Volume 19 Issue 2, May 2024, p.

125-133
http://dx.doi.org/10.20473/jn.v19i2.54610

ORIGINAL ARTICLE OPEN ACCESS

The predictor of non-suicidal self-injury behavior

among adolescents: a cross-sectional study
Dwi Indah Iswanti1 , Lee-Lee Lai2 , I Made Moh. Yanuar Saifudin3 , Kandar Kandar4 , Rian
Kusuma Dewi4 , and Dessy Dwi Cahyaningrum4
1 Faculty of Nursing and Health Science, Universitas Karya Husada Semarang, Semarang, Indonesia
2 Universiti Malaya, Kuala Lumpur, Malaysia
3 Department of Nursing, Faculty of Medicine, Universitas Tanjungpura, Pontianak, Indonesia
4 RSJD Dr. Amino Gondohutomo Central Java Province, Semarang, Indonesia
*Correspondence: Dwi Indah Iswanti. Address: Faculty of Nursing and Health Science, Universitas Karya Husada Semarang,
Semarang, Indonesia. Email: dwi.indah.iswanti@unkaha.ac.id
Responsible Editor: Laily Hidayati
Received: 31 January 2024○ Revised: 8 May 2024 ○ Accepted: 13 May 2024

ABSTRACT
Introduction: Non-Suicidal Self-Injury (NSSI) among adolescents is a prevalent issue in Indonesia. Comprehensive
understanding of NSSI is essential for uncovering the factors that trigger and predispose adolescents to such behavior.
This knowledge serves as a foundation for crafting targeted nursing interventions to address and mitigate NSSI among
this vulnerable population. This study aimed to identify determinant factors contributing to the occurrence of Non-
Suicidal Self-Injury behavior in adolescents.

Methods: The study employed a cross-sectional approach conducted between October and December 2023, with
570 respondents selected through simple random sampling. Socio-demographic, precipitating, and predisposing
factors were measured using a checklist sheet. The Self-Harm Inventory (SHI) instrument was utilized to assess NSSI.
Data analysis involved Pearson correlation and multiple regression to examine the relationships between variables.

Results: The study revealed significant relationships among five variables. Gender (p-value = 0.004), bullying (p-value
= 0.002), disappointment (p-value = 0.001), sharing place (p-value = 0.002), and communication pattern (p-value =
0.010) were identified as factors associated with Non-Suicidal Self-Injury behavior in adolescents. On the other hand,
personality (p-value = 0.174), environment (p-value = 0.260), coping mechanism (p-value = 0.458), and parenting style
(p-value = 0.054) showed no association with Non-Suicidal Self-Injury behavior.
Conclusions: The findings underscore the significance of disappointment and the absence of a supportive
environment in influencing NSSI. This highlights important considerations for healthcare professionals, educators, and
policymakers. Strategies should encompass comprehensive approaches, early detection, and targeted interventions
to foster supportive environments and address the complex nature of NSSI among adolescents.

keywords: adolescents, bullying, Indonesia, non-suicidal self-injury

Introduction Self-Injury (NSSI). Furthermore, according to Apsari et al.

Adolescents go through puberty or sexual maturity (2021), NSSI is a form of behavior carried out to cope
involving changes or transitions in hormonal, cognitive, with emotional pressure or emotional pain by
and psychosocial aspects (Apsari et al., 2021). According deliberately harming oneself without intending suicide.
to Kaligis et al. (2021), adolescents become a vulnerable The most frequently employed methods of NSSI include
population to various mental health issues, and the most self-cutting and self-hitting, but NSSI methods vary from
common ones in Indonesia are anxiety and Non-Suicidal cutting, burning, or stabbing (Zakaria and Theresa,

© 2024 Jurnal Ners. This is an open-access article distributed under the terms of the Creative http://e-journal.unair.ac.id/JNERS 125
Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
Iswanti, Lai, Saifudin, Kandar, Dewi, and Cahyaningrum (2024)

