Non-suicidal self injury in the school context: Secondary educators’ knowledge, confidence and attitudes

Manuscript (ελληνικά)
Published: jul 24, 2026
DOI: https://doi.org/10.12681/psy_hps.42130
Keywords:
non-suicidal self injury, adolescent mental health, secondary educators
Eleni Tsironi
School of Psychology, Faculty of Philosophy, Aristotle University of Thessaloniki
https://orcid.org/0009-0009-1800-9699
Lito Eleni Michalopoulou
School of Psychology, Faculty of Philosophy, Aristotle University of Thessaloniki
https://orcid.org/0000-0002-9746-0307
Abstract

Non-suicidal Self-Injury (NSSI) is a major mental health difficulty typically encountered during adolescence and emerging adulthood. As schools can have a preventive focus and assist in the early identification of self-harm behaviours, the purpose of the current study was to investigate the knowledge, acquired and perceived, as well as the attitudes of secondary education teachers regarding non-suicidal self-injury (NSSI). This study aimed to contribute to the limited published Greek literature regarding such incidents in the school context. The sample was comprised of 146 educators serving in Middle Schools, General High Schools and Vocational High Schools who were invited to complete an online self-report questionnaire. Multiple regression analysis showed that educators with higher perceived competence and responsibility and fewer negative emotions regarding adolescent mental health issues had more perceived knowledge and confidence about non-suicidal self-harm but did not have more positive attitudes about the phenomenon. Furthermore, educators' previous experience with NSSI incidents and specialised training did not function as statistically significant moderator variables in the statistical models. Research results indicate the perceived rise of NSSI in school settings and also the low acquired and perceived knowledge and confidence educators report when it comes to identifying, responding, and addressing NSSI. The findings are discussed in relation to existing theory and research. Finally, school context implications and future research directions are formulated.

Article Details
  • Section
  • RESEARCH PAPERS
Creative Commons License

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

The journal PSYCHOLOGY adopts a Platinum open-access policy. Submission, processing or publication costs are waived by the Hellenic Psychological Society. Papers published in the journal PSYCHOLOGY are licensed under a 'Creative Commons Attribution-ShareAlike 4.0 International' licence. The authors reserve the copyright of their work and grant the journal the right of its first publication. Third-party licensees are allowed to use the published paper immediately after publication as they wish, provided they retain the defined by the license copyright formalities, regarding the reference to its author(s) and its initial publication in the journal PSYCHOLOGY. Moreover, any adjusted work should be shared under the same reuse rights, so with the same CC license.

Downloads
Download data is not yet available.
References
American Academy of Child and Adolescent Psychiatry (AACAP). (2019). Self-injury in adolescents. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Self-Injury-In-Adolescents-073.aspx
Antoniou, A.-S., Polychroni, F., & Vlachakis, A. N. (2006). Gender and age differences in occupational stress and professional burnout between primary- and high-school teachers in Greece. Journal of Managerial Psychology, 21(7), 682–690. https://doi.org/10.1108/02683940610690213
Arora, P., Collins, T. A., Dart, E. H., Hernández, S., Fetterman, H., & Doll, B. (2019). Multi-tiered systems of support for school-based mental health: A systematic review of depression interventions. School Mental Health, 11(2), 240–264. https://doi.org/10.1007/s12310-019-09314-4
Beames, J. R., Johnston, L., O’Dea, B., Torok, M., Boydell, K., Christensen, H., & Werner-Seidler, A. (2022). Addressing the mental health of school students: Perspectives of secondary school teachers and counselors. International Journal of School & Educational Psychology, 10(1), 128–143. https://doi.org/10.1080/21683603.2020.1838367
Berger, E., Hasking, P., & Reupert, A. (2014b). “We're working in the dark here”: Education needs of teachers and school staff regarding student self-injury. School Mental Health, 6(3), 201–212. https://doi.org/10.1007/s12310-013-9114-4
Berger, E., Hasking, P., & Reupert, A. (2014b). Response and training needs of school staff towards student self-injury. Teaching and Teacher Education, 44, 25–34. http://dx.doi.org/10.1016/j.tate.2014.07.013
Berger, E., Reupert, A., & Hasking, P. (2015a). Pre-service and in-service teachers’ knowledge, attitudes and confidence towards self-injury among pupils. Journal of Education for Teaching, 41(1), 37–51. http://dx.doi.org/10.1080/02607476.2014.992633
Berger, E., Hasking, P., & Reupert, A. (2015b). Developing a policy to address nonsuicidal self-injury in schools. Journal of School Health, 85(9), 629–647. https://doi.org/10.1111/josh.12292Berelson, B. (1952). Content analysis in communication research. Free Press.
