Prevalence and Pattern of Self‐Harm Among University Students in Dhaka: A Cross‐Sectional Study

Abstract

ABSTRACT

Background

Self‐harm remains a significant public health issue worldwide, with university students being particularly affected. This study examines its prevalence and associated factors among university students in Dhaka, Bangladesh, while considering broader global, regional, and local trends.

Methods

This study utilized a cross‐sectional design, surveying 200 students from the University of Dhaka and the Bangladesh University of Business and Technology. Data were gathered through in‐person interviews and analyzed using SPSS version 26.

Results

The study found that self‐harm was prevalent at 17%, with a striking gender difference—females exhibited a four times higher occurrence than males. Bivariate analysis indicated no significant variations across institutions, academic disciplines, habitat, or socioeconomic status. However, logistic regression revealed key associations: females were more prone to self‐harm, while middle and high socioeconomic status served as protective factors.

Conclusion

This study highlights the critical need for customized mental health programs targeting university students in Dhaka. The identified prevalence and influencing factors provide a foundation for future research and support the development of evidence‐based strategies to reduce self‐harm and promote overall mental well‐being on campus.

Introduction

Self-harm, a multifaceted manifestation of psychological distress, has emerged as a significant global public health concern, especially among university students. This issue not only affects individual well-being but also poses challenges to the overall mental health landscape of educational institutions. A deliberate action with a nonfatal outcome, where an individual engages in an atypical behavior that, without external intervention, leads to self-harm, or intentionally consumes a substance in quantities exceeding prescribed or widely accepted therapeutic limits, with the intent of achieving desired changes through its actual or anticipated physical effects [1].

Globally, the prevalence of self-harm among university students varies, with alarming rates documented across diverse cultural contexts. Studies from China [2–4] and England [5] reported prevalence rates ranging from 7.5% to 16.2%, highlighting the pervasive nature of this phenomenon. The widespread impact of self-harm on university campuses is underscored by a recent nationwide study in China, emphasizing the need for comprehensive mental health strategies [2].

In the Asian region, the prevalence of self-harm among university students has been a subject of increasing concern. Hong Kong witnessed a substantial prevalence of 32.7% of students reporting at least one form of deliberate self-harm [6]. Similarly, Malaysia recorded a prevalence of 7.3% among university students during the COVID-19 pandemic [7]. These regional trends emphasize the urgent need for targeted interventions to adress the unique challenges university students face in diverse cultural and socioeconomic cotexts intended meaning.

Within the local context of Dhaka, Bangladesh, where mental health issues are gaining recognition, evidence on self-harm among university students has been limited. A clinical study reported a 16.4% prevalence of mental and behavioral emergencies among all cases attended during a specific period [8]. However, comprehensive research specific to university students in Dhaka has been sparse. Our study seeks to address this gap by investigating the occurrence and contributing factors of self-harm among university students in Dhaka.

Recognizing the underlying causes of self-harm among university students in Dhaka is essential for multiple reasons. A significant number of patients with self-harm are students and the majority of them are university students. This group of people is vulnerable due to academic stressor, financial crisis, unhealthy lifestyle, unstable relationship, substance use, bullying, depression and so forth.

First and foremost, it enables the identification of at-risk groups, allowing for the development of targeted preventive and intervention strategies. Given the cultural nuances and unique stressors students face in Dhaka, our study aims to contribute context-specific insights that can inform mental health initiatives tailored to the local university population.

Moreover, the global and regional variations in self-harm prevalence underscore the need for localized interventions that consider the cultural and socioeconomic specificities of the Dhaka context. Self-harm is under-reported due to a negative view of society about self-harm behavior. People have lack of awareness and knowledge about self-harm. For this reason, social stigma is present toward self-harm behavior. This study will also assist in creating an information baseline to carry out further studies in this field in the future. As far as the researcher's knowledge no such study was conducted in our country. Therefore, hope this study will attend to fill the evidence-based knowledge gap in this area.

By shedding light on the prevalence and correlates of self-harm, this study strives to provide a foundation for evidence-based mental health programs that address the distinct challenges faced by university students in Dhaka.

Methods

This study aimed to gain a comprehensive understanding of self-harming behaviors among university students in Dhaka, contributing to the development of targeted prevention and intervention strategies. The study adheres to the STROBE guidelines, which provide a standardized framework for effectively reporting cross-sectional studies.

