The relationships between sporadic and repetitive non-suicidal self-injury and mental disorders among first-year college students: results from the World Mental Health International College Student Initiative

World Mental Health International College Student collaborators

doi:10.1017/S0033291725100688

The relationships between sporadic and repetitive non-suicidal self-injury and mental disorders among first-year college students: results from the World Mental Health International College Student Initiative

World Mental Health International College Student collaborators

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

BACKGROUND: Non-suicidal self-injury (NSSI) is associated with mental disorders, yet work regarding the direction of this association is inconsistent. We examined the prevalence, comorbidity, time-order associations with mental disorders, and sex differences in sporadic and repetitive NSSI among emerging adults. METHODS: We used survey data from n = 72,288 first-year college students as part of the World Mental Health-International College Student Survey Initiative (WMH-ICS) to explore time-order associations between onset of NSSI and mental disorders, based on retrospective age-of-onset reports using discrete-time survival models. We distinguished between sporadic (1-5 lifetime episodes) and repetitive (≥6 lifetime episodes) NSSI in relation to DSM-5 mood, anxiety, and externalizing disorders. RESULTS: We estimated a lifetime NSSI rate of 24.5%, with approximately half reporting sporadic NSSI and half repetitive NSSI. The time-order associations between onset of NSSI and mental disorders were bidirectional, but mental disorders were stronger predictors of the onset of NSSI (median RR = 1.94) than vice versa (median RR = 1.58). These associations were stronger among individuals engaging in repetitive rather than sporadic NSSI. While associations between NSSI and mental disorders generally did not differ by sex, repetitive NSSI was a stronger predictor for the onset of subsequent substance use disorders among females compared to males. Most mental disorders marginally increased the risk for persistent repetitive NSSI (median RR = 1.23). CONCLUSIONS: Our findings offer unique insights into the temporal order between NSSI and mental disorders. Further work exploring the mechanism underlying these associations will pave the way for early identification and intervention of both NSSI and mental disorders.

Original language	English
Article number	e280
Pages (from-to)	1-15
Number of pages	15
Journal	Psychological Medicine
Volume	55
Early online date	25 Sept 2025
DOIs	https://doi.org/10.1017/S0033291725100688
Publication status	Published - 2025

Bibliographical note

Publisher Copyright:
© The Author(s), 2025. Published by Cambridge University Press.

