Functions,characteristics,and experiences of non-suicidal self-injury: A cross-sectional study of youth and adolescents in Singapore

Abstract

Approximately 22.1% of youth would engage in Non-Suicidal Self-Injury (NSSI). While studies have examined the prevalence of NSSI in the local context, there is a lack of studies on the presentation and phenomenology of NSSI in Singapore. This study used the Non-Suicidal Self-Injury – Assessment Tool (NSSI-AT) to examine the functions, characteristics, and NSSI experiences of local youths. 121 youths between 12 and 25 years old were recruited. Outcomes for the NSSI-AT, including the actions, functions, frequency, age of onset, initial motivations, severity, practice patterns, and disclosure of self-harm, were reported using descriptive analysis. Personal reflections were analysed using thematic analysis. Participants engaged in NSSI actions such as cutting and scratching to manage agitating and depressive emotional states. Most participants started engaging in NSSI in early adolescence (mean = 13.0 years, SD = 2.37, range = 7–23) and had disclosed their NSSI with others’ initiation. When reflecting on NSSI experiences, participants gave encouragement to others and reported the negative aspects of self-harm. Findings support emotional regulation as a function of NSSI in the local population, who may be more vulnerable during early adolescence. This study also suggests the importance of having a person-centred treatment approach to effectively serve this age group and their challenges.

Plain language summary

Objective: About a quarter of youth engage in self-harm activities through their lives. Some studies have investigated the frequency and experiences of self-harm in Singapore. However, there is a lack of information on how self-harm is presented and experienced in the local youth population. This study examined the presentation of self-harm using the Non-Suicidal Self-Injury – Assessment Tool (NSSI-AT). This tool measures the functions, characteristics, and experiences of self-harm in Singaporean youths, to inform and improve quality of care for such youths. Method: The study included 121 youths aged between 12 and 25 years old from the National University Health System. We collected survey data on the actions, functions, frequency, starting age, motivations, severity, help-seeking behaviours, and treatment experiences of self-harm in youths. Personal reflections on the experience of self-harm were analysed together with the survey data. Results: Participants engaged in self-harm actions such as cutting, scratching, and banging on objects, to manage stressful emotions and low mood. Most participants started harming themselves when they were about 13 years old. When reflecting on their self-harm experiences, participants gave encouragement to others and reported the negative aspects of self-harm. Conclusion: The regulation of emotions was found to be a key reason why youths engage in self-harm in the local population. These youths may be more vulnerable to self-harm during early adolescence. Findings also suggest the importance of targeting interventions based on one’s self-harm experiences. Overall, this study highlights the need for interventions that can effectively serve this age group and their specific challenges to provide good quality of care.