Study Design and Setting

This cross-sectional study was carried out at the Department of Psychiatry, Bangabandhu Sheikh Mujib Medical University (BSMMU) in Dhaka, Bangladesh, from September 2018 to March 2021.

Participants and Sampling

A randomized convenient sampling technique was applied. Both Universities were selected according to convenience. The Departments were selected by random sampling by lottery. Then, students of each department were selected by lottery according to their registration numbers.

Students from the University of Dhaka and the Bangladesh University of Business and Technology (BUBT) who participated in the study were selected using a convenient random sampling technique [9]. The sample size was 200 students, comprising 102 from the University of Dhaka (51 from computer science and 51 from sociology) and 98 from BUBT (51 computer science majors and 47 English majors). The sampling approach aimed to ensure representativeness within the constraints of the study's scope.

Ethical Considerations

Ethical approval reference number of our study is BSMMU/2020/7154 which is given by Institutional Review Board(IRB) of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Informed written consent was obtained from chairman of every participating faculty of both universities. Informed consent was obtained from all participants, emphasizing the voluntary nature of participation and confidentiality assurances. Ethical considerations were paramount throughout the study.

Data Collection

Data collection involved face-to-face interviews, where participants completed a sociodemographic questionnaire and the SHI-Bangla version. As our previous experience we saw that most of the Self-Harm patient try to hide their incidence in survey and most of the time they couldn't understand meaning of question and real objective of this question. So interviews were chosen instead of an anonymous survey. Each interview took 8 to 10 min and we personally conducted them. Each participants gave written informed consent.

SHI is the self-harm inventory; the interviews, conducted in private to protect participant confidentiality, were guided by a structured protocol. Self-harm was determined by the SHI questionnaire and taking detailed history from students during the interview.

The Self-Harm Inventory (SHI) Bangla version was validated and culturally adapted by Dr. Himadri Mahajan, Department of Psychiatry BSMMU. The Self-Harm Inventory is an 22-item scale that was developed by Randy A. Sansone, Michael W. Wiederman, and Lori A. Sansone (Sansone in 1998). The SHI has utility (1) as an instrument to see the lifetime presence of 22 self-harm behaviors. SHI's reliability and internal consistency were examined across various samples, and strong validity was demonstrated. The instruments selected were chosen based on their relevance to the study's objectives.

Variables and Measurements

The sociodemographic questionnaire covered key variables, including age, gender, area of living (urban/rural), and family income, while the SHI-Bangla version assessed self-harming behaviors. The selection of these instruments aligns with the study's focus and aims.

Response Rate and Nonparticipation

Of the 240 students contacted, 200 agreed to participate, yielding an 83% response rate. While specific reasons for nonparticipation were not systematically recorded, potential biases were considered in the analysis and interpretation of results.

Data Analysis

Statistical analysis was conducted using SPSS version 23.0. Descriptive statistics were applied to sociodemographic variables, and appropriate statistical procedures were employed for comparative analyses. Assumptions made during the analysis are explicitly stated to enhance the transparency of the study's findings.

Results

Demographic Characteristics of Participants

The study encompassed a varied group of university students from the University of Dhaka and the Bangladesh University of Business and Technology (BUBT). The mean age of the participants was 21 years (SD: 1.95), reflecting a relatively homogenous age group. Participants were evenly distributed between the two universities, demonstrating a balanced representation of students from different academic environments. In terms of gender distribution, 65.5% of participants identified as male, while 34.5% identified as female. Academic disciplines varied within the sample, with 51% of participants majoring in Computer Science, 23.5% in English, and 25.5% in Sociology (Table 1). This distribution allowed for the examination of self-harming behaviors across diverse academic backgrounds. Geographically, the majority of participants (55.5%) resided in urban areas, underscoring the urban-rural diversity within the sample. Socioeconomic status, a key determinant in mental health research, showed that 4% of participants were in the low-income group, 67% in the middle-income group, and 29% in the high-income group. The socioeconomic subgroups we classified as low-income upto taka 5000, middle-income TK 5000–50,000, high-income above TK 50,000. Due to very low range of low-income and wide range of middle-income and high-income, most of the students of Universities in this study were classified in the middle–high income groups. Only 8 (4%) of students belonged to a low-income group according to this scale.

Table 1 Demographic characteristics of the participants.

