persistence of NSSI into adulthood.

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