Funding

RB reports grant funding from Eli Lilly (IIT-H6U-BX-I002). DDE has served as a consultant to/on the scientific advisory boards of Sanofi, Novartis, Minddistrict, Lantern, Schoen Kliniken, Ideamed, and German health insurance companies (BARMER, Techniker Krankenkasse) and a number of federal chambers for psychotherapy. He is also shareholder of ‘GET.ON Institut für Online Gesundheitstrainings GmbH für Gesundheitstrainings online GmbH’ (HelloBetter), which aims to implement scientific findings related to digital health interventions into routine care. XH has received grants from Sexual Violence Research Institute, Volkswagen Foundation, Wellspring Philanthropies, Foreign, Commonwealth and Development Office (UK government), PANDA Holding Limited, National Research Foundation of South Africa, Center for Inclusive Policy. XH reports consulting fees from Mastercard Foundation, Missing Billion Initiative, UNICEF, International Food Policy Research Institute and the African Union. Hunt has received funding support to attend conferences from Mastercard Foundation and Charité University (Germany). MMH reports consulting fees from Child Mind Institute, New York. South Africa: The work reported herein was made possible through funding by the South African Medical Research Council (SAMRC) through its Division of Research Capacity Development under the MCSP (awarded to JB and XH). The World Mental Health International College Student (WMH-ICS) initiative is carried out as part of the World Mental Health (WMH) Survey Initiative. The WMH survey is supported by the National Institute of Mental Health NIMH R01MH070884, the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, GlaxoSmithKline, and Bristol-Myers Squibb (RCK). In the past 3 years, Dr. Kessler was a consultant for Cambridge Health Alliance, Canandaigua VA Medical Center, Child Mind Institute, Holmusk, Massachusetts General Hospital, Partners Healthcare, Inc., RallyPoint Networks, Inc., Sage Therapeutics and University of North Carolina. He has stock options in Cerebral Inc., Mirah, PYM (Prepare Your Mind), Roga Sciences and Verisense Health. GK had received funding from the Research Foundation Flanders (12ZZM21N/1204924 N). MKN receives publication royalties from Macmillan, Pearson, and UpToDate. He has been a paid consultant in the past 3 years for Cambridge Health Alliance, and for legal cases regarding a death by suicide. He has stock options in Cerebral Inc. He is an unpaid scientific advisor for Empatica, Koko, and TalkLife. DJS reports personal fees from Discovery Vitality, Johnson & Johnson, Kanna, L’Oreal, Lundbeck, Orion, Sanofi, Servier, Takeda, and Vistagen. DVV reports grant support from Health Canada, Canadian Institutes for Health Research, Provincial Health Services Authority and an internal research grant from the University of British Columbia. He received payments from the Canadian Ministry of Health and the Department of Interior Health for projects related to mental health service provision. Australia: PH has received funding for this work from Suicide Prevention Australia, the Feilman Foundation, and the National Health and Medical Research Council (ID 2032058). Saudi Arabia: The Saudi University Mental Health Survey is conducted by the King Salman Center for Disability Research; funded by Saudi Basic Industries Corporation, King Abdulaziz City for Science and Technology, Ministry of Health (Saudi Arabia) and King Saud University. Funding in-kind was provided by King Faisal Specialist Hospital & Research Center, and Ministry of Economy & Planning, General Authority for Statistics, Riyadh. The Netherlands: ZonMw (Netherlands Organisation for Health Research and Development; grant number 636110005) and the PFGV (PFGV; Protestants Fonds voor de Geestelijke Volksgezondheid) in support of the student survey project. Spain: The PROMES-U study, is supported by Instituto de Salud Carlos III (ISCIII) and cofunded by the European Union, grant number PI20/00006; the Departament de Recerca i Universitats of the Generalitat de Catalunya (AGAUR 2021 SGR 00624); and CIBER -Consorcio Centro de Investigación Biomédica en Red- (CB06/02/0046), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea. For surveys directed by Parc Sanitari Sant Joan de Déu, funding was provided by Fundació Sant Joan de Déu. Northern Ireland: The Student Psychological Intervention Trial (SPIT) was supported by Clinical Healthcare Intervention Trials in Ireland Network (CHITIN). CHITIN has received €10.6 million funding from the European Union’s INTERREG VA programme managed by the Special EU Programmes Body (SEUPB) with match funding from the Departments of Health in NI and ROI (CHI/5433/18). Romania:This work was supported by Romanian National Authority for Scientific Research, CNCS—UEFISCDI, Grant number PN-III-P2–2.1-PED-2021-3882, awarded to OD. Chile: VM, JG, ÁIL, and DN received funding from ANID/Millennium Science Initiative Program-NCS2021_081 and ANID/FONDECYT 1221230. New Zealand: The WMH-ICS NZ surveys were supported by a Rutherford Discovery Fellowship awarded to Associate Professor Damian Scarf, with additional support from the James Hume Bequest Fund and a research grant from University of Otago. SM-G received funding from ANID/Millennium Science Initiative Program-NCS2021_081 and ANID/PFCHA/DOCTORADO EN EL EXTRANJERO BECAS CHILE/2019–72200092. Belgium: The Belgian Fund for Scientific Research (11N0514N/11N0516N/ 1114717 N), the King Baudouin Foundation (2014-J2140150–102905) (RB), the Ministry of Education, Flanders - Grant# EDC-E3738, institutional payment, awarded to RB. Sweden: CA, MB and AHB received funding for this work from the Swedish Research Council (ID 2019–01127) as well as from a Public Health Agency in Sweden (ID 04252–2021-2.3.2). Both grants were awarded to AHB.

