Psychosocial triggers of non-suicidal self-injury in a clinical sample of adolescents in Albania: pilot study

Background: Non-suicidal self-injury (NSSI) is a clinically significant behavior frequently observed among adolescents and young adults and is associated with emotional dysregulation, affective symptoms, interpersonal difficulties, and increased risk for subsequent psychiatric disorders. NSSI often emerges during early adolescence and may serve multiple psychological functions, particularly in the regulation of overwhelming emotional states. While a growing body of international research has identified key psychosocial risk factors for NSSI, there remains a lack of data from Southeastern Europe. In Albania, sociocultural characteristics, including family dynamics, stigma surrounding mental health, and rapidly evolving digital environments, may influence both the onset and maintenance of self-injurious behaviors. Understanding these contextual factors is essential for improving clinical assessment and early intervention strategies.

Aims: This pilot study aims to explore the main triggering and maintaining factors associated with NSSI in a clinical sample of adolescents and young adults aged 11–25 years in Albania, with particular attention to emotional, interpersonal, and culturally influences.

Methods: A cross-sectional clinical pilot study was conducted among adolescents and young adults aged 11–25 years presenting to mental health services in Albania. NSSI was assessed using the Brief Non-Suicidal Self-Injury Assessment Tool (BNSSI), focusing on the presence, frequency, methods, age of onset, emotional antecedents, triggers, and perceived functions of self-injurious behavior. Cultural and contextual factors were explored using the Cultural Formulation Interview, with attention to family dynamics, culturally shaped meanings of distress, stigma, help-seeking patterns, peer relationships, and digital and social media-related stressors. Descriptive statistical analyses were conducted to identify the most frequent clinical, interpersonal, and cultural factors associated with NSSI.

Results: The clinical sample included n = 36 participants aged 11–25 years. The most commonly reported NSSI methods were cutting (62%) and scratching (31%), with onset typically occurring around 12 years of age. Repetitive engagement was frequently observed.

Emotional antecedents, including sadness, anger, and internal tension, were reported by the majority of participants, while the primary function of NSSI was affect regulation (61%). Initiation was associated with emotional distress (36%) and interpersonal factors.

Cultural formulation findings indicated that 72% of participants reported family communication difficulties and 53% perceived lack of emotional support. Peer-related stressors, including bullying and cyberbullying, along with social media-related pressures (42%), were identified as contributing factors.

Conclusion: This clinical pilot study indicates that NSSI in this population is associated with a complex interaction of emotional dysregulation, interpersonal stressors, and culturally embedded factors, particularly within the context of limited emotional communication in families. Digital stressors, including cyberbullying and social media-related pressures, appear to contribute to both the onset and maintenance of self-injurious behaviors. These findings highlight the importance of integrating culturally informed assessment, including evaluation of online experiences, into routine clinical practice. Early, targeted interventions focusing on emotion regulation, interpersonal functioning, and digital risk factors may support improved prevention and treatment outcomes in adolescents and young adults.

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