Revealing unseen wounds: a cluster analysis of psychological and pandemic-driven factors associated with self-injury among global students

Despite extensive research on the mental health effects of the COVID-19 pandemic, limited attention has been given to how pandemic-related stressors uniquely influence self-injury and suicidal ideation among global student populations. This cross-national study examines both psychological and pandemic-related determinants of self-harm in international and domestic Indonesian students, highlighting divergent drivers of self-injury across these groups. Conducted as a cross-sectional study from 2022 to 2023, the research involved 393 participants—200 studying overseas and 193 based in Indonesia. Data were collected via online questionnaires, including the Depression Anxiety Stress Scale (DASS) and the Self-Harm Inventory (SHI). Additional assessments captured social and educational factors such as living arrangements, marital status, family income, perceived study difficulties, academic performance, and financial concerns. Hierarchical clustering of correlation matrices was used to identify distinct patterns in mental health outcomes and associated drivers. No significant differences were observed between international and domestic students in overall levels of depression (10.1 ± 8.6 vs. 10.0 ± 8.4), anxiety (7.7 ± 6.4 vs. 8.6 ± 6.6), or loneliness (42.9 ± 8.9 vs. 42.7 ± 8.5; all pcorrected ≥ 0.98). However, the determinants of severe self-harm differed substantially between groups. Among domestic students, self-injury attempts were significantly associated with pandemic-related stressors, including COVID-19–related worry about family and friends (r = 0.26, puncorrected < 0.001) and worry about missing out on important experiences (r = 0.33, puncorrected < 0.001). These associations were not observed in international students (r ≤ 0.05, puncorrected ≥ 0.47), with between-group differences confirmed by Fisher’s z tests (p ≤ 0.039). In contrast, self-harm in international students was more strongly linked to broader psychological vulnerabilities rather than pandemic-specific concerns. Subcluster analyses supported these distinct contextual and psychological patterns. These findings highlight the need to address the unique psychological and social challenges faced by both international and domestic students. A holistic, culturally responsive approach to student mental health is critical, particularly in mitigating the risks of self-injury and suicidal ideation. These insights can support educators and institutions in identifying at-risk students and implementing effective support strategies, especially for global learners in times of crisis.