Culturally and structurally embedded pathways to youth self-harm in Rwanda: perspectives from young people, parents,...

Self-harm (with and without fatal intent) among young people in low- and middle-income countries (LMICs) remain under-researched despite disproportionately high rates. Little is known about the social, cultural, and psychological factors influencing these behaviours in settings such as Rwanda. The study aimed to explore how young people in Rwanda, their parents, and healthcare providers perceive and experience self-harm, including the psychological, social, and cultural factors that contribute to self-harm.

This qualitative study used a phenomenologically informed approach. Semi-structured interviews were held with 102 participants across two districts of Rwanda: Gasabo (urban) and Nyagatare (rural), which have high prevalence of self-harm/suicidality, including young people with and without self-harm experience, parents of young people with and without such experience, and healthcare professionals. Data were analysed thematically, using iterative coding, with triangulation and member-checking to enhance rigour.

Five themes emerged: 1) Diverse triggers and reasons-including family conflict, abuse, poverty, peer dynamics, and school-related stress; 2) Build-up of emotional and psychological distress-highlighting feelings of entrapment, isolation, and worthlessness; 3) Functions and characteristics of self-harm, ranging from emotional regulation to communication of distress; 4) Maintenance and cessation, showing the role of coping strategies, social support, and barriers to seeking help; and 5) Duality of community responses, where community responses both exacerbated stigma and provided support. Self-harm was shaped by cultural beliefs, stigma, family and social structures, and poverty, challenging individualistic framings of self-harm. Reflexive insights highlight the importance of team communication during cross-cultural research and provide practical strategies.

Findings extend existing psychological theories by evidencing culturally embedded pathways to youth self-harm, where distress is produced and sustained through a mixture of individual experience, structural hardship, social exclusion, and cultural belief systems. Effective prevention requires cross-sectoral strategies addressing poverty, education, family support, and community mental health. Community-based approaches fostering emotional expression and reducing stigma could play a crucial role in prevention and recovery. The insights generated are transferable to other LMICs facing similar social and structural challenges.