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Health Risk Behaviours: Self-Injury and Suicide in Young People
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Health Risk Behaviours: Self-Injury and Suicide in Young People

A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: closed (31 December 2025) | Viewed by 21907

Printed Edition Available!
A printed edition of this Special Issue is available here.

Editors

Dr. Jo Bell

E-Mail Website
Guest Editor
School of Psychology and Social Work, University of Hull, Hull HU6 7RX, UK
Interests: self-harm; suicide; young people;public health; lived experience
Dr. Cathy Brennan

E-Mail Website
Guest Editor
School of Medicine, University of Leeds, Leeds LS2 9NL, UK
Interests: public mental health; self-harm and suicical behaviour; evaluation of complex interventions

Special Issue Information

Dear Colleagues,

Self-injury and suicide among young people have become a pressing public health concern for contemporary society. Rates of self-injury have been rising sharply over the past two decades, particularly in the last five years, and suicide rates remain unacceptably high. Addressing these challenges demands a multifaceted approach that integrates theoretical, empirical, and practical perspectives. This Special Issue welcomes submissions that explore the complex dimensions of self-injury and suicide in young people. Contributions may include (but are not limited to) the following:

  • Qualitative research: studies capturing lived experiences and contextual factors related to self-injury and suicide.
  • Reviews: systematic reviews, narrative reviews, or scoping reviews synthesizing existing knowledge.
  • Theoretical and conceptual articles: innovative frameworks or critical insights into understanding and addressing these issues.
  • Practice-focused articles: studies addressing therapeutic interventions for vulnerable young people or research that informs mental health service delivery.
  • Ethics and implementation: discussions of ethical considerations and implementation challenges in intervention.
  • Actionable insights and strategies: contributions offering evidence-based interventions or practical strategies for schools, communities, and mental health services.

We look forward to receiving your contributions.

Dr. Jo Bell
Dr. Cathy Brennan
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • self-injury
  • suicide
  • young people
  • public health
  • lived experience
  • interventions
  • mental health services

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Published Papers (9 papers)

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Editorial

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4 pages, 145 KB  
Editorial
Self-Harm and Suicide in Young People: Advancing Understanding and Intervention
by Jo Bell and Cathy Brennan
Healthcare 2026, 14(9), 1151; https://doi.org/10.3390/healthcare14091151 - 25 Apr 2026
Viewed by 506
Abstract
Self-harm and suicide among young people represent one of the most pressing public health challenges facing contemporary societies [...] Full article
(This article belongs to the Special Issue Health Risk Behaviours: Self-Injury and Suicide in Young People)

