A quarter of Singaporean youths engage in self-harm

For every four young people in Singapore, one has a history of nonsuicidal self-injury (NSSI), as shown in a study.

In a cohort of 2,600 youths (50.2 percent female, 71,5 percent Chinese) between 15 and 35 years of age from the general population, the lifetime self-reported prevalence of NSSI was 25.0 percent (95 percent confidence interval [CI, 23.1–26.8). The 12-month prevalence was 6.8 percent (95 percent CI, 5.7–7.8). [Child Adolesc Psychiatry Ment Health 2025;19:27]

NSSI was more prevalent among female than male participants during their lifetime (p<0.001) and within the previous 12 months (p<0.001). Females were also nearly twice as likely as males to engage in repetitive NSSI (14.9 percent vs 8.1 percent; p<0.001), which had an overall prevalence of 11.6 percent.

The median age of NSSI onset was 14 years, and this was the age when it was most common for both genders. Cutting was the most common type of self-injury (13.4 percent), followed by severe scratching (7.9 percent), punching oneself (4.9 percent), and banging head (4.9 percent). Other types of behaviours such as slapping oneself, punching walls/objects, and snapping rubber bands on skin were reported by 2.6 percent of participants.

Significantly more females than males reported engaging in cutting (p<0.001), carving words into skin (p=0.010), severe scratching (p<0.001), sticking a sharp object into skin (p=0.047), and preventing wounds from healing (p<0.001).

Unpacking the data

The prevalence of NSSI in the general youth population of Singapore is consistent with that reported in two meta-analyses and indicates that self-injurious behaviour is common among youths, according to researchers from the Institute of Mental Health.

They identified two broad categories of risk factors for NSSI: sociodemographic and behavioural/psychosocial factors. Younger age (15–29 vs 30–35 years: OR range, 1.511–2.113), female gender (OR, 1.875), and lower educational attainment (vs university or above educational attainment: OR range, 1.589 to 1.990) were the most important sociodemographic factors.

On the other hand, behavioural and psychosocial factors for NSSI included more severe mental health symptoms (depression: OR, 1.468; anxiety: OR, 1.464), greater use of avoidance coping strategies (OR, 1.049), body shape dissatisfaction (OR, 1.969), daily smoking (OR, 1.735), and hazardous alcohol use (OR,1769).

“It is plausible that the lower 12-month prevalence compared to the lifetime prevalence observed in this study could be attributed to older participants who had ceased engaging in NSSI, perhaps through professional intervention or learning of healthier coping methods with increasing maturity,” the researchers said.

What can be done

While the data paints a stark picture, it also provides an opportunity for action. The researchers outlined several recommendations and considerations that may help stem NSSI behaviours in youths.

“Firstly, given that the onset and peak of NSSI occurrences in youths overlap with schooling years, an important implication would be to equip school personnel including teachers, counsellors, and administrators with the knowledge and skills to detect and respond appropriately to self-injury in students,” they said.

The researchers stressed that training to recognize and respond to self-harm is not merely about identifying warning signs, but also about fostering an environment where students feel safe to disclose their struggles.

“Next, preventive programs can be developed to reduce the onset of self-injurious behaviours. Such specialized programs could include various psychoeducational components aimed at enhancing resilience in youths or teaching healthier coping strategies, specifically more effective ways of regulating emotions,” they continued.

Finally, the researchers emphasized the importance of societal shift, wherein professionals and nonprofessionals alike are educated on the realities of self-harm with the aim of breaking the stigma that discourages young people from seeking help.

“There is a need to facilitate open communications about NSSI and foster an understanding and nonjudgemental environment in which youths feel safe to seek professional help, and also one in which their peers are prepared to provide support and direct them to trusted adults,” they said.