Prevalence and associated factors of non-suicidal self-injury (NSSI) among university students: the role of Generalized Anxiety Disorder and substance use disorder

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.