2020), to hitting, digging into scars, pulling hair, and The NSSI behavior creates a broad spectrum of
even consuming toxic substances (Kusumadewi et al., losses, encompassing physical, psychological, economic,
2019). Although NSSI is an unhealthy coping mechanism, social, and academic aspects (Hidayati, Fanani and
some young individuals perceive NSSI as an objective Mulyani, 2021). From a physical perspective, NSSI leads
way and can become addicted to repeating it (Alifiando, to wounds and bruises on the body, subsequently
Pinilih and Amin, 2022). impacting the economic aspect due to the need for
The actual data on NSSI behavior are like an iceberg medical care expenses. On the social and psychological
phenomenon, making it extremely challenging to fronts, NSSI damages or severs social relationships and
identify (Apsari et al., 2021). This is because NSSI is gives rise to feelings of shame. Academically, NSSI is
considered a highly personal issue, leading to many directly proportional to lower academic performance.
cases going undetected, except for those receiving NSSI is carried out without an intent to commit suicide,
treatment for mental condition (Sivasankari et al., but it serves as a significant risk factor for suicide
2016). A prior meta-analysis revealed that. globally, attempts across various demographics, especially
8.3% of adolescents engaged in episodic NSSI, while among adolescents, adolescent psychiatric patients, and
20.3% reported repetitive NSSI (Xiao et al., 2022). students and adults (Apsari et al., 2021). Moreover,
However, there is currently no available report many NSSI cases lead to death, with individuals engaging
regarding the prevalence of NSSI in Indonesia. According in NSSI having a 1.68 times higher risk of suicide.
to Piarulli et al. (2023), the prevalence of NSSI ranges Additionally, individuals engaging in NSSI cause
from 13-28% in community-based samples and up to considerable damage to body tissues, resulting in
80% in inpatient samples. Furthermore, previous studies medical complications and even death (Elvira et al.,
showed that NSSI is more common in females (Zakaria 2021).
and Theresa, 2020; Xiao et al., 2022; Piarulli et al., 2023; NSSI cannot be regarded as a trivial phenomenon,
Putri and Dewi, 2023). The average onset age reported especially among vulnerable populations such as
for NSSI behavior is between 12-19 years. Out of 100 adolescents. Further studies on NSSI are crucial to
participants, 38% had engaged in self-harm 5-10 times, understanding the precipitating and predisposing
and 28% had self-harmed 11-50 times (Hidayati, Fanani factors that lead adolescents to engage in NSSI, forming
and Mulyani, 2021). NSSI behavior can occur in both the the basis for developing appropriate nursing
normal population and individuals with diagnosed interventions. Therefore, this study aimed to identify
mental health disorders. Some mental health disorders determinant factors contributing to the occurrence of
associated with NSSI behavior include borderline NSSI behavior in adolescents.
personality disorder, depressive disorders, bipolar
disorder, and schizophrenia (Kusumadewi et al., 2019) Materials and Methods
Some of the contributing factors to NSSI behavior Design
include the inability to regulate emotions, issues with
This study was an explanatory survey with a cross-
negative peer relationships such as bullying, and
sectional approach. Drawing upon a review of existing
disharmony within family relationships (Zakaria and
literature that has identified known factors related to
Theresa, 2020). Emotional dysregulation is a closely
NSSI, this study analyzes the relationships between
related factor to NSSI behavior (Mitchell et al., 2023)
socio-demographic factors (including gender, age, type
Various studies consistently show that individuals
of residence and living status) (Park, In and Hur, 2022),
engaged in NSSI behavior have higher levels of
precipitating factors (including bullying,
emotional dysregulation compared to those who do not
disappointment, sharing places, and communication
(Shafti et al., 2021). The exact mechanisms through
patterns) (Baiden, Stewart and Fallon, 2017; Geng et al.,
which emotional dysregulation leads to NSSI behavior
2023), and predisposition in adolescents with NSSI
are still unknown, but there are several theories
behavior, and subsequently identifies the most
attempting to explain, including the experiential
contributing factor (including personality,
avoidance theory, where NSSI is seen as an attempt to
environmental influences, coping mechanisms, and
escape from stressors (Shafti et al., 2021) and the
parenting styles) (Khazaie et al., 2021; Rosario‐Williams,
urgency theory, which suggests that individuals are
Kaur and Miranda, 2021; Kataria et al., 2023).
more prone to NSSI when experiencing negative affect
(Piarulli et al., 2023).