Research

Jump to: Editorial, Other

23 pages, 2616 KB  
Article
The “Supporting Adolescents with Self Harm” (SASH) Intervention Supporting Young People (And Carers) Presenting to the Emergency Department with Self-Harm: Therapeutic Assessment, Safety Planning, and Solution-Focused Brief Therapy
by Rose McCabe, Sally O’Keeffe and Maria Long
Healthcare 2026, 14(2), 168; https://doi.org/10.3390/healthcare14020168 - 8 Jan 2026
Viewed by 1902
Abstract
Background: Self-harm is a growing public health concern and the strongest predictor of suicide in young people (YP). The “Supporting Adolescents with Self-Harm” (SASH) intervention was developed with YP with lived experience and expert clinicians. It involves rapid follow-up after ED attendance [...] Read more.
Background: Self-harm is a growing public health concern and the strongest predictor of suicide in young people (YP). The “Supporting Adolescents with Self-Harm” (SASH) intervention was developed with YP with lived experience and expert clinicians. It involves rapid follow-up after ED attendance and up to six intervention sessions. The intervention has three components: Therapeutic Assessment (TA) of self-harm; an enhanced safety plan (SP); and Solution-Focused Brief Therapy (SFBT). Depending on the YP’s preference, carers can join sessions. Carers can also receive two individual sessions. The clinical and cost-effectiveness of SASH is being evaluated in a randomised controlled trial across nine emergency departments in three NHS Trusts in London, England. A total of 154 YP were recruited between May 2023 and March 2025 and randomised on a 1:1 ratio to SASH alongside Treatment As Usual (TAU) or TAU. A logic model describes the SASH inputs, activities, mechanisms, outcomes and longer-term impacts. The aim of this paper is to (1) illustrate how TA, SP, and SFBT were implemented in practice by presenting intervention materials and session recordings for four YP cases and one carer case and (2) explore how the case study materials/recordings reflect the intervention mechanisms in the SASH logic model. Methods: Each case focused on a different component of the intervention. Intervention materials (TA self-harm diagram and completed SP) and recorded SFBT sessions with four YP and one carer were analysed using a descriptive case study approach. The TA diagram and SP were extracted from medical records. Audio/video recordings of intervention sessions were identified. Recordings of intervention sessions and qualitative interviews were transcribed. Quotes from qualitative interviews with the same participants were included where relevant. Results: Across the four YP cases, some core themes emerged. The role of friendships for young people, particularly at school, was important in both negative and positive ways. Experiencing difficulties with friends at school led to feelings of sadness and stress, which could become overwhelming, leading to thoughts of self-harm (“I just need to hurt myself”), triggering self-harm behaviour. YP described mood changes and signs that they were becoming stressed, which improved their self-awareness and understanding of the link between their feelings and self-harm behaviour. They reflected on what kept them feeling calm and overcoming their fear of burdening others by sharing how they were feeling, as this helped them not to self-harm. They also described difficult feelings stemming from a need to please everyone or needing validation from others. Overcoming these feelings led to less social anxiety and more confidence. This made it easier to go to school and to be more social with friends/student peers, which in turn improved their mood. Conclusions: These case studies demonstrate how YP improved their self-awareness and understanding of the link between feelings and self-harm behaviour and identified personal strategies for managing difficult feelings and situations. The carer case study demonstrates how sessions with carers can facilitate carers better supporting their YP’s mental health. Supporting YP and carers in this way has the potential to reduce the risk of future self-harm. Full article
(This article belongs to the Special Issue Health Risk Behaviours: Self-Injury and Suicide in Young People)
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17 pages, 538 KB  
Article
The Experience of Goals and Rewards in Young People Who Self-Harm: A Qualitative Exploration
by Martina Di Simplicio, Ruksana Begum-Meades, Emily Gaardner-Bougard, Charis Eleftheriou, Oyinlola Akinsanya, Rachel Rodrigues, Lavanya Thana and Lindsay H. Dewa
Healthcare 2025, 13(24), 3308; https://doi.org/10.3390/healthcare13243308 - 17 Dec 2025
Viewed by 1137
Abstract
Background/Objectives. Self-harm is a heterogeneous behaviour with a lifetime prevalence of around 20% in young people aged 16–25 years old. Recent neurocognitive evidence suggests that, for some individuals, self-harm is associated with motivational processes similar to addiction, including maladaptive mental imagery, reward anticipation, [...] Read more.
Background/Objectives. Self-harm is a heterogeneous behaviour with a lifetime prevalence of around 20% in young people aged 16–25 years old. Recent neurocognitive evidence suggests that, for some individuals, self-harm is associated with motivational processes similar to addiction, including maladaptive mental imagery, reward anticipation, and goal pursuit. However, our knowledge of young people’s subjective experiences of rewards and goals in relation to self-harm behaviour remains limited. Our study aimed to investigate how young people who self-harm experience enjoying and wanting rewards and pursuing goals in daily life and whether this experience changes during periods of self-harm. We also explored their use of mental imagery as a key cognitive process to support motivation. Methods. We conducted two parallel focus groups online (total of N = 12) with young people (mean age = 12.2, SD = 3; nine women, two men, and one non-binary) with a past-year history of self-harm behaviour. Qualitative data was analysed using inductive thematic analysis. Two young people with lived experience of self-harm informed the topic guide and data interpretation. Examples of questions were “Do you think your experiences of enjoying and/or looking forward to pleasant things are related in any way to self-harm, or not?” and “Do you visualise things you enjoy or may look forward to? If you do, how is that experience?”. Results. There were six themes: rewards need deserving, high self-standards, keeping control, trapped into long-term goals, unhelpful mental imagery, and self-harm alters the experience and anticipation of rewards and goal attainment. Most young people reported enjoying conditional rewards and working towards long-term goals that tend to be unattainable and beyond their control. Imagining these goals was experienced as unhelpful by most. For all young people, periods of self-harm thwarted enjoyment and goal achievement, shifted the preference to short-term immediate gratification, including from self-harm behaviour, and devalued long-term goals. However, our data cannot determine if these experiences are specific to young people who self-harm. Conclusions. Our findings indicate that the reciprocal relationship between motivational processes and self-harm behaviour in young people warrants further investigation. Helping individuals develop more adaptive rewards and goals, including appreciation of short-term goals and use of motivational mental imagery, could represent valued support for young people with self-harm. Full article
