Trend Analysis of Self-Harm Behaviors and Stress Management Skills in Adolescents Between 2018, 2022, and 2024: A Comprehensive Ecological Model.

Background/objectives: Although non-suicidal self-harming behaviors (NSSHBs) are increasingly recognized as both a symptom and risk factor in adolescent development, few studies have explored their biopsychosocial correlates, such as stress management, quality of life, family and peer support, and school-related factors, within a longitudinal framework. The present study aims to explore self-harm behaviors among adolescents from an ecological and biopsychosocial perspective over three distinct time points: pre-pandemic (2018), during the pandemic (2022), and post-pandemic (2024).

Methods: The total sample comprised 12,233 adolescents, with 5695 in 2018, 5931 in 2022, and 607 in 2024. The percentage of adolescents reporting self-harm behaviors increased from 18.0% in 2018 to 21.8% in 2022 and slightly decreased to 20.2% in 2024.

Results: Results show that, in both groups, stress management skills were positively predicted by family support, teacher relationship, quality of friendship, and future expectations, and they were negatively predicted by psychosomatic symptoms. The explained variance (adjusted R²) was consistently higher in the self-harm behavior group. The findings confirm that NSSHB is not only a symptom of individual distress but also a marker of insufficient psychosocial support and coping resources.

Conclusions: Stress management skills emerged as a key vulnerability domain and were consistently lower among adolescents with NSSHB. Family support, school relationships, and mental well-being were central predictors of coping skills, reinforcing the relevance of multilevel, ecological approaches to prevention and intervention.