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Samples and Settings indicating good validity. The reliability testing resulted in
The population in this study consists of 4000 high a Cronbach's alpha value of 0.831, signifying excellent
school and vocational school students in the Central Java reliability. Therefore, it can be concluded that the
Province of Indonesia. The sample size was 570 Indonesian version of the Self-Harm Inventory is valid
respondents, determined using the Raosoft sample size and reliable.
calculator (https://www.raosoft.com/samplesize.htm), Data Collection
considering a population of 4000 teenage students from
The data collection for this study was conducted
high schools (SMA-SMK) in the city of Semarang, with a
from October to December 2023. The researcher
margin of error of 5% and a confidence level of 99%. The
obtained ethical approval from the Ethical Assessment
sampling technique employed was simple random
Team of Regional Mental Hospital of Dr. Amino
sampling, with the criteria being active high school and
Gondohutomo from Central Java Province. Permission
vocational school students in Semarang, aged between
for the study was also sought from the Department of
17 and 20 years old.
Education, Central Java Province. An online meeting was
Research Instruments held with representatives of guidance counselors from
The tools employed in this study include a checklist high schools and vocational schools in the city of
sheet created by the authors, which draws from existing Semarang. The questionnaires were distributed through
information regarding factors associated with NSSI. a Google Form link provided to the guidance counselors
Furthermore, the assessment of NSSI behavior in in each high school and vocational school. To maintain
adolescents utilized a validated questionnaire, data confidentiality, the Google Forms utilized in this
specifically the Self-Harm Inventory (SHI) instrument. study adopt an anonymous response method, wherein
respondents are not prompted to provide their names,
Checklist sheet emails, or any other confidential information.
The checklist sheet is utilized to measure socio- Moreover, access to data analysis and curation is
demographic variables, including age, gender, type of restricted to authorized personnel by the author.
residence, and domicile. Precipitating factors, consisting Subsequently, the students from high schools and
of bullying, disappointment, sharing places, and vocational schools in Semarang were invited to fill out
communication patterns, are measured using a checklist the questionnaires after providing informed consent.
sheet with two options: none and unnone. Meanwhile,
Ethical Consideration
predisposing factors such as personality, environmental
influences, coping mechanisms, and parenting styles are Adolescents were provided with comprehensive
also measured using a checklist sheet with single-answer information regarding the purpose of the study. Prior to
or dichotomous questions: none and unnone. However, completing the questionnaires, verbal and written
validity and reliability testing were not conducted for consent was obtained from the respondents.
this checklist sheet due to the inappropriate context for Participants were guaranteed confidentiality and the
such assessments. freedom to participate in the study. The study obtained
approval from the Ethics Review Board at the health
The Self-Harm Inventory (SHI) research ethics committee of Dr. Amino Gondohutomo
The Indonesian version of the Self-Harm Inventory Regional Psychiatric Hospital (Ethic approval ID
(SHI) instrument was employed to measure NSSI 420/10402), granted on September 19th, 2023.
behavior in adolescents in this study. The SHI comprises
Table 1. Characteristics of Respondents (n=570)
22 open-ended questions with a score range of 0 to 22, Variable Category n %
where a score of 1 indicates a 'Yes' response and a score Gender Male 195 34.2
Female 375 65.8
of 0 indicates 'No.' A score of 0 signifies the absence of
Age Early Adolescence (10- 0 0.00
self-harm, a score of 1-5 indicates a risk of self-harm, a 12 years old)
Middle Adolescence 148 26.0
cutoff score > 5 is considered valid for mild self-harm, (13-15 years old)
and a cutoff score > 11 indicates a tendency toward Late Adolescence (16- 422 74.0
19 years old)
psychopathological conditions. This instrument has Type of House 553 97.0
undergone validity and reliability testing by Residence Rental/Boarding House 14 2.5
Relative's House 3 0.5
Kusumadewi (2017), where the results of content Living status Living with parents 522 91.6
validity testing, according to expert consensus, yielded Living with relatives 41 7.2
Living/Residing alone 7 1.2
Aiken's validity index ranging from 0.83 to 0.97,