(This article belongs to the Special Issue Health Risk Behaviours: Self-Injury and Suicide in Young People)
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21 pages, 649 KB  
Article
The Impact of Attempted Suicide on Young Adults: Learning from the Lived Experiences of UK Students in Further and Higher Education
by Jude Smit, Lisa Marzano and Erminia Colucci
Healthcare 2025, 13(24), 3222; https://doi.org/10.3390/healthcare13243222 - 9 Dec 2025
Viewed by 1253
Abstract
Background/Objectives: A need for suicide prevention and postvention strategies in Higher Education was identified in the United Kingdom and has more recently been addressed with policies that provide national guidance for organisations. However, a paucity of qualitative research related to the lived [...] Read more.
Background/Objectives: A need for suicide prevention and postvention strategies in Higher Education was identified in the United Kingdom and has more recently been addressed with policies that provide national guidance for organisations. However, a paucity of qualitative research related to the lived and living experiences of attempted suicide in young adults remains. The experts in attempted suicide are those who have experienced it and the objective of our study was to learn from these lived experiences, with a particular focus on 16–25-year-olds in Further and Higher Education. Methods: The research presented in this article was part of a nationwide study in the UK which included 21 semi-structured interviews with young adults who met these criteria on the impact of attempting suicide on a personal, interpersonal, and institutional level, and support service experiences and engagement. It aimed to answer two key questions: 1. What can we learn from the lived experiences of young adults who have attempted suicide? and 2. How can these findings be applied to better meet the needs of young adults experiencing suicidal thoughts/behaviour in Further and Higher Education? Results: Reflexive Thematic Analysis was used to analyse the data, and four main themes were identified: firstly, the impact on ‘self’, including emotional and psychological impact; secondly, ‘others’, revealing the impact of and on relational factors, stigma, and judgement; thirdly, ‘systemic’, which highlighted support service experiences and barriers to accessing and engaging with possible support, and, fourthly, ‘what helps or could help’ on a relational, educational, and institutional level. Conclusions: The findings from this study generate new insights into this under-explored and stigmatised area and point to key barriers to support and gaps in service provision. Attempting suicide is one of the highest risk factors for a death by suicide and this study highlights the need for additional policy and support guidance for attempted suicide in Further and Higher Education. Full article
(This article belongs to the Special Issue Health Risk Behaviours: Self-Injury and Suicide in Young People)
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17 pages, 782 KB  
Article
Psychological Strain and Suicide Rumination Among University Students: Exploring the Mediating and Moderating Roles of Depression, Resilient Coping, and Perceived Social Support
by Nuri Türk, Mustafa Özmen and Sümeyye Derin
Healthcare 2025, 13(15), 1875; https://doi.org/10.3390/healthcare13151875 - 31 Jul 2025
Cited by 8 | Viewed by 4263
Abstract
Background/Objectives: Suicide is among the biggest causes of death in the world. In recent years, suicide rates have increased remarkably in developing countries such as Türkiye. Therefore, there is a need to understand the psychological mechanisms underlying suicidal ideation and behaviors. Within this [...] Read more.
Background/Objectives: Suicide is among the biggest causes of death in the world. In recent years, suicide rates have increased remarkably in developing countries such as Türkiye. Therefore, there is a need to understand the psychological mechanisms underlying suicidal ideation and behaviors. Within this context, this study aimed to examine the complex relationships between psychological strain and suicide rumination. Methods: The study was conducted on 470 university students because young adults constitute the largest suicide risk group in Türkiye. Results: The findings showed that psychological strain was a significant predictor of suicide rumination. Additionally, depression was found to play a mediating role between psychological strain and suicide rumination. Furthermore, both resilient coping and perceived social support were shown to play a moderating role in the relationships among psychological strain, depression, and suicide rumination. The results confirmed the Strain Theory of Suicide in a sample from Türkiye. Conclusions: These findings are expected to contribute to psychologists, psychiatrists and public health specialists’ development of suicide prevention and intervention programs for university students. These suicide prevention and intervention efforts may focus on enhancing resilient coping and perceived social support in combating psychological strain and depression. Full article
(This article belongs to the Special Issue Health Risk Behaviours: Self-Injury and Suicide in Young People)
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17 pages, 258 KB  
Article
Mental Health Professionals’ Views on the Influence of Media on Self-Harm in Young People: A Critical Discourse Analysis
by Tharushi Denipitiya, Annette Schlösser and Jo Bell
Healthcare 2025, 13(14), 1640; https://doi.org/10.3390/healthcare13141640 - 8 Jul 2025
Viewed by 2019
Abstract
Background: Self-harm in young people is influenced by multiple factors, with media playing a significant role. While research has examined its harmful and protective effects, little attention has been paid to how healthcare professionals interpret and respond to media’s role in shaping young [...] Read more.
