Self-harm in adolescence: young people report on strategies to alleviate mental suffering in a booklet

The publication, which resulted from a project conducted at the Federal University of São Carlos, is available in Portuguese and English and has the potential to be an important, low-cost therapeutic and educational tool.

By Fernanda Bassette  |  Agência FAPESP – Adolescence is a time of intense emotional and social transformation when many young people face significant psychological challenges, including social isolation and self-harm – the practice of intentionally harming oneself without suicidal intent. It is estimated that one in seven adolescents suffers from a mental illness, with around half of these cases beginning before the age of 14. In addition, it is estimated that 14% of adolescents have self-harmed at least once in their lives, using this behavior as an attempt to cope