Association of Adverse Childhood Experiences with Self-Harm Ideation among Students at Selected Universities of Karachi

Abstract

Background: Self-harm (SH) is an important yet understudied public health concern among university students in Pakistan. Suicide is reported as the leading cause of death in this population, accounting for approximately 19% of all deaths. International literature highlights a strong association between adverse childhood experiences (ACEs) and self-harm ideation (SHI); however, evidence from Pakistani university populations remains limited. This study aimed to examine the association between ACEs and SHI among university students in Karachi, Pakistan.

Methodology: An analytical cross-sectional study was conducted over one year across three selected universities in Karachi. Using non-probability purposive sampling, 420 students were recruited and interviewed using the Suicide Behaviors Questionnaire–Revised and the Adverse Childhood Experiences Questionnaire. The Chi-square test was applied to identify statistically significant associations, with p < 0.05 considered significant.

Results: Nearly half of the participants (45%) reported SHI. Exposure to ACEs was significantly associated with SHI (OR = 2.31, 95% CI = 1.52–3.49, p < 0.001). Specific ACEs significantly linked to SHI included emotional abuse, physical abuse, emotional neglect, physical neglect, sexual abuse, domestic violence, and parental separation or divorce. Additional factors associated with higher SHI included female gender, nuclear family structure, and histories of bullying, smoking, and substance use.

Conclusion: This study demonstrates strong associations between SHI and multiple ACE categories among university students in Karachi. Early identification, targeted prevention strategies, and timely referral to mental health professionals are essential to reduce the risk of self-harm in this vulnerable population.