Why do adolescents hurt themselves? A qualitative study

Abstract

Background: Non-suicidal self-injury is highly prevalent among adolescents with mood disorders. It not only severely jeopardizes their physical and mental health but also imposes a substantial burden on families. Nurses working in psychiatric settings frequently report challenges in providing care to these young people, often experiencing negative emotional impacts and occupational burnout. The personal experiences of non-suicidal self-injury, and how they intersect with the broader socio-cultural context to influence behavior in this population, are not well understood, thereby hindering the development of effective nursing interventions.

Objective: This study applied the Benefits and Barriers Model to elucidate the dynamic interplay of motivations, barriers, and contextual factors underlying non-suicidal self-injury among Chinese adolescents with mood disorders, with a specific focus on its cultural relevance.

Methods: An exploratory qualitative design was adopted. Eighteen adolescents with mood disorders and experience of non-suicidal self-injury were recruited from a tertiary psychiatric hospital in mainland China. Semi-structured interviews were conducted between January 2024 and January 2025. Data were analyzed using reflexive thematic analysis.

Results: Three core dimensions of perceived benefits were identified: release of negative emotions, pleasurable experience following stress reduction, and escape from interpersonal and communication difficulties. Three primary categories of barriers emerged: internal psychological resources, external emotional support, and awareness of social norms. Key contextual factors that intersect with these benefits and barriers were identified as emotional state, the quality of parent-child relationships, social adaptation strategies, and involvement in online communities. Distinctive socio-cultural contexts were also observed, including a highly competitive academic environment, shifting parent-child dynamics and relational insecurities, and cultural traditions prioritizing introspection and emotional restraint.

Conclusions: This study examined non-suicidal self-injury among adolescents with mood disorders through a benefits-barriers framework, characterizing it as a dynamic adaptation shaped by the interplay of perceived benefits, barriers, and contextual factors. The findings highlight the need for culturally responsive, systemic nursing interventions that foster emotional regulation, interpersonal trust, and environmental support across individual, familial, and societal levels. This holistic approach, grounded in the participants' lived experiences, provides a critical foundation for mitigating self-injury risk in this population.

Keywords: Adolescent; Culture; Emotional regulation; Mood disorders; Parent–child relations; Qualitative research; Self-injurious behavior.