Background: Self-harm in young people is influenced by multiple factors, with media playing a significant role. While research has examined its harmful and protective effects, little attention has been paid to how healthcare professionals interpret and respond to media’s role in shaping young people’s experiences of self-harm. To our knowledge, no research has examined adolescent mental health professionals’ perspectives and, crucially, how these are constructed and understood. The study aimed to examine the following: (1) how mental health practitioners construct and use discourses to interpret the role of media in young people’s self-harm; and (2) how these discourses shape clinical understanding and practice. Methods: This qualitative study employed semi-structured interviews with ten clinicians from child and adolescent mental health services across England working with young people who self-harm. Data were analysed using critical discourse analysis to uncover how broader societal and institutional narratives shape clinicians’ perspectives. Results: Two dominant discourses were identified: “Media as Disruptor” and “The Hidden World of Youth”. These discourses framed media as both a risk factor and a potential intervention tool, positioning media as a powerful yet morally ambiguous force in young people’s lives. Clinicians largely framed media’s influence as negative but acknowledged its capacity for education and intervention. Conclusions: This research offers new insights into how media-related self-harm risks and benefits are framed and managed in mental health care settings. The study underscores the need for systemic changes in clinical practice, enhanced training, updated guidelines and a shift towards broader sociocultural perspectives in understanding self-harm and suicidal behaviour. Full article
(This article belongs to the Special Issue Health Risk Behaviours: Self-Injury and Suicide in Young People)
15 pages, 366 KB  
Article
Suicide and Self-Harming Among Young Women: A Qualitative Exploratory Study in Southern Punjab, Pakistan
by Farooq Ahmed, Eileen Yuk Ha Tsang, Razia Anjum, Najma Iqbal Malik, Sidra Zia, Rashed Nawaz, Jeffrey S. Wilkinson and Yueyao Fang
Healthcare 2025, 13(11), 1284; https://doi.org/10.3390/healthcare13111284 - 29 May 2025
Cited by 1 | Viewed by 4217
Abstract
Background: Suicide and self-injury are serious public health concerns, especially in young populations, owing to multiple social, cultural, and gender determinants. Qualitative evidence exploring narratives regarding the factors behind suicide among young women is rare in Pakistan. Objective: The present study aims to [...] Read more.
Background: Suicide and self-injury are serious public health concerns, especially in young populations, owing to multiple social, cultural, and gender determinants. Qualitative evidence exploring narratives regarding the factors behind suicide among young women is rare in Pakistan. Objective: The present study aims to explore the complex dimensions of suicide or self-injury among young women of Southern Punjab. Methods: Semi-structured interviews were conducted in a marginalized district in South Punjab, with participants consenting to in-person meetings at their homes or phone interviews. We collected detailed accounts of fifteen deceased girls or self-harm survivors, with insights provided by close relatives of the victims. Results: Our findings identified several conducive factors to suicidality, including receiving insults in front of others, low self-esteem, household pressures, work burdens, unfulfilled romantic desires, feelings of worthlessness, cheating in love, marriage without choice, and engagement in risky behaviors. These causes could be categorized into personal (such as an inferiority complex), social (a lack of family support and frequent conflicts), and cultural factors (forced marriages). Conclusions: Our study advocates for empowering women through education and restricting access to suicide means, such as pesticides or Paraphenylenediamine (PPD). Moreover, the government should take strict measures to discourage the forced marriage of young females in rural contexts. This study highlights the importance of integrating suicide prevention initiatives with research efforts within Pakistan’s healthcare system. Full article
(This article belongs to the Special Issue Health Risk Behaviours: Self-Injury and Suicide in Young People)
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13 pages, 222 KB  
Article
Rates of Suicide Ideation and Associated Risk Factors Among Female Secondary School Students in Iraq
by Saad Sabet Alatrany, Molly McCarthy, Ashraf Muwafaq Flaiyah, Emma Ashworth, Hasan ALi Sayyid ALdrraji, Abbas Saad Alatrany, Dhiya Al-Jumeily, Sarmad Nadeem, Jo Robinson and Pooja Saini
Healthcare 2025, 13(11), 1260; https://doi.org/10.3390/healthcare13111260 - 27 May 2025
Cited by 3 | Viewed by 3352
Abstract
Background: The suicide rate among Iraqis is rising, with many analysts attributing it to political instability, exposure to trauma, economic hopelessness, social stigma surrounding mental health as well as cultural and societal pressures. However, the prevalence of suicidal ideation and associated risk factors [...] Read more.
Background: The suicide rate among Iraqis is rising, with many analysts attributing it to political instability, exposure to trauma, economic hopelessness, social stigma surrounding mental health as well as cultural and societal pressures. However, the prevalence of suicidal ideation and associated risk factors in Iraqi youth is unknown, requiring urgent attention and effective public health initiatives. Thus, the aim of this study was to explore rates of suicidal ideation and associated risk factors among female secondary school students in Baghdad, Iraq. Method: A cross-sectional study was conducted, utilising quantitative survey data collected in four girls’ secondary schools across Baghdad, Iraq, between August and December 2023. The survey consisted of questions relating to their demographic characteristics (age, gender, school) and a series of measures pertaining to participants’ levels of suicidal ideation, as well as factors commonly identified in the literature as predictors of suicide. Results: Four-hundred and two female participants took part. Participants were aged between 13 and 17 years (M = 15.50; SD = 1.22). In total 11.3% of the students scored in the at-risk range for suicidal behaviour and only 20.1% (n = 91) said they had not had some thoughts of suicide in the previous two weeks. Previous diagnoses of anxiety, high levels of depression and hopelessness, and poor quality of life were significant risk factors for suicidal ideation. On average, students reported moderate levels of depression and high levels of hopelessness. Conclusions: Female Iraqi secondary school students experience high levels of suicidality, alongside several other known risk factors for suicide ideation. However, a limitation of this study is that cross-sectional designs limit causal interpretation. Findings emphasise the importance of developing targeted school-based interventions to support students’ mental health. Increasing research and attention in this area is vital to not only improving the mental health of students in Iraq but also reducing the stigma around mental health and suicide. Future policies should include specific mental health support for those young people affected by conflict, displacement and family loss, integrating trauma-informed care into both mental health and educational services. Full article
(This article belongs to the Special Issue Health Risk Behaviours: Self-Injury and Suicide in Young People)