Funders	Funder number
Volkswagen Foundation
South African Medical Research Council
Charité University
Eli Lilly and Company
Canadian Institutes for Health Research
Sexual Violence Research Institute
Health Canada
Provincial Health Services Authority
Feilman Foundation
Saudi Basic Industries Corporation
Protestants Fonds voor de Geestelijke Volksgezondheid
Departament de Recerca i Universitats
Mastercard Foundation
Ministerio de Ciencia e Innovación and Unión Europea
King Abdulaziz City for Science and Technology, Ministry of Health
King Saud University
EU Programmes Body
ZonMw
Generalitat de Catalunya
Instituto de Salud Carlos III
National Authority for Scientific Research
Pan American Health Organization
John D. and Catherine T. MacArthur Foundation
ANID
University of Otago
PFCHA
GlaxoSmithKline
National Research Foundation of South Africa
Suicide Prevention Australia
Saudi University Mental Health Survey
University of British Columbia
James Hume Bequest Fund
Pfizer Foundation
PANDA Holding Limited
CNCS
CIBER
Ortho-McNeil Pharmaceutical
SEUPB
National Institute of Mental Health NIMH	R01MH070884
Fogarty International Center	FIRCA R03-TW006481
Departments of Health in NI	CHI/5433/18
US Public Health Service	R01 DA016558, R13-MH066849, R01-MH069864
Belgian Fund for Scientific Research	11N0514N/11N0516N/ 1114717 N
Research Foundation Flanders	12ZZM21N/1204924 N
Ministry of Education, Flanders	EDC-E3738
Netherlands Organisation for Health Research and Development	636110005
European Union	PI20/00006
UEFISCDI	PN-III-P2–2.1-PED-2021-3882
Fondecyt	1221230
Eli Lilly	IIT-H6U-BX-I002
Swedish Research Council	2019–01127
Consorcio Centro de Investigación Biomédica en Red	CB06/02/0046
AGAUR	2021 SGR 00624
Doctorado	CHILE/2019–72200092
National Health and Medical Research Council	2032058
King Baudouin Foundation	2014-J2140150–102905
Public Health Agency in Sweden	04252–2021-2.3.2

Keywords

college students
mental disorders
non-suicidal self-injury
NSSI

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World Mental Health International College Student collaborators (2025). The relationships between sporadic and repetitive non-suicidal self-injury and mental disorders among first-year college students: results from the World Mental Health International College Student Initiative. Psychological Medicine, 55, 1-15. Article e280. https://doi.org/10.1017/S0033291725100688

@article{f1034e7cf49542c38a9b48c6488b8cc0,

title = "The relationships between sporadic and repetitive non-suicidal self-injury and mental disorders among first-year college students: results from the World Mental Health International College Student Initiative",

abstract = "BACKGROUND: Non-suicidal self-injury (NSSI) is associated with mental disorders, yet work regarding the direction of this association is inconsistent. We examined the prevalence, comorbidity, time-order associations with mental disorders, and sex differences in sporadic and repetitive NSSI among emerging adults. METHODS: We used survey data from n = 72,288 first-year college students as part of the World Mental Health-International College Student Survey Initiative (WMH-ICS) to explore time-order associations between onset of NSSI and mental disorders, based on retrospective age-of-onset reports using discrete-time survival models. We distinguished between sporadic (1-5 lifetime episodes) and repetitive (≥6 lifetime episodes) NSSI in relation to DSM-5 mood, anxiety, and externalizing disorders. RESULTS: We estimated a lifetime NSSI rate of 24.5\%, with approximately half reporting sporadic NSSI and half repetitive NSSI. The time-order associations between onset of NSSI and mental disorders were bidirectional, but mental disorders were stronger predictors of the onset of NSSI (median RR = 1.94) than vice versa (median RR = 1.58). These associations were stronger among individuals engaging in repetitive rather than sporadic NSSI. While associations between NSSI and mental disorders generally did not differ by sex, repetitive NSSI was a stronger predictor for the onset of subsequent substance use disorders among females compared to males. Most mental disorders marginally increased the risk for persistent repetitive NSSI (median RR = 1.23). CONCLUSIONS: Our findings offer unique insights into the temporal order between NSSI and mental disorders. Further work exploring the mechanism underlying these associations will pave the way for early identification and intervention of both NSSI and mental disorders.",