Characteristics	Frequency	Percentage
Sex
Male	131	65.5
Female	69	34.5
Institution
BUBT	98	49.0
DU	102	51.0
Subject
Computer Science	102	51.0
English	47	23.5
Sociology	51	25.5
Habitat
Urban	111	55.5
Rural	89	44.5
Socioeconomic status
Low	8	4.0
Middle	134	67.0
High	58	29.0

This socioeconomically diverse composition enriches the study's ability to explore potential associations between socioeconomic factors and self-harm.

Self-Harm Behaviors and Associated Factors

Among the 200 university students who participated in the study, 34 individuals reported a history of self-harm, resulting in an overall prevalence of 17% (95% CI: 12–22.5). This indicates a significant proportion of the student population engaging in self-harming behaviors. There is self-poisoning 6 (17.65%), self-injury 14 (41.18%), other 7 (20.59%), multiple methods 7 (20.59%). Our study conducted during the COVID-pandemia. During this pandemic, due to the emergency and lockdown situation, people feel more stressed than at any other time. We found a notable prevalence of 17% among the participating students.

Upon closer examination of gender differences, it was found that 9.9% of male participants (n = 13) and 30.4% of female participants had a history of self-harm. The occurrence of self-harm was notably higher among female participants than their male counterparts, with a statistically significant difference (p = 0.001). The socioeconomic sub groups we classified as low-income, middle-income, high-income. Low-income group students 8 (4%); among them 2 (25%) had self-harm. Middle-income group students 134 (67%); among them, 25 (18.7%) had self-harm. High-income group students 58 (29%); among them 7, (12.1%) had self-harm. So low-income group students had more proportion of self- harm then other group.

Bivariate analyses were conducted to explore potential differences in self-harm behaviors among various demographic and contextual factors (Table 2). The results revealed that, when measured separately, there were no significant differences in self-harm behavior based on the institutions attended, academic disciplines, habitat (urban or rural). The age range of the sample is 18 to 26 years. There is no significant difference in self-harm relative to age or year of study.

Table 2 Bivariate analysis of self-harm behaviors.

Characteristics	DSH	OR (95% CI)	p value
Yes (n, %)	No (n, %)
Sex
Male	13, 9.9	118, 90.1
Female	21, 30.4	48, 69.6	3.971 (1.841–8.566)	< 0.001
Institution
BUBT	18, 18.4	80, 81.6
DU	16, 15.7	86, 84.3	0.827 (0.395–1.731)	0.614
Subject
Computer Science	15, 14.7	87, 85.3
English	9, 19.1	38, 80.9	1.415 (0.586–3.418)	0.441
Sociology	10, 19.6	41, 80.4	1.030 (0.378–2.807)	0.954
Habitat
Urban	12, 13.5	77, 86.5
Rural	22, 19.8	89, 80.2	0.630 (0.293–1.357)	0.238
Socioeconomic status
Low	2, 25.0	6, 75.0
Middle	25, 18.7	109, 81.3	0.412 (0.069–2.453)	0.330
High	7, 12.1	51, 87.9	0.598 (0.243–1.474)	0.264

A significant gender disparity was identified as a key factor in self-harm behaviors. Bivariate analysis revealed a statistically significant difference between male and female participants (p = < 0.001). Female participants were nearly four times more likely to report a history of self-harm than their male counterparts (OR = 3.971, 95% CI: 1.841–8.566).

To further explore the factors associated with self-harm behaviors while adjusting for potential confounders, a binary logistic regression analysis was conducted. The results revealed significant differences in self-harm among different groups of socioeconomic status and gender.

After adjusting for all variables, the Adjusted Odds Ratio (AOR) for male participants compared to female participants was 6.512 (95% CI: 2.343–18.095), with a p-value of < 0.001. This suggests that, even when considering other variables, the likelihood of self-harm remained significantly higher among female participants (Table 3).

Table 3 Multivariate analysis of self-harm behaviors.

	aOR	95% CI	p value
	Lower	Upper
Sex
Male	1.000
Female	6.512	2.343	18.095	< 0.001
Socioeconomic status
Low
Middle	0.068	0.008	0.592	0.015
High	0.297	0.104	0.844	0.023
Constant	5.906			0.002

Compared to the low-income group, the AOR for the middle-income group was 0.068 (95% CI: 0.008–0.592) with a p-value of 0.015. Similarly, the AOR for the high-income group was 0.297 (95% CI: 0.104–0.844) with a p-value of 0.023.