Other

Jump to: Editorial, Research

13 pages, 268 KB  
Perspective
Is Life Unlivable for Youth in Post-DEI America?: Understanding Rising Suicide Rates Across Diverse Youth Groups Through Traditional Suicide Paradigms
by Mimi Yen Li, Christina Mata and Kalpana Nathan
Healthcare 2025, 13(20), 2585; https://doi.org/10.3390/healthcare13202585 - 14 Oct 2025
Cited by 1 | Viewed by 1833
Abstract
We pose the question of whether life has become unlivable for the young in America amidst the current political climate, which has systematically deregulated our social structures that safeguard against oppressive and unjust practices. What leads the young to become demoralized to the [...] Read more.
We pose the question of whether life has become unlivable for the young in America amidst the current political climate, which has systematically deregulated our social structures that safeguard against oppressive and unjust practices. What leads the young to become demoralized to the point of wanting to end their lives? Drawing on several established psychosocial models for suicide, including those of Durkheim, Joiner, and Butler, we highlight how groups of youth as disparate as youth of color, LGBTQ+ youth, and young men experience unique sociopolitical stressors that contribute to increased suicidality. We argue that despite differences in their contexts, they experience shared pathways to suicide. At a time when U.S. funding cuts threaten to dismantle the progress made in recent years to address structural racism and sexism, we also make a case for the importance of mental health clinicians’ engagement in advocacy work that recognizes the sociopolitical influences on mental health and highlight universal school-based social emotional learning (USB SEL) as one beneficial intervention to target mental health outcomes across disparate youth groups. Full article
(This article belongs to the Special Issue Health Risk Behaviours: Self-Injury and Suicide in Young People)
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