keywords = "college students, mental disorders, non-suicidal self-injury, NSSI",

author = "Penelope Hasking and Glenn Kiekens and Petukhova, \{Maria V.\} and Yesica Albor and Ahmad Al-Hadi and Jordi Alonso and Nouf Al-Saud and Yasmin Altwaijri and Claes Andersson and Lukoye Atwoli and \{Ayuya Muaka\}, Caroline and Patricia B{\'a}ez-Mansur and Laura Ballester and Jason Bantjes and Harald Baumeister and Marcus Bendtsen and Corina Benjet and Anne Berman and Ronny Bruffaerts and Paula Carrasco and Silver Chan and Irina Cohut and \{Covarrubias D{\'i}az Couder\}, Maria and Paula Crist{\'o}bal-Narvaez and Pim Cuijpers and Oana David and Dong Dong and David Ebert and Jorge Gaete and \{Garc{\'i}a Forero\}, Carlos and Ra{\'u}l Guti{\'e}rrez-Garc{\'i}a and Josep Haro and Xanthe Hunt and Petra Hurks and Mathilde Husky and Florence Jaguga and Leontien Jansen and Ana Jim{\'e}nez-P{\'e}rez and Fanny K{\"a}hlke and Elisabeth Klinkenberg and {\'A}lvaro Langer and Sue Lee and Lima, \{Rodrigo Antunes\} and Yan Liu and Christine Lochner and Scarlett Mac-Ginty and Vania Mart{\'i}nez and Andre Mason and Margaret McLafferty and Tiana Mori and Elaine Murray and Catherine Musyoka and Caitalin Nedelcea and Daniel N{\'u}{\~n}ez and Siobhan O'Neill and Jos{\'e} Piqueras and Codruta Popescu and Charlene Rapsey and Kealagh Robinson and Miquel Roca and Tiscar Rodriguez-Jimenez and Elske Salemink and Nancy Sampson and Damian Scarf and Siu, \{Oi Ling\} and Dan Stein and Struijs, \{Sascha Y.\} and Cristina Tomoiaga and Karla Vald{\'e}s-Garc{\'i}a and \{van der Heijde\}, Claudia and Daniel Vigo and Wouter Voorspoels and Angel Wang and Samuel Wong and Matthew Nock and Ronald Kessler and \{World Mental Health International College Student collaborators\}",

note = "Publisher Copyright: {\textcopyright} The Author(s), 2025. Published by Cambridge University Press.",

year = "2025",

doi = "10.1017/S0033291725100688",

language = "English",

volume = "55",

pages = "1--15",

journal = "Psychological Medicine",

issn = "0033-2917",

publisher = "Cambridge University Press",

}

World Mental Health International College Student collaborators 2025, 'The relationships between sporadic and repetitive non-suicidal self-injury and mental disorders among first-year college students: results from the World Mental Health International College Student Initiative', Psychological Medicine, vol. 55, e280, pp. 1-15. https://doi.org/10.1017/S0033291725100688

The relationships between sporadic and repetitive non-suicidal self-injury and mental disorders among first-year college students: results from the World Mental Health International College Student Initiative. / World Mental Health International College Student collaborators.
In: Psychological Medicine, Vol. 55, e280, 2025, p. 1-15.

Research output: Contribution to Journal › Article › Academic › peer-review

TY - JOUR

T1 - The relationships between sporadic and repetitive non-suicidal self-injury and mental disorders among first-year college students

T2 - results from the World Mental Health International College Student Initiative

AU - Hasking, Penelope

AU - Kiekens, Glenn

AU - Petukhova, Maria V.

AU - Albor, Yesica

AU - Al-Hadi, Ahmad

AU - Alonso, Jordi

AU - Al-Saud, Nouf

AU - Altwaijri, Yasmin

AU - Andersson, Claes

AU - Atwoli, Lukoye

AU - Ayuya Muaka, Caroline

AU - Báez-Mansur, Patricia

AU - Ballester, Laura

AU - Bantjes, Jason

AU - Baumeister, Harald

AU - Bendtsen, Marcus

AU - Benjet, Corina

AU - Berman, Anne

AU - Bruffaerts, Ronny

AU - Carrasco, Paula

AU - Chan, Silver

AU - Cohut, Irina

AU - Covarrubias Díaz Couder, Maria

AU - Cristóbal-Narvaez, Paula

AU - Cuijpers, Pim

AU - David, Oana

AU - Dong, Dong

AU - Ebert, David

AU - Gaete, Jorge

AU - García Forero, Carlos

AU - Gutiérrez-García, Raúl

AU - Haro, Josep

AU - Hunt, Xanthe

AU - Hurks, Petra

AU - Husky, Mathilde

AU - Jaguga, Florence

AU - Jansen, Leontien

AU - Jiménez-Pérez, Ana

AU - Kählke, Fanny

AU - Klinkenberg, Elisabeth

AU - Langer, Álvaro

AU - Lee, Sue

AU - Lima, Rodrigo Antunes

AU - Liu, Yan

AU - Lochner, Christine

AU - Mac-Ginty, Scarlett

AU - Martínez, Vania

AU - Mason, Andre

AU - McLafferty, Margaret

AU - Mori, Tiana

AU - Murray, Elaine

AU - Musyoka, Catherine

AU - Nedelcea, Caitalin

AU - Núñez, Daniel

AU - O'Neill, Siobhan

AU - Piqueras, José

AU - Popescu, Codruta

AU - Rapsey, Charlene

AU - Robinson, Kealagh

AU - Roca, Miquel

AU - Rodriguez-Jimenez, Tiscar

AU - Salemink, Elske

AU - Sampson, Nancy

AU - Scarf, Damian

AU - Siu, Oi Ling

AU - Stein, Dan

AU - Struijs, Sascha Y.

