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Stories etched into Scars: The Identification of Non-Suicidal Self-Injury (NSSI) among University Students

non-suicidal self-injury SNIH




By Bharati Chandran, Master of International Health, Uppsala University


Self-injury is one aspect of mental health that seldom grabs the limelight. The only incidents that drive attention to it are attempted and successful suicides.  Self-harm is not always practiced with the intention of taking one’s life. Non-suicidal self-injury (NSSI) refers to the act of inflicting deliberate physical harm to oneself, expecting it to cause a change. It sometimes is a hopeful attempt at coping with, or venting out psychological stress in the form of physical pain (1). NSSIs are not considered suicide attempts. However, they may lead to the latter if not addressed to promptly (2).

According to the American journal of Orthopsychiatry, 14% to 38% of university students disclosed having indulged in at least one episode with the intention of causing harm to oneself (3,4).  

A vast survey of university students reported that addictions, mood instabilities and a low socio-economic status were the most prominent supplementary factors (1)Does this imply that the student population of a socioeconomically stable setting (and a good infrastructure) is safe? Probably not. An open cohort study in Sweden, incorporating 5 million young to middle-aged individuals, conducted over a span of 18 years concluded that the risk of suicides doubles whilst pursuing university studies (5).  A study conducted in the USA showed that the likelihood of NSSI seems to be higher in women, younger students, Caucasians and individuals self-identifying as multi-racial, whereas Arab Americans and African Americans had particularly low rates (4).

Identifying the signs:  Carving on or burning the skin, hitting oneself or causing any sort of physical harm to oneself intentionally.  They occur at a greater frequency when compared to suicide attempts. They are predominantly a result of the reflection on past events, having no evident association with cognitive functioning. Suicide attempts, on the other hand, show a strong association with ruminating and cognitive inflexibility (2,6).

The findings of a study conducted by Hamza et al. in a large cohort of undergraduate students in Canada proved that NSSI in the first year of university is significantly associated with suicide attempts in the years to follow (7). The converging point of four samples showed that most people with NSSI had a seemingly clear motive to attempt suicide. It was hence identified as a major risk factor for the prime aspects involved in a suicide attempt, its desire and the determination to go through with it (2).  

As mentioned earlier, women are more likely to indulge in NSSI. Studies have also shown that the factors paving NSSI differ greatly between genders. For instance, a comparatively greater number of men resort to NSSI as a “sensation-seeking” act and a greater number of women, as an act of retribution (3). The intervention scheme for university students who are at risk of, or have a history of NSSI should, therefore, incorporate: (a) specifically designed approaches for students of each gender, (b) career/guidance counseling, keeping the student’s interests secure and (c) regular follow-ups with students showing signs of or a history of NSSI.



  1. Gollust SE, Eisenberg D, Golberstein E. Prevalence and correlates of self-injury among university students. J Am Coll Health. 2008 Mar;56(5):491–8.
  2. Klonsky ED, May AM, Glenn CR. The relationship between nonsuicidal self-injury and attempted suicide: Converging evidence from four samples. J Abnorm Psychol. 2013;122(1):231–7.
  3. Whitlock J, Muehlenkamp J, Purington A, Eckenrode J, Barreira P, Baral Abrams G, et al. Nonsuicidal Self-injury in a College Population: General Trends and Sex Differences. J Am Coll Health. 2011 Nov;59(8):691–8.
  4. Kuentzel JG, Arble E, Boutros N, Chugani D, Barnett D. Nonsuicidal self-injury in an ethnically diverse college sample. Am J Orthopsychiatry. 2012 Jul;82(3):291–7.
  5. Lageborn CT, Ljung R, Vaez M, Dahlin M. Ongoing university studies and the risk of suicide: a register-based nationwide cohort study of 5 million young and middle-aged individuals in Sweden, 1993?2011. BMJ Open. 2017 Mar;7(3):e014264.
  6. Polanco-Roman L, Jurska J, Quiñones V, Miranda R. Brooding, reflection, and distraction: Relation to non-suicidal self-injury versus suicide attempts. Arch Suicide Res Off J Int Acad Suicide Res. 2015;19(3):350.
  7. Hamza CA, Willoughby T. Nonsuicidal Self-Injury and Suicidal Risk Among Emerging Adults. J Adolesc Health. 2016 Oct;59(4):411–5.

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