Risk and protective factors of deliberate self-harm among individuals with substance use disorder: A qualitative study in Pakistan

Objectives: This study aimed "To identify the factors which increase the vulnerability of self-harm behavior among individuals with substance use and factors which buffer that risk". Methods: The present qualitative study was hosted by National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan. It took seven months, from October 2021 to April 2022 to conduct the study. Face-to-face indepth interviews were conducted in rehabilitation centers of two different cities. The sample of the study included (N = 26) participants, 21 individuals with substance use disorder (with/without deliberate self-harm), and five experts (experienced in dealing with the target population). All the interviews were recorded and transcribed for reflexive thematic analysis. A brief survey was also used to get information about demographics and self-harm behaviors. Results: The analysis helped to develop nine themes (six risk factors & three protective factors), including separate subthemes for each. The themes were named as a spectrum of adverse experiences, maladaptive personality traits, poor methods of dealing with stressors, chaotic emotions and thoughts about self, internalizing and externalizing problems, and self-harm-related specific factors. Additionally, themes generated for the protective factors were supportive social ties, adaptive coping strategies, and promoting personal resources. Conclusion: Specific familial, social, and personal factors increase the likelihood of self-harm by causing negative self- evaluation, poor coping skills and psychological distress. This vulnerability ends with self-harm, when combined with conducive environmental situations for the risky behavior. However, the risk can be decreased by providing social and emotional support and encouraging positive mental attitudes.