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Data analysis
Table 2. Description of Study Variable
The collected data were processed and analyzed Precipitating
Category n %
Factors
using Statistical Package for the Social Sciences (SPSS)
Bullying Experienced Bullying 286 50.2
version 26. Univariate and multivariate analyses were None 284 49.8
conducted on the data. Socio-demographic data, Disappointment Deep Disappointment 368 64.6
None 202 35.4
precipitating factors, predisposition, and Non-Suicidal Sharing Place Has a Sharing Place 215 37.7
Self-Injury behavior were depicted with frequency None 355 62.3
Communication Good Communication 334 58.6
distributions. Subsequently, relationships between
Pattern Poor Communication 236 41.4
socio-demographic variables, precipitating factors, and Predisposing
Category n %
predisposition with NSSI behavior were examined using Factors
Personality Introverted 286 50.2
Pearson correlation. The results of these bivariate Extroverted 284 49.8
analyses were then subjected to multivariate analysis Environment Support NSSI 167 29.3
using multiple regression to identify the factors that Does not support NSSI 403 70.7
Coping Adaptive Coping 334 58.6
most contribute to NSSI behavior, with a significance Mechanism Maladaptive Coping 236 41.4
level set at 95%. Parenting Style Democratic 375 65.8
Authoritarian 195 34.2
Non-Suicidal Mean=4.29, SD=3.67
Results Self-Injury None 11 1.9
NSSI Risk 340 59.6
The response rate for this study was 100% and 570 Mild NSSI 190 33.3
respondents’ data were recruited for analysis. The Psychopathological NSSI 29 5.1
analysis was focused on the specific study questions and bullying, 64.6% have deep-seated feelings of
objectives. The study focused on specific study disappointment, and 62.3% lack a sharing place even
questions, including "which socio-demographic factors, though their communication patterns are considered
precipitating elements, and predispositions are good at 58.6%. Predisposing factors for NSSI behavior
associated to Non-Suicidal Self-Injury (NSSI) behavior?" include 50.2% of adolescents having an introverted
To address this question, the authors provide the personality with an unsupportive environment for NSSI
following findings. occurrence at 70.7%, adolescents employing adaptive
Respondents’ Characteristics coping mechanisms at 58.6%, and a democratic
parenting style in the family at 65.8%. Meanwhile, the
Table 1 illustrates the socio-demographic
majority of adolescents are at risk of engaging in NSSI
characteristics of adolescents, where the majority are
behavior, accounting for 59.6%.
aged 16-19 years, representing late adolescence. The
adolescents are predominantly female, and the type of Correlation among Variables
residence is living together with their parents. Table 3 describes the inter-correlation of variables,
Description of Precipitating Factors, Predisposition, and which was tested using Pearson correlation. It was found
NSSI Behavior in Adolescents that only four variables had a relationship, so these
Table 2 illustrates the description of the precipitating variables were further tested by multiple regression
factors, predisposition, and NSSI behavior variables in analysis. The variables of personality (p-value = 0.174),
adolescents. Regarding the precipitating factors for NSSI environment (p-value = 0.260), coping mechanism (p-
occurrence, 50.2% of adolescents have experienced value = 0.458), and parenting style (p-value = 0.054)

