From prevalent to personal: how social exposure predicts attitudes toward non-suicidal self-injury and what prevalence reveals – Frontiers

Report on Attitudes Toward Non-Suicidal Self-Injury (NSSI) and Alignment with Sustainable Development Goals

Introduction: Mental Health as a Core Component of Sustainable Development

Poor mental health among students is a significant global challenge, directly impeding progress toward Sustainable Development Goal 3 (SDG 3), which aims to ensure good health and well-being for all. A critical concern within this demographic is non-suicidal self-injury (NSSI), a behaviour that undermines SDG Target 3.4, focused on promoting mental health. Stigma and shame are primary barriers preventing individuals from seeking help, creating inequalities in health access and outcomes, which contravenes the principles of SDG 10 (Reduced Inequalities). This report analyses the factors influencing supportive attitudes toward NSSI, with a specific focus on social exposure—knowing a friend or family member who engages in NSSI. Understanding these dynamics is essential for developing interventions that foster inclusive environments within educational institutions (SDG 4: Quality Education) and promote gender equality in health support (SDG 5: Gender Equality).

The study’s objectives were threefold:

1. To examine the association between supportive attitudes toward NSSI and key variables: gender, personal experience with NSSI, mental health history, and social exposure to NSSI.
2. To evaluate the relative strength of these predictors, with a focus on social exposure as a modifiable factor for stigma-reduction initiatives.
3. To determine if acquiring new social exposure to NSSI over time corresponds with a positive change in attitudes.

Methodology and Study Design

Research Framework

A mixed-design study was conducted at a large university in Southern Sweden, combining cross-sectional and short-term longitudinal data collection. Self-report questionnaires were distributed to students in February 2022 (baseline) and September 2022 (follow-up). The study received ethical approval from the Swedish Ethics Review Authority (Dnr 2021–05102).

Key Measurements

• Attitudes toward NSSI: Measured using the Lund Tolerance toward Self-Harm (LUTOSH) scale.
• Social Exposure to NSSI: A binary measure indicating awareness of a friend or family member who engages in NSSI.
• Personal Experience: Dichotomous variables for lifetime prevalence of NSSI and mental health problems.
• Mental Health Symptoms: Assessed using the Symptom Checklist – Core Depression (SCL-CD6) and the Generalized Anxiety Disorder-7 (GAD-7) scale.

Key Findings and Alignment with SDGs

Predictors of Supportive Attitudes

A multiple linear regression analysis identified four significant predictors of more supportive attitudes toward individuals who engage in NSSI. These findings are crucial for designing targeted interventions that advance SDG 3 and SDG 10.

• Personal Experience with NSSI: The strongest predictor (β = 0.21), highlighting that direct experience fosters empathy and understanding.
• Gender: Being female was a significant predictor (β = 0.18), indicating gender-based differences in attitudes that must be addressed to achieve SDG 5.
• History of Mental Health Problems: Personal experience with mental health challenges also predicted greater supportiveness (β = 0.15).
• Social Exposure to NSSI: Knowing someone who engages in NSSI was a significant predictor of supportive attitudes (β = 0.09), presenting a key opportunity for contact-based interventions.

Impact of Social Exposure Over Time

The longitudinal analysis provided evidence that social exposure can be a catalyst for positive attitudinal change. Participants who reported new social exposure to NSSI at the six-month follow-up demonstrated a statistically significant increase in supportive attitudes (p = 0.043). In contrast, no significant change was observed in the group without new social exposure. This suggests that interpersonal contact is a dynamic factor in reducing stigma.

Prevalence Rates: A Call to Action for SDG 3 and SDG 4

The study revealed high prevalence rates of mental health challenges among university students, underscoring the urgency for institutions (SDG 4) to address student well-being (SDG 3).

• Lifetime NSSI: 38.7% of students reported a history of NSSI.
• Social Exposure to NSSI: 62.5% of students knew a friend or family member who engaged in NSSI.
• Mental Health Problems: 82% of the sample reported a lifetime history of mental health problems.

Significant gender disparities were observed across all prevalence estimates, with women and individuals of other genders reporting higher rates than men, reinforcing the need for gender-sensitive approaches in line with SDG 5.

Analysis and Implications for Sustainable Development

Social Contact as a Tool for Stigma Reduction (SDG 3 & SDG 10)

The findings strongly support Intergroup Contact Theory, positioning social exposure as a viable, ethically modifiable factor for reducing mental health stigma. While personal experience is the most potent predictor of empathy, it cannot be ethically induced. Social exposure, however, can be facilitated through structured awareness campaigns and peer support programs. Such initiatives can help normalize mental health struggles and foster supportive communities, directly contributing to the reduction of health-related inequalities (SDG 10) and the promotion of well-being (SDG 3).

The Role of Educational Institutions in Advancing Global Goals (SDG 4, SDG 16, SDG 17)

Universities are not only centres for learning (SDG 4) but also strong institutions (SDG 16) with a responsibility to safeguard student health. The high prevalence of NSSI and social exposure within this population makes universities ideal settings for intervention. By integrating NSSI-specific education into existing mental health services, universities can create a more inclusive and supportive campus climate. This requires partnerships (SDG 17) between university administrations, student health services, and national public health authorities to ensure that resources are available to support both those who disclose NSSI and those who receive disclosures.

Conclusion and Recommendations

This report confirms that personal experience with mental health challenges is a primary driver of supportive attitudes toward NSSI. More importantly, it provides quantitative evidence that social exposure is a significant and dynamic factor that can foster positive attitudinal change. The high prevalence of both NSSI and social exposure in university populations presents a critical opportunity for targeted interventions that align with multiple Sustainable Development Goals.