Best, R. (2005). An educational response to deliberate self-harm: Training, support, and school policy issues. Pastoral Care in Education, 23(4), 27–33. https://doi.org/10.1111/j.1468-0122.2005.00347.x
Best, R. (2006). Deliberate self-harm in adolescence: A challenge for schools. British Journal of Guidance & Counselling, 34(2), 161–175. https://doi.org/10.1080/03069880600583196
Brown, R. C., & Plener, P. L. (2017). Nonsuicidal self-injury in adolescence. Current Psychiatry Reports, 19(20), 1–8. https://doi.org/10.1007/s11920-017-0767-9
Brunzell, T., Stokes, H., & Waters, L. (2016). Trauma-informed positive education: Using positive psychology to strengthen vulnerable students. Contemporary School Psychology, 20, 63–83. https://doi.org/10.1007/s40688-015-0070-x
Burger, K., Becker, M., & Schoon, I. (2024). Mental health and educational attainment: How developmental stage matters. Developmental Psychology, 60(1), 108–123. https://doi.org/10.1037/dev0001634
Calvo, N., García-Gonzales, S., Perez-Galbarro, C., Regales Peco, C., Lugo-Marin, J., Ramos-Quiroga, J., & Ferrer, M. (2022). Psychotherapeutic interventions specifically developed for nonsuicidal self-injury in adolescence: A systematic review. European Neuropsychopharmacology, 58, 86–98. https://doi.org/10.1016/j.euroneuro.2022.02.009
Carlson, L., DeGeer, S. M., Deur, C., & Fenton, K. (2005). Teachers’ awareness of self-cutting behavior among the adolescent population. PRAXIS, 5, 22–29.
Cipriano, A., Cella, S., & Cotrufo, P. (2017). Nonsuicidal self-injury: A systematic review. Frontiers in Psychology, 8, Article 1946. https://doi.org/10.3389/fpsyg.2017.01946
Claes, L., Vanderycken, W., & Vertommen, H. (2001). Self-injurious behaviors in eating-disordered patients. Eating Behaviors, 2, 263–272. https://doi.org/10.1016/S1471-0153(01)00033-2
Crawford, T., Geraghty, W., Street, K., & Simonoff, E. (2003). Staff knowledge and attitudes towards deliberate self-harm in adolescents. Journal of Adolescence, 26, 619–629. https://doi.org/10.1016/S0140-1971(03)00060-5
De Riggi, M. E., Moumne, S., Heath, N. L., & Lewis, S. P. (2017). Nonsuicidal self-injury in our schools: A review and research-informed guidelines for school mental health professionals. Canadian Journal of School Psychology, 32(2), 122–143. https://doi.org/10.1177/0829573516645563
Duggan, J. M., Heath, N. L., Toste, J. R., & Ross, S. (2011). School counsellors' understanding of non-suicidal self-injury: Experiences and international variability. Canadian Journal of Counselling and Psychotherapy, 45(4), 327–348. https://cjc-rcc.ucalgary.ca/index.php/rcc/article/view/59271
Duggan, J. M., Heath, N. L., Lewis, S. P., & Baxter, A. L. (2012). An examination of the scope and nature of Non-Suicidal Self-Injury online activities: Implications for school mental health professionals. School Mental Health, 4, 56–67. https://doi.org/10.1007/s12310-011-9065-6
Ekornes, S. (2017). Teacher stress related to student mental health promotion: The match between perceived demands and competence to help students with mental health problems. Scandinavian Journal of Educational Research, 61(3), 333–353. https://doi.org/10.1080/00313831.2016.1147068
