Self-harm: young people report strategies to alleviate mental suffering

Adolescence is a phase of intense emotional and social transformations, a time when many young people face significant psychological challenges – including social isolation and self-harm, the practice of hurting oneself without suicidal intent.

It is estimated that one in seven adolescents suffers from mental distress and that around half of these cases begin before the age of 14. Furthermore, it is estimated that 14% of adolescents have self-harmed at least once in their lives, using this behavior as an attempt to deal with internal anguish, such as depression , anxiety or trauma.

This type of behavior is not just an isolated symptom, but rather a reflection of deep suffering that directly impacts the young person's quality of life. Self-harm can affect self-esteem, interpersonal relationships, and school performance, in addition to increasing the risk of suicide. It is no wonder that the mental health of adolescents has become a global concern in recent years, especially after the Covid-19 pandemic. Studies indicate that, during the health crisis, symptoms of depression increased by 26% and anxiety symptoms increased by around 10% among young people up to 19 years old. In Brazil, the number of cases of self-harm among young people increased by 21% between 2011 and 2022.

In 2018, before the pandemic, psychologist Luiza Cesar Riani Costa, then a student at the Federal University of São Carlos (UFSCar), carried out a scientific initiation project funded by FAPESP with the aim of understanding the issues related to non-suicidal self-harm among young people, that is, how adolescents who experienced this experience conceptualized this phenomenon and why it happened. The results revealed that adolescents saw self-harm as a way to alleviate emotional suffering, highlighting the importance of a supportive environment to deal with psychological pain.

“At the time, the phenomenon of self-harm was relatively new in Brazil, but it gained prominence after some challenges on social media encouraged many teenagers to cut themselves. A state school in São Carlos, where we had projects, noticed the increase in cases and encouraged us to research the topic,” says professor Diene Monique Carlos, who now works at the University of São Paulo (USP), on the Ribeirão Preto campus.

After completing his undergraduate research, Costa continued his studies on self-harm among adolescents during his master's degree at the same university. Also funded by FAPESP, the study explored the meaning of non-suicidal self-harm.

The research findings were transformed into the booklet What eases my pain: photos and experiences of adolescents , which was made available digitally to schools, health services and professionals who work with adolescents. In addition, the experience was presented at the 15th Ibero-American Congress of Qualitative Research (CIAIQ2025), in Spain, and published in New Trends in Qualitative Research .

The origin of the primer

To develop the booklet, Costa began a qualitative research approach, that is, one that did not presuppose a large number of people participating, since the objective was to deepen the understanding of what was happening. In total, nine adolescents between the ages of 12 and 17 who were suffering from psychological distress, had a history of self-harm and who spontaneously sought to participate in the project were evaluated.

One of the highlights is that all the teenagers were female – a coincidence, since boys were also invited to participate but did not express interest. “We noticed a strong gender issue, so we thought of another project to look specifically at boys. Why don’t they seek help?” explained Professor Diene Carlos, the project’s advisor.

Costa started with the following question: “What relieves your pain?” and asked the teenagers to answer the question using photographs they had taken themselves, presenting other strategies they would use to get through difficult situations that cause them pain, as long as it was not self-harm.

To achieve this, the research used the Photovoice methodology, a technique widely applied in contexts of vulnerability, in which images are used as a form of expression to address sensitive issues. “It is a methodology widely used by researchers in situations where it is difficult to talk about a certain subject,” explains Carlos.

The participants had two weeks to photograph scenes that answered the question – at the end of the deadline, Costa received 50 images. The initial idea was to discuss the photos together with the teenagers, but due to the pandemic, this was not possible (the interviews took place between March and July 2021). Therefore, the analysis of the material was done individually. The photos served as a starting point for deeper reflections, guided by questions such as: “What do you see in this photograph?”, “What motivated you to take this photo?”, “What does this image awaken in you?” and “How does this relate to self-harm?”

The images depicted scenes of nature, pets, physical activities (such as skateboarding or cycling), cooking, arts (drawings, music, films), affection and spirituality. After conducting a reflective analysis, the teenagers themselves presented the idea of jointly creating a booklet in which they could share the photos and what they meant as a way of drawing attention to the issue and helping other teenagers who might be suffering as well.

“The contact with the girls showed that what they were doing was more complex and profound than just creating coping strategies. They were showing in a completely creative way what sustained them,” the study’s author wrote in a letter to the reader presented with the public defense of the master’s thesis.

According to Carlos, when analyzing the photographs produced by the teenagers, it was possible to identify common elements among them, despite their individual peculiarities: the focus on nature, the importance of emotional relationships, the presence of family, affection for animals, music, films and other forms of artistic expression. “We found many similarities and similarities between the images and, therefore, we concluded that this could also make sense to other teenagers. For us, this was the most beautiful moment of the research, since the original idea was not to have a primer”, says the advisor.

The publication is available in Portuguese and English and has the potential to be an important low-cost therapeutic and educational tool, especially because it uses accessible language that is coherent with the world of adolescents. “Self-harm is still very present in the lives of these young people as a way of alleviating pain and suffering. Therefore, this instrument can be used to think about other possibilities for alleviating this pain,” says Carlos.

The booklet What eases my pain: photos and experiences of teenagers is available in the UFSCar Institutional Repository and can be consulted at: repositorio.ufscar.br/server/api/core/bitstreams/ddb95d76-9252-4e7d-90b8-96b0e805555a/content .