Recommendations for Action

1. Integrate NSSI into Mental Health Initiatives: Universities and public health bodies should explicitly include NSSI in mental health awareness campaigns to combat stigma and provide targeted information, advancing SDG 3.
2. Promote Safe Social Connectedness: Develop programs that encourage safe disclosure and peer-to-peer support, leveraging the positive impact of social exposure to build more inclusive communities in line with SDG 10 and SDG 16.
3. Equip Students with Support Skills: Offer training and resources to help students respond empathetically and effectively to disclosures of NSSI, thereby strengthening the campus support network and ensuring educational environments are conducive to well-being (SDG 4).
4. Address Gender Disparities: Design and implement mental health support systems that are sensitive to the gender-specific differences in prevalence and attitudes, ensuring equitable support for all students (SDG 5).

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being: The article’s central theme is the poor mental health among university students, focusing specifically on depression, anxiety, suicidal ideation, and non-suicidal self-injury (NSSI). It discusses the prevalence of these conditions, the need for support, and strategies to promote well-being, which are core components of SDG 3.
• SDG 4: Quality Education: The research is set within a university context, examining the mental health of students. The article implicitly connects mental well-being to the ability to participate in and benefit from education. It also highlights the role of educational institutions in creating supportive, non-stigmatizing, and inclusive learning environments and implementing awareness initiatives.
• SDG 5: Gender Equality: The study explicitly analyzes and reports significant differences between genders regarding the prevalence of NSSI, mental health problems, and supportive attitudes. It finds that women and those identifying as ‘Other’ report higher rates of NSSI and mental health issues but also demonstrate more supportive attitudes, highlighting gender-specific dimensions of the mental health crisis.
• SDG 10: Reduced Inequalities: The article addresses the stigma surrounding mental illness and NSSI, which creates social barriers and inequality for affected individuals. By investigating methods to reduce stigma, such as social exposure, the research contributes to promoting the social inclusion of people with mental health conditions, irrespective of their health status.

2. What specific targets under those SDGs can be identified based on the article’s content?

• SDG 3: Good Health and Well-being

  • Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. The article directly supports this target by focusing on promoting mental health among young people. It investigates the high prevalence of depression, psychological distress, and NSSI, which is described as a “gateway to suicide,” and explores factors that can foster supportive environments to encourage help-seeking and improve well-being.

• SDG 4: Quality Education

  • Target 4.A: Build and upgrade education facilities that are child, disability and gender sensitive and provide safe, non-violent, inclusive and effective learning environments for all. The article advocates for universities to become more supportive and inclusive environments. It suggests that since universities have a high prevalence of both NSSI and social exposure to it, they are “uniquely positioned to play a pivotal role in shaping intervention and awareness strategies” to reduce stigma and create a safer climate for students with mental health challenges.

• SDG 5: Gender Equality

  • Target 5.1: End all forms of discrimination against all women and girls everywhere. The research provides gender-disaggregated data showing that women and individuals identifying as ‘Other’ are disproportionately affected by NSSI and mental health problems. The article notes, “Significantly fewer men (21.3%) reported lifetime NSSI than women (44.4%) or Other (72.2%).” By highlighting these disparities, the article provides evidence needed to develop targeted, gender-sensitive policies to address discrimination and inequality in mental health outcomes.

• SDG 10: Reduced Inequalities

  • Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status. The article’s focus on reducing the stigma associated with NSSI directly relates to promoting the social inclusion of individuals based on their health status. It states that “stigma and shame often serve as significant barriers to help-seeking.” The study’s finding that social exposure can increase supportive attitudes points to a mechanism for fostering greater inclusion.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• For Target 3.4 (Promote mental health and well-being)

  • Official Indicator (related): The article relates to SDG Indicator 3.4.2 (Suicide mortality rate) by discussing precursors such as “suicidal ideation” (reported by one in six undergraduates) and noting that NSSI is associated with “increased suicide risk.”
  • Implied Indicators from the article:
    • Prevalence of depression: “one in four undergraduates experiencing depression.”
    • Lifetime prevalence of NSSI: “Lifetime NSSI prevalence was 38.7%.”
    • Prevalence of anxiety symptoms: Measured using the GAD-7 scale, with results showing “one in three” with generalized anxiety.
    • Rates of hospitalization due to NSSI: The article notes that these rates “have increased in recent years.”

• For Target 4.A (Provide safe and inclusive learning environments)

  • Implied Indicators from the article:
    • Student attitudes toward NSSI: Measured by the “Lund Tolerance toward Self-Harm (LUTOSH) scale,” where higher scores indicate more supportive (and thus more inclusive) attitudes.
    • Implementation of university-based anti-stigma programs: The article references initiatives like the “College Toolbox Project” as examples of actions that create more inclusive campus climates.

• For Target 5.1 (End discrimination against women)

  • Implied Indicators from the article:
    • Gender-disaggregated prevalence of NSSI: The study reports specific rates for men (21.3%), women (44.4%), and Other (72.2%).
    • Gender-disaggregated prevalence of mental health problems: The study reports rates for men (74.3%), women (84.3%), and Other (100%).
    • Gender-disaggregated data on supportive attitudes: The article notes that “women demonstrating more supportive attitudes toward NSSI than men.”

• For Target 10.2 (Promote social inclusion)

  • Implied Indicators from the article:
    • Measures of public stigma: The article’s entire premise is based on understanding and reducing stigma. The LUTOSH scale serves as a proxy measure for stigma, with lower scores indicating more stigmatizing attitudes.
    • Rates of social exposure to NSSI: Reported as 62.5% in the sample, this is presented as a key factor that can reduce stigma and therefore promote inclusion.
    • Rates of help-seeking: The article identifies stigma as a barrier to help-seeking, so an increase in help-seeking would indicate reduced stigma and greater inclusion.

4. Table of SDGs, Targets, and Indicators

Source: frontiersin.org