AU - Tomoiaga, Cristina

AU - Valdés-García, Karla

AU - van der Heijde, Claudia

AU - Vigo, Daniel

AU - Voorspoels, Wouter

AU - Wang, Angel

AU - Wong, Samuel

AU - Nock, Matthew

AU - Kessler, Ronald

AU - World Mental Health International College Student collaborators

PY - 2025

Y1 - 2025

N2 - BACKGROUND: Non-suicidal self-injury (NSSI) is associated with mental disorders, yet work regarding the direction of this association is inconsistent. We examined the prevalence, comorbidity, time-order associations with mental disorders, and sex differences in sporadic and repetitive NSSI among emerging adults. METHODS: We used survey data from n = 72,288 first-year college students as part of the World Mental Health-International College Student Survey Initiative (WMH-ICS) to explore time-order associations between onset of NSSI and mental disorders, based on retrospective age-of-onset reports using discrete-time survival models. We distinguished between sporadic (1-5 lifetime episodes) and repetitive (≥6 lifetime episodes) NSSI in relation to DSM-5 mood, anxiety, and externalizing disorders. RESULTS: We estimated a lifetime NSSI rate of 24.5%, with approximately half reporting sporadic NSSI and half repetitive NSSI. The time-order associations between onset of NSSI and mental disorders were bidirectional, but mental disorders were stronger predictors of the onset of NSSI (median RR = 1.94) than vice versa (median RR = 1.58). These associations were stronger among individuals engaging in repetitive rather than sporadic NSSI. While associations between NSSI and mental disorders generally did not differ by sex, repetitive NSSI was a stronger predictor for the onset of subsequent substance use disorders among females compared to males. Most mental disorders marginally increased the risk for persistent repetitive NSSI (median RR = 1.23). CONCLUSIONS: Our findings offer unique insights into the temporal order between NSSI and mental disorders. Further work exploring the mechanism underlying these associations will pave the way for early identification and intervention of both NSSI and mental disorders.

AB - BACKGROUND: Non-suicidal self-injury (NSSI) is associated with mental disorders, yet work regarding the direction of this association is inconsistent. We examined the prevalence, comorbidity, time-order associations with mental disorders, and sex differences in sporadic and repetitive NSSI among emerging adults. METHODS: We used survey data from n = 72,288 first-year college students as part of the World Mental Health-International College Student Survey Initiative (WMH-ICS) to explore time-order associations between onset of NSSI and mental disorders, based on retrospective age-of-onset reports using discrete-time survival models. We distinguished between sporadic (1-5 lifetime episodes) and repetitive (≥6 lifetime episodes) NSSI in relation to DSM-5 mood, anxiety, and externalizing disorders. RESULTS: We estimated a lifetime NSSI rate of 24.5%, with approximately half reporting sporadic NSSI and half repetitive NSSI. The time-order associations between onset of NSSI and mental disorders were bidirectional, but mental disorders were stronger predictors of the onset of NSSI (median RR = 1.94) than vice versa (median RR = 1.58). These associations were stronger among individuals engaging in repetitive rather than sporadic NSSI. While associations between NSSI and mental disorders generally did not differ by sex, repetitive NSSI was a stronger predictor for the onset of subsequent substance use disorders among females compared to males. Most mental disorders marginally increased the risk for persistent repetitive NSSI (median RR = 1.23). CONCLUSIONS: Our findings offer unique insights into the temporal order between NSSI and mental disorders. Further work exploring the mechanism underlying these associations will pave the way for early identification and intervention of both NSSI and mental disorders.

KW - college students

KW - mental disorders

KW - non-suicidal self-injury

KW - NSSI

UR - https://www.scopus.com/pages/publications/105017466061

UR - https://www.scopus.com/inward/citedby.url?scp=105017466061&partnerID=8YFLogxK

U2 - 10.1017/S0033291725100688

DO - 10.1017/S0033291725100688

M3 - Article

C2 - 40995649

AN - SCOPUS:105017466061

SN - 0033-2917

VL - 55

SP - 1

EP - 15

JO - Psychological Medicine

JF - Psychological Medicine

M1 - e280

ER -

The relationships between sporadic and repetitive non-suicidal self-injury and mental disorders among first-year college students: results from the World Mental Health International College Student Initiative

Abstract

Bibliographical note

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Keywords

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