Table 3. Inter-Correction of the Variables on Predictors of Non-Suicidal Self-Injury Behavior in Adolescents

1 2 3 4 5 6 7 8 9 10
1. NSSI 1
2. Gender 0.004* 1
3. Bullying 0.002* 0.016* 1
4. Disappointment 0.001* <0.001* <0.001* 1
5. Sharing Place 0.002* 0.007* <0.001* <0.001* 1
6. Communication 0.010* 0.011* <0.001* <0.001* <0.001* 1
Pattern
7. Personality 0.174 0.419 <0.001* 0.051 0.003* 0.104 1
8. Environment 0.260 0.359 0.015* 0.132 0.011* 0.071 <0.001* 1
9. Coping Mechanism 0.458 0.343 0.007* 0.009* <0.001* 0.011* <0.001* <0.001* 1
10. Parenting Style 0.054 0.448 0.289 0.297 0.460 0.411 <0.001* <0.001* <0.001* 1
Note: *Significant with p-value <0.05

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Table 4. Regression of Non-Suicidal Self-Injury Behavior, Gender, Javanese culture, with parental control remaining
Bullying, Disappointment, Sharing Place, and Communication Pattern
Dependent Variables: Non- consistent throughout their upbringing (Hasanah et al.,
Independent Variables Suicidal Self-Injury 2019).
Beta p-Value The results of this study indicate that NSSI behavior
Gender 0.085 0.045
Bullying 0.310 0.002 is more common among female adolescents. This aligns
Disappointment 0.203 0.003 with several previous studies that suggest female
Sharing Place 0.194 0.003
Communication Pattern 0.050 0.535
adolescents tend to engage in NSSI (Yue et al., 2023).
R2=0.55; Adjusted R2=0.40; (p=<0.001) Additionally, previous study has shown that females are
twice as likely to report NSSI behavior compared to
showed no relationship with Non-Suicidal Self-Injury males. This condition is associated with higher
behavior in adolescents. The testing results of the five psychological pressure and a lower ability to regulate
variables indicated a relationship, where gender (p- emotions effectively among females (Lutz et al., 2023).
value = 0.004), bullying (p-value = 0.002), deep Similar findings were also demonstrated in a previous
disappointment (p-value = 0.001), sharing place (p-value cohort study, which revealed that NSSI behavior is more
= 0.002), and communication pattern (p-value = 0.010) prevalent in females across the sample, increasing since
were found to be associated with Non-Suicidal Self- early adolescence, peaking in mid-adolescence (ages 16-
Injury behavior in adolescents. 17), and gradually declining thereafter (Wilkinson et al.,
2022). More specifically, previous study by Yue et al.
Regression Analysis Results
(2023). added that gender moderates the relationship
Table 4 outlines the highest strengths in bullying (p- between childhood violence and NSSI behavior. Their
value = 0.002; Beta = 0.310), disappointment (p-value = study suggests that females who have experienced
0.003; Beta = 0.203), and sharing place (p-value = 0.003; emotional violence have a higher risk of engaging in NSSI
Beta = 0.194), indicating that these factors contribute behavior.
significantly to the increase in Non-Suicidal Self-Injury Moreover, the findings of the study reveal that
(NSSI) behavior in adolescents. All independent bullying emerges as the strongest significant predictor of
variables collectively influence NSSI behavior in non-suicidal self-injury (NSSI) behavior, compared to
adolescents by 47% (R2 = 0.55). The most significant other variables, as demonstrated by regression analysis
predictor variable for NSSI behavior in adolescents is (Beta = 0.310; p-value = 0.002). Bullying emerges as a
bullying (Beta = 0.310). potent predictor of NSSI due to its detrimental effects
on psychological well-being, intersections with adverse
Discussions childhood experiences, and socio-environmental
The findings of this study indicate that NSSI behavior influences. Firstly, bullying inflicts psychological distress
in adolescents is associated with various causative and emotional pain, creating a profound sense of
factors. Socio-demographic factors such as gender are helplessness and vulnerability in its victims. This
related to NSSI behavior in adolescents. Precipitating persistent exposure to hostile behavior can lead
factors, such as bullying, disappointment, and the individuals to resort to NSSI as a maladaptive coping
absence of a sharing place, are significantly associated mechanism to alleviate emotional distress and regain a
with the occurrence of NSSI behavior in adolescents. sense of control over their lives (Karneli et al., 2022;
Adolescents who have experienced bullying emerge as Tsuno, 2022; Hahn, 2023; Newman, Alexander and
the strongest predictor for the occurrence of NSSI Rovers, 2023).
behavior. Furthermore, previous study showed that individuals
This study took place in Semarang city, who have experienced trauma in childhood, such as
predominantly inhabited by the Javanese ethnic group. abuse and neglect, may be more prone to both bullying
Javanese culture, characterized by hierarchical victimization and engaging in NSSI as a coping
parenting dynamics, presents challenges for educators mechanism (Zhao et al., 2023). Additionally, adolescents
and parents in catering to adolescents' need for who engage in repetitive NSSI may have a heightened
autonomy in identity development. Study on parenting pain threshold, potentially reinforcing NSSI behaviors as
practices from Javanese adolescents' perspectives a means of seeking relief from emotional pain (Liu et al.,
remains scarce. Previous study indicates that parental 2022; Vishwanath and Praharaj, 2022). Additionally, the
values instilled since childhood significantly influence prevalence and severity of bullying incidents can be
Indonesian teenagers' identity development within impacted by the geographical and socio-economic

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Iswanti, Lai, Saifudin, Kandar, Dewi, and Cahyaningrum (2024)

characteristics of the areas where adolescents reside. seeking sensation relief, and self-punishment (Serafini et
Previous study indicates a comparable intervention rate al., 2023). The results of this study, along with previous
across all bullying roles and contexts, urban and rural study, consistently show that bullying and NSSI are
alike. Victimization and physical bullying perpetration interconnected. Adolescents who are victims of bullying
are more prevalent in urban school settings, However, may engage in NSSI as a form of seeking help or self-
victims in rural environments tend to express greater punishment because they feel powerless to voice or
distress compared to those in urban schools (Cabrera, resist the unpleasant behavior they experience.
Larrañaga and Yubero, 2022). In the next variable, the results of this study also
Moreover, in today's technological landscape, indicate that NSSI behavior is associated with deep
bullying transcends physical boundaries to manifest in feelings of disappointment, manifested in self-critical
the digital realm, commonly referred to as behavior. Previous study shows that self-blaming
cyberbullying. Cyberbullying entails individuals or behavior significantly moderates the relationship
groups repeatedly transmitting hostile or aggressive between stressors, depression, and NSSI. Self-critical
messages via internet platforms with the aim of inflicting behavior increases an individual's desire to self-punish,
harm or discomfort upon others (Yu et al., 2020). This lowers positive self-perception, and motivates
phenomenon can contribute to predicting NSSI due to individuals to directly choose self-harm over other
the fact that constant exposure to derogatory messages, coping behaviors (Gao et al., 2023). Additionally, in
threats, or harassment online can lead to profound another study, self-blaming behavior partially mediated
psychological distress among victims, increasing their the relationship between poor self-concept and NSSI
vulnerability to engaging in NSSI as a maladaptive coping behavior (Kruzan, Muehlenkamp and Claes, 2022).
mechanism (Sampasa-Kanyinga, Lalande and Colman, Based on explanations from previous study findings,
2020; Gu, Fang and Yang, 2023). Additionally, the public experiencing deep disappointment leads adolescents to
humiliation and shame associated with cyberbullying, excessively criticize themselves in a non-objective
often occurring in a highly visible online environment, manner, potentially fostering a desire for self-
amplify the psychological trauma experienced by punishment through engaging in NSSI behavior.
victims, further increasing their susceptibility to The results of this study also indicate that
engaging in NSSI as a means of coping with adolescents who do not have a place to share their
overwhelming emotional distress (Mahtani, Melvin and stories are associated with NSSI behavior. This is
Hasking, 2018; Worsley, McIntyre and Corcoran, 2019). supported by several previous study findings that align
Several previous studies indicate that exposure to with the results of this study. Loneliness is described as
bullying behavior is a significant risk factor for the a subjective sense of isolation concerning social
emergence of NSSI issues, regardless of genetic interaction or a lack of contact with others (Huang et al.,
predisposition (Huang et al., 2022; Serafini et al., 2023; 2023). One of the main developmental tasks during
Wu et al., 2021). Other study also suggests that both adolescence is forming interpersonal relationships with
victims of bullying and perpetrators are more likely to peers, so adolescents with a history of NSSI tend to be
report NSSI behavior, although victims of bullying have more sensitive to social exclusion than their peers
a higher likelihood (Wu et al., 2021). Not only direct (Brown et al., 2020). Additionally, the experience of
experiences of bullying are linked to NSSI behavior, but adolescent loneliness has a significant impact on
individuals who are victims of cyberbullying are also cognition, emotions, and behavior, with previous study
associated with NSSI behavior (Yu et al., 2020; Wiguna showing that feelings of loneliness are proportional to
et al., 2021), including engaging in activities in online the tendency for NSSI behavior (Huang et al., 2023).
games (Nursalam et al., 2023). Victims of cyberbullying On the other hand, adolescents with a history of
are exposed to violence in online games and engage in NSSI, based on previous study, are also more likely to
verbal abuse or physical harassment, both directly and keep their experiences to themselves due to feelings of
through social media chatting with others (Hidayat, shame and fear of being perceived as manipulative
Permatasari and Mani, 2022). (Brown et al., 2020). Interpersonal interaction is crucial
Individuals who are victims of bullying may use NSSI for adolescents, even a major developmental task, so
behavior as a form of seeking help, stress relief, or even the condition where adolescents do not have a place to
as a form of self-punishment (Huang et al., 2022). share their current conditions and problems can lead to
Bullying and NSSI behaviors may also be related to feelings of loneliness, emptiness, and the burden of
impulsivity, self-directed and other-directed anger, psychological stress kept within oneself. Such conditions

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may give rise to maladaptive coping mechanisms in contribute to a comprehensive approach aimed at
dealing with stressors, including NSSI behavior. addressing and preventing NSSI among adolescents.
Although some previous study results indicate that Despite the valuable insights gleaned from this
addressing bullying issues cannot be achieved solely by study, it is important to acknowledge its limitations. The
intervening with the perpetrators or victims, and study's cross-sectional design provides a static view of
requires a comprehensive approach involving various the relationships between variables at a specific point,
stakeholders (Yulia Rohmana, Estelina and Iskandar, thereby constraining the ability to infer causality.
2020). nursing interventions can still be implemented at Longitudinal studies would be more appropriate for
various stages, including preventive, promotive, exploring the temporal dynamics and causal pathways
curative, and rehabilitative approaches (Celdrán- linking socio-demographic factors, precipitating
Navarro et al., 2023; Yosep, Hikmat and Mardhiyah, elements, predisposition, and Non-Suicidal Self-Injury
2023). In the preventive and promotive stages, nurses (NSSI) in adolescents. Future study employing mixed-
need to raise awareness about the impact of bullying methods approaches could offer a more nuanced
across various layers of society and engage in early understanding of the phenomenon. Additionally, the
detection. In the curative stage, providing a safe study's examination of factors associated with NSSI may
environment for victims and delivering mental health not encompass all potential variables, thereby allowing
nursing care tailored to the patient's condition is for the possibility of other influential factors not
essential. Meanwhile, in the rehabilitative stage, addressed in this study.
interventions such as behavioral therapy, counseling, Moreover, it is worth noting that this study did not
relational skills training, and referrals to other include rural areas in Central Java Province, potentially
professionals can be performed. limiting the generalizability of the findings to diverse
The implications of this study are significant across geographical settings. Furthermore, the utilization of a
various domains. In clinical practice, healthcare self-administered questionnaire introduces a potential
professionals, particularly nurses and mental health source of bias, as participants may interpret questions
practitioners, can benefit from the findings to enhance differently or may not accurately report their
their understanding of factors associated with NSSI in experiences. Lastly, another limitation of this study lies
adolescents. This knowledge informs improved in the measurement of precipitating and predisposing
assessment skills, early detection, and intervention variables such as bullying, disappointment, sharing
strategies tailored to the identified risk factors. Public place, communication patterns, personality traits,
health initiatives stand to gain insights for awareness environment, coping mechanisms, and parenting styles
campaigns and community-based interventions that using single-answer or dichotomous questions. This
address socio-demographic factors, precipitating approach may not fully capture the complexity inherent
elements, and predisposition, ultimately aiming to in these constructs.
reduce the prevalence of NSSI among adolescents.
In the education sector, school counselors and Conclusion
educators can use the study's results to design targeted This study identifies key factors associated with Non-
prevention programs and offer support to at-risk Suicidal Self-Injury (NSSI) among adolescents, including
students, fostering a more supportive and protective gender, bullying, profound disappointment, and the
environment. Policymakers may consider incorporating absence of a sharing space. Bullying emerges as a robust
the study's findings into mental health support policies predictor of NSSI, emphasizing the need for targeted
in schools and communities, emphasizing interventions. The study underscores the higher
comprehensive approaches to address NSSI. prevalence of NSSI among females and highlights the
Additionally, the study lays the groundwork for future importance of addressing gender-specific factors in
study, encouraging more in-depth investigations into mental health strategies. The findings emphasize the
specific risk and protective factors, as well as exploring role of disappointment and the lack of a supportive
the effectiveness of different interventions and space in contributing to NSSI, providing insights for
prevention programs. Finally, the implications extend to healthcare professionals, educators, and policymakers.
professional training, where healthcare professionals, Strategies should involve comprehensive approaches,
educators, and counselors dealing with adolescent early detection, and tailored interventions to create
mental health can incorporate these findings into their supportive environments and address the multifaceted
training curricula. Collectively, these implications nature of NSSI among adolescents.

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Iswanti, Lai, Saifudin, Kandar, Dewi, and Cahyaningrum (2024)

Acknowledgments Pembelajaran Komprehensif untuk Mengembangkan Karakter

peserta didik : Berdasarkan Pendekatan Psikologi Positif.
The authors would like to express our deepest Malang.
Huang, H. et al. (2022) ‘A meta-analysis of the relationship between
gratitude to all respondents who were sincerely willing
bullying and non-suicidal self-injury among children and
to be the subjects of this study. adolescents’, Scientific Reports, 12(1). doi: 10.1038/s41598-
022-22122-2.
Huang, X. et al. (2023) ‘The Effect of Loneliness on Non-Suicidal Self-
Funding Source Injury Behavior in Chinese Junior High School Adolescents: A
Moderated Mediation Model’, Psychology Research and
Not applicable. Behavior Management, Volume 16, pp. 1831–1843. doi:
10.2147/PRBM.S410535.
Conflict of Interest Kaligis, F. et al. (2021) ‘Mental Health Problems and Needs among
Transitional-Age Youth in Indonesia’, International Journal of
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10.3390/ijerph18084046.
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How to cite this article: Iswanti, D. I., Lai, L. L., Saifudin, I. M. M.
Y., Kandar, K., Dewi, R. K., and Cahyaningrum, D. D. (2024)
‘The predictor of non-suicidal self-injury behavior among
adolescents: a cross-sectional study’, Jurnal Ners, 19(2), pp.
125-133. doi: http://dx.doi.org/10.20473/jn.v19i2.54610

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