Evans, R., & Hurrell, C. (2016). The role of schools in children and young people’s self-harm and suicide: Systematic review and meta-ethnography of qualitative research. BMC Public Health, 16(401), 1–16. https://doi.org/10.1186/s12889-016-3065-2
Evans, R., Parker, R., Russell, A. E., Mathews, F., Ford, T., Hewitt, G., Scourfield, J., & Janssens, A. (2019). Adolescent self-harm prevention and intervention in secondary schools: A survey of staff in England and Wales. Child and Adolescent Mental Health, 24(3), 230–238. https://doi.org/10.1111/camh.12308
Farmer, E. M., Burns, B. J., Phillips, S. D., Angold, A., & Costello, E. J. (2003). Pathways into and through mental health services for children and adolescents. Psychiatric Services, 54(1), 60–66. https://doi.org/10.1176/appi.ps.54.1.60
Favaro, A., & Santonastaso, P. (1996). Purging behaviors, suicide attempts, and psychiatric symptoms in 398 eating disordered subjects. International Journal of Eating Disorders, 20, 99–103. https://doi.org/10.1002/(SICI)1098-108X(199607)20:1<99::AID-EAT11>3.0.CO;2-E
Favazza, A. R. (1998). The coming of age of self-mutilation. The Journal of Nervous and Mental Disease, 186(5), 259–268. https://doi.org/10.1097/00005053-199805000-00001
Fazel, M., Patel, V., Thomas, S., & Tol, W. (2014). Mental health interventions in schools in low-income and middle-income countries. The Lancet Psychiatry, 1(5), 388–398. https://doi.org/10.1016/S2215-0366(14)70357-8
Graham, A., Phelps, R., Maddison, C., & Fitzgerald, R. (2011). Supporting children’s mental health in schools: Teacher views. Teachers and Teaching, 17(4), 479–496. https://doi.org/10.1080/13540602.2011.580525
Green, J. G., Guzmán, J., Didaskalou, E., Harbaugh, A. G., Segal, N., & LaBillois, J. (2018). Teacher identification of student emotional and behavioral problems and provision of early supports: A vignette-based study. Journal of Emotional and Behavioral Disorders, 26(4), 225-242. https://doi.org/10.1177/1063426617740879
Groschwitz, R., Munz, L., Straub, J., Bohnacker, I., & Plener, P. L. (2017). Strong schools against suicidality and self-injury: Evaluation of a workshop for school staff. School Psychology Quarterly, 32(2), 188–198. https://doi.org/10.1037/spq0000185
Hamza, C. A., & Heath, N. L. (2018). Nonsuicidal self-injury: What schools can do. In W. Alan Leschied, D. H. Saklofske, & G. L. Flett (Eds.), Handbook of school-based mental health promotion (pp. 237–260). Springer. https://doi.org/10.1007/978-3-319-89842-1_13
Hasking, P. A., Heath, N. L., Kaess, M., Lewis, S. P., Plener, P. L., Walsh, B. W., Whitlock, J., & Wilson, M. S. (2016). Position paper for guiding response to nonsuicidal self-injury in schools. School Psychology International, 37(6), 644–663. https://doi.org/10.1177/0143034316678656
Hayes, A. F. (2018). Introduction to mediation, moderation, and conditional process analysis: A regression - based approach. Guilford Press.
Heath, N. L., Toste, J. R., & Beettam, E. L. (2006). “I am not well-equipped”: High school teachers’ perceptions of self-injury. Canadian Journal of School Psychology, 21(1–2), 73–92. https://doi.org/10.1177/0829573506298471
Heath, N. L., Toste, J. R., Sornberger, M. J., & Wagner, C. (2011). Teachers’ perceptions of nonsuicidal self-injury in the schools. School Mental Health, 3(1), 35–43. https://doi.org/10.1007/s12310-010-9043-4
Jimerson, S. R., Boyle, C. Begeny, J. King, R. Liem, G. A. D., Wang, C., Gawrilow, C., Hall, J., Huang, F., Datu, J. A. D., Lyons, M. D., Allen, K., Humphrey, N., Worrell, F.C., Veiga, F., Watanabe, Y., Espelage, D. L., Guzzo, R. S. L., Kikas, E. Green, J. G., Hatzichristou, C., Spilt, J. Bradshaw, C., Salmivalli, C., Kaur, L., & Holland, S. (2025). Advancing the science and practice of School Psychology internationally: Transnational leadership cultivating diversity, equity, innovation, inclusion, and global impact. Psychology in the Schools, 63, 763–775. https://doi.org/10.1002/pits.70131
Kidger, J., Gunnell, D., Biddle, L., Campbell, R., & Donovan, J. (2010). Part and parcel of teaching? Secondary school staff’s views on supporting student emotional health and well-being. British Educational Research Journal, 36(6), 919–935. https://doi.org/10.1080/01411920903249308
Klonsky, E. D., Victor, S. E., & Saffer, B. Y. (2014). Nonsuicidal self-injury: What we know, and what we need to know. The Canadian Journal of Psychiatry, 59(11), 565–568. https://doi.org/10.1177/070674371405901101
Kokaliari, E. D., Roy, A. W., & Koutra, K. (2016). A cross-sectional study comparing predictors of Non-Suicidal Self-Injury among college students in the United States and Greece. International Journal of Culture and Mental Health, 10(1), 50–61. http://dx.doi.org/10.1080/17542863.2016.1259339
Koutra, K., Roy, A. W., Kokaliari, E. D. (2020). The effect of social capital on nonsuicidal self-injury and suicidal behaviors among college students in Greece during the current economic crisis. International Social Work, 63(1), 100–112. https://doi.org/10.1177/0020872818776726
Levkovich, I., & Stregolev, B. (2024). Nonsuicidal self-injury among adolescents: Effect of knowledge, attitudes, role perceptions, and barriers in mental health care on teachers’ responses. Behavioral Sciences, 14(7), 617. https://doi.org/10.3390/bs14070617
Maclean, L., & Law, J. M. (2022). Supporting primary school students’ mental health needs: Teachers’ perceptions of roles, barriers, and abilities. Psychology in the Schools, 59, 2359–2377. https://doi.org/10.1002/pits.22648
Madjar, N., Shabat, S. B., Elia, R., Fellner, N., Rehavi, M., Rubin, S. E., Segal, N., & Shoval, G. (2017). Nonsuicidal self-injury within the school context: Multilevel analysis of teachers’ support and peer climate. European Psychiatry, 41, S238. https://doi.org/10.1016/j.eurpsy.2017.01.730
McAllister, M., Creedy, D., Moyle, W., & Farrugia, C. (2002). Nurses’ attitudes towards clients who self-harm. Journal of Advanced Nursing, 40(5), 578–586. https://doi.org/10.1046/j.1365-2648.2002.02412.x
McIntosh, K., & Goodman, S. (2016). Integrating multi‐tiered systems of support: Blending RTI and PBIS. The Guilford Press.
Modrowski, C. A., Chaplo, S. D., Kerig, P. K., & Mozley, M. M. (2019). Trauma exposure, posttraumatic overmodulation and undermodulation, and nonsuicidal self-injury in traumatized justice-involved adolescents. Psychological Trauma: Theory, Research, Practice, and Policy, 11(7), 743–750. https://doi.org/10.1037/tra0000469
Ohrt, J., Deaton, J. D., Linich, K., Guest, J., Wymer, B., & Sandonato, B. (2020). Teacher training in K-12 student mental health: A systematic review. Psychology in the Schools, 57(5), 833–846. https://doi.org/10.1002/pits.22356
Reinke, W. M., Stormont, M., Herman, K. C., Puri, R., & Goel, N. (2011). Supporting children’s mental health in schools: Teacher perceptions of needs, roles, and barriers. School Psychology Quarterly, 26(1), 1–13. https://doi.org/10.1037/a0022714
Robinson, J., Gook, S., Yuen, H. P., McGorry, P. D., & Yung, A. R. (2008). Managing deliberate self-harm in young people: An evaluation of a training program developed for school welfare staff using a longitudinal research design. BMC Psychiatry, 8(75). https://doi.org/10.1186/1471-244X-8-75
Ross, S., & Heath, N. (2002). A study of the frequency of self-mutilation in a community sample of adolescents. Journal of Youth and Adolescence, 31(1), 67–77. https://doi.org/10.1023/A:1014089117419
Ross, S., Heath, N., & Toste, J. (2009). Non-Suicidal Self-Injury and eating pathology in high school students. American Journal of Orthopsychiatry, 79(1), 83–92. https://doi.org/10.1037/a0014826
Rossouw, T. I., & Fonagy, P. (2012). Mentalization-based treatment for self-harm in adolescents: a randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 51(12), 1304–1313. https://doi.org/10.1016/j.jaac.2012.09.018
Rothi, D. M., Leavey, G., & Best, R. (2008). On the front-line: Teachers as active observers of pupils’ mental health. Teaching and Teacher Education, 24, 1217–1231. https://doi.org/10.1016/j.tate.2007.09.011
Solano, R., Fernandez-Aranda, F., Aitken, A., Lopez, C., & Vallejo, J. (2005). Self-injurious behavior in people with eating disorders. European Eating Disorders Review, 13(1), 3–10. https://doi.org/10.1002/erv.618
Spyropoulou, E., Athanasiades, C., Stogiannidou, A., & Kourkoutas, E. (2025). Mental health literacy of Greek teachers: Highlighting critical factors for identifying and supporting students in need. Psychology: The Journal of the Hellenic Psychological Society, 30(1), 38–57. https://doi.org/10.12681/psy_hps.38443
Stavrou, M., Fotiou, A., Kanavou, E., & Kokkevi, A. (2023). Adolescents' psychosocial health in Greece: 2022 findings and trends. Series of Thematic Reports from the Greek arm of the Health Behaviour in School-aged Children study (HBSC/WHO). University Mental Health, Neurosciences, & Precision Medicine Research Institute "COSTAS STEFANIS". https://www.epipsi.gr/images/Documents/EPIPSI_2022-Mental_health__wellbeing-Adolescents-Greece_UMHRI.pdf
The Key. (2017). State of Education Survey Report 2017. Rising to the challenge: Examining the pressures of schools and how they are responding. https://view.joomag.com/state-of-education-report-2017/0676372001494577623
Thomas, M. S., Crosby, S., & Vanderhaar, J. (2019). Trauma-informed practices in schools across two decades: An interdisciplinary review of research. Review of Research in Education, 43(1), 422–452. https://doi.org/10.3102/0091732X18821123
Toste, J. R., & Heath, N. L. (2010). School response to non-suicidal self-injury. The Prevention Researcher, 17(1), 14–17.
Τουλουμάκου Ά. K., Αδαμοπούλου Ε., & Τσιτιρίδου-Ευαγγέλου Μ. (2023). Αντίξοες εμπειρίες κατά την παιδική ηλικία: προεκτάσεις για ένα ευαισθητοποιημένο σχολείο στις ψυχοκοινωνικές και μαθησιακές ανάγκες των μαθητών. Ψυχολογία: το περιοδικό της Ελληνικής Ψυχολογικής Εταιρείας, 28(1), 159–175. https://doi.org/10.12681/psy_hps.26786
Tunno, A. M., Inscoe, A. B., Goldston, D. B., & Asarnow, J. R. (2021). A trauma-informed approach to youth suicide prevention and intervention. Evidence-Based Practice in Child and Adolescent Mental Health, 6(3), 302–314. https://doi.org/10.1080/23794925.2020.1815208
UNICEF. (2025, Δεκέμβριος 1). Ξεκίνησε το πρώτο Πρόγραμμα στην Ελλάδα για την αντιμετώπιση του αυτοτραυματισμού στους νέους. https://www.unicef.org/greece/%CE%B4%CE%B5%CE%BB%CF%84%CE%AF%CE%B1-%CF%84%CF%8D%CF%80%CE%BF%CF%85/%CE%BE%CE%B5%CE%BA%CE%AF%CE%BD%CE%B7%CF%83%CE%B5-%CF%84%CE%BF-%CF%80%CF%81%CF%8E%CF%84%CE%BF-%CF%80%CF%81%CF%8C%CE%B3%CF%81%CE%B1%CE%BC%CE%BC%CE%B1-%CF%83%CF%84%CE%B7%CE%BD-%CE%B5%CE%BB%CE%BB%CE%AC%CE%B4%CE%B1-%CF%80%CE%B3%CE%B9%CE%B1-%CF%84%CE%B7%CE%BD-%CE%B1%CE%BD%CF%84%CE%B9%CE%BC%CE%B5%CF%84%CF%8E%CF%80%CE%B9%CF%83%CE%B7-%CF%84%CE%BF%CF%85-%CE%B1%CF%85%CF%84%CE%BF%CF%84%CF%81%CE%B1%CF%85%CE%BC%CE%B1%CF%84%CE%B9%CF%83%CE%BC%CE%BF%CF%8D
Victor, S. E., & Klonsky, E. D. (2014). Daily emotion in non-suicidal self-injury. Journal of Clinical Psychology, 70(4), 364–375. https://doi.org/10.1002/jclp.22037
von der Embse, N., Rutherford, L., Mankin, A., & Jenkins, A. (2019). Demonstration of a trauma-informed assessment to intervention model in a large urban school district. School Mental Health, 11(2), 276–289. https://doi.org/10.1007/s12310-018-9294-z
Χριστίδου Π., Ανθοπούλου Β., & Μιχαλοπούλου Λ. Ε. (2024). Ο αντιλαμβανόμενος ρόλος των εκπαιδευτικών στην προαγωγή της ψυχικής υγείας των μαθητών/τριών πρωτοβάθμιας εκπαίδευσης: Αναζήτηση υποστήριξης και τεχνική συμβουλευτική. Διάλογοι! Θεωρία και Πράξη στις Επιστήμες Αγωγής και Εκπαίδευσης, 10, 152–173. https://doi.org/10.12681/dial.38778
Weist, M. D., Hoover, S. A., Daly, B. P., Short, K. H., & Bruns, E. J. (2023). Propelling the global advancement of school mental health. Clinical Child and Family Psychology Review, 26(4), 851–864. https://doi.org/10.1007/s10567-023-00443-5
Wester, K. L., Wachter Morris, C., & Williams, B. (2017). Nonsuicidal self-injury in the schools: A tiered prevention approach for reducing social contagion. Professional School Counseling, 21(1), 142–151. https://doi.org/10.5330/1096-2409-21.1.142
Willig, C. (2013). Introducing qualitative research in psychology (3rd edition). Open University Press.
World Health Organization. (2012). Mapping actions of nongovernmental associations and other international development organisations. World Health Organisation. http://apps.who.int/iris/bitstream/handle/10665/44875/9789241503648_eng.pdf;jsessionid=B09D1D46A7AA36AA5757E9E191B3F023?sequence=1
Zetterqvist, M. (2015). The DSM-5 diagnosis of nonsuicidal self-injury disorder: a review of the empirical literature. Child and Αdolescent Psychiatry and Mental Health, 9(1), 31. https://doi.org/10.1186/s13034-015-0062-7