Prevalence, Forms, Motivations, and Associated Factors of Non-Suicidal Self-Injury Among High School Students in Hue: A Cross-Sectional Study

Abstract

This cross-sectional study examined the prevalence, forms, motivations, and associated factors of non-suicidal self-injury (NSSI) among 747 high school students (grades 10–12) in Hue City, Vietnam, using an anonymous online survey. NSSI was assessed via the Functional Assessment of Self-Mutilation (FASM), alongside standardized measures for academic stress, self-esteem, social media addiction, and sleep quality. Overall, 46.7% of students reported past-12-month self-harm; pure NSSI accounted for 26.1% (95% CI: 23.1%–29.4%), while 8.4% reported suicidal intent. Most students with pure NSSI utilized multiple methods, dominantly wound picking, self-biting, and intentional hitting; skin cutting was uncommon (8.7%). Median age of onset was 14 years, with high impulsivity. Automatic negative reinforcement (emotion regulation) drove behaviors, while attention-seeking motives were minimal. Pure NSSI was significantly associated with female gender, poor sleep quality, high academic stress, social media addiction, bedtime procrastination, and low self-esteem. School-based interventions should prioritize emotional regulation, digital hygiene, and sleep optimization.