Abstract
Non-suicidal self-injury (NSSI) is an important public health concern among university students, particularly medical students, who face unique academic, emotional, and clinical stressors. However, evidence on the burden and correlates of NSSI in sub-Saharan Africa remains limited. This study assessed the prevalence of NSSI among medical students in Uganda and examined its association with generalized anxiety disorder (GAD) and substance use disorder (SUD). An analytical cross-sectional study was conducted among 224 undergraduate medical students at a private university in Kampala, Uganda. Data were collected between September and December 2024 using validated self-report instruments: the Self-Harm Inventory, the Generalized Anxiety Disorder-7 scale, and the Drug Abuse Screening Test-10. Sociodemographic and clinical characteristics were also assessed. Logistic regression models were used to examine factors associated with NSSI, and structural equation modeling was applied to evaluate the direct and indirect relationships between anxiety, substance use, and self-harm. The prevalence of NSSI was 8.0%, while 9.4% of participants screened positive for GAD and 7.6% for SUD. Students with GAD and those with SUD had significantly higher odds of reporting NSSI, even after adjusting for potential confounders. The presence of a chronic medical illness was also independently associated with increased likelihood of NSSI. Structural equation modeling demonstrated that both anxiety and substance use had significant direct effects on NSSI, but substance use did not mediate the relationship between anxiety and self-harm. These findings indicate that NSSI is present among medical students in Uganda and is strongly associated with anxiety and substance use through independent pathways. The results underscore the need for integrated, student-centered mental health interventions that prioritize early identification and management of anxiety and substance use problems to reduce self-harming behaviors and improve the well-being of medical students in low-resource settings.
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The authors wish to acknowledge the support of KCU, the participants, and the dedicated research assistants. This study did not receive any funding.
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J.A. wrote the main manuscript text and D.K.K. and A.S. prepared tables 2–4. All authors reviewed the manuscript.
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Ethical approval for this study was obtained from the Mulago Hospital Research Ethics Committee (MHREC), Kampala, Uganda (Approval Number: MHREC 2810), since KCU operates under a memorandum of understanding with Mulago National Referral Hospital for research oversight. Ethical clearance was granted on 30th September 2024, prior to the commencement of data collection, and all study activities were conducted between 1 October 2024 and 1 December 2024 strictly within the approved period and scope. The approved protocol covered recruitment of undergraduate medical students aged 18 years and above, administration of structured self-report questionnaires. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki (2013 revision) and complied with applicable national and institutional guidelines governing research involving human participants in Uganda. All procedures adhered to approved ethical standards, including confidentiality protections, voluntary participation, and risk-minimization protocols.
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Written informed consent was obtained from all participants prior to enrollment and before completion of any study procedures. Consent was obtained in person by four trained research assistants between 1 October 2024 and 1 December 2024 at designated university locations that did not interfere with academic activities. Eligible students received a detailed participant information sheet and written consent form in English, and the research assistants explained the study’s purpose and objectives, procedures and estimated duration, the voluntary nature of participation, potential risks including possible emotional discomfort when responding to questions about self-harm, anxiety, and substance use, measures to ensure confidentiality and anonymity, the right to decline or withdraw at any time without academic or personal consequences, and how anonymized data would be used for research and publication purposes. Participants were given adequate time to read the materials and ask questions before signing the consent form, and only those who voluntarily signed were enrolled. Given that the study involved university students discussing sensitive mental health topics, additional safeguards were implemented: no personal identifiers were collected; signed consent forms were stored separately from completed questionnaires; hard copy data were secured in locked cabinets; and electronic data were password-protected with access restricted to the research team. Participants were informed that their responses would remain anonymous, data would be analyzed in aggregate form, findings may be published in peer-reviewed journals, and that no direct financial incentives were provided. Because the study addressed self-harm and substance use, a structured risk management protocol was in place, and participants who screened positive for NSSI, GAD, or SUD were offered immediate psychological first aid and provided referral information to the university counselling unit or a nearby psychiatric clinic for further assessment and support.
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Abaatyo, J., Sodeinde, S.O., Ssekibaamu, A. et al. Prevalence and associated factors of non-suicidal self-injury (NSSI) among university students: the role of Generalized Anxiety Disorder and substance use disorder. Humanit Soc Sci Commun (2026). https://doi.org/10.1057/s41599-026-06911-y
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DOI: https://doi.org/10.1057/s41599-026-06911-y