Discussion

The prevalence of self-harm among university students has been a growing concern worldwide. In our study, we observed a notable prevalence of 17% among the participating students. This finding aligns with global trends, where the rates of self-harm among university students vary widely across different regions and time periods.

Comparing our results with existing literature, our prevalence is notably higher than the 7.5% reported among university students in China [2], but closer to the 16.4% clinical prevalence of deliberate self-harm documented in mental and behavioral emergencies attended during the same period in India [8]. These variations underscore the need for region-specific approaches and interventions to address the multifaceted nature of self-harm behaviors in university settings.

Consistent with previous research, our study revealed demographic patterns influencing self-harm behaviors. The dominance of females among self-harm cases in our study resonates with global patterns, as documented in studies from Hong Kong [6] and Norway [10].

Our study revealed a significant gender disparity, with female participants exhibiting a self-harm prevalence four times higher than that of their male counterparts. This trend aligns with extensive research highlighting the heightened risk of self-harm among females [3, 4, 11–15]. These findings emphasize the necessity of gender-sensitive risk assessment and intervention strategies tailored to the specific challenges faced by female university students.

Our study uncovered a significant association between socioeconomic status and self-harm, with the logistic regression analysis indicating a protective effect of middle and high socioeconomic status. These results contrast with findings from a study in Malaysia, where the prevalence of self-harm among university students during the COVID-19 pandemic was 7.3% [7]. The variations in prevalence rates emphasize the importance of considering local socioeconomic contexts and stressors that may contribute to self-harm behaviors.

Furthermore, our results align with studies indicating an inverse association between socioeconomic status and self-harm, emphasizing the potential role of economic factors in shaping mental health outcomes among university students [16–20]. The protective effect observed in middle and high-income groups highlights the need for targeted interventions addressing socioeconomic disparities and promoting mental health resilience among students from low-income backgrounds.

The complex interplay of gender and socioeconomic factors revealed in our study has critical implications for designing preventive and intervention strategies. Tailoring mental health initiatives to address the unique challenges faced by female students and those from lower socioeconomic backgrounds is paramount. Considering the global and regional variations in self-harm prevalence, future research should delve deeper into the cultural, economic, and social determinants influencing self-harm among university students.

In conclusion, our study adds to the growing body of literature on self-harm among university students, providing insights into the demographic and socioeconomic factors associated with these behaviors. By understanding the unique risk profiles of subgroups within this population, we can inform targeted interventions to mitigate the prevalence of self-harm and promote mental well-being on university campuses.

Limitations

Although this study offers important insights into the prevalence and contributing factors of self-harm among university students in Dhaka, certain limitations must be considered. First, its cross-sectional design restricts the ability to determine causation, as the data provides only a single-point snapshot, preventing analysis of temporal trends in self-harm behaviors. Additionally, the reliance on self-reported data raises concerns about social desirability bias and the potential underreporting of sensitive information. Additionally, the study was conducted in two specific institutions in Dhaka, limiting the generalizability of findings to other university populations in Bangladesh. Furthermore, the convenient random sampling technique may introduce selection bias, as students who chose not to participate may differ systematically from those who did. Lastly, the study's focus on university students may not capture the full spectrum of self-harm behaviors in the broader young adult population. Despite these limitations, this study provides a foundational understanding of self-harm in the Dhaka University context, paving the way for future research and targeted interventions.

Conclusion

Our study on self-harm among university students in Dhaka reveals a significant prevalence of 17%, with a fourfold higher rate among females. The logistic regression underscores the protective role of middle and high socioeconomic status. These findings emphasize the need for targeted interventions addressing gender-specific and socioeconomic factors. Our study serves as a critical step in understanding and addressing self-harm among university students in Dhaka, guiding the development of focused mental health initiatives for this population.

Author Contributions

Abdullah Muhammad Fariduzzaman: conceptualization, investigation, methodology, data curation, writing – original draft, writing – review and editing. Zunayed Al Azdi: writing – original draft, writing – review and editing. Sayedul Ashraf Kushal: writing – review and editing. Yahia Md Amin: writing – review and editing. Krishna Roy: writing – review and editing. Jhowhar Datta: writing – review and editing. Erina Tabassum: writing – review and editing. Jhunu Shamsun Nahar: supervision, writing – review and editing.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Transparency Statement

The lead author Abdullah Muhammad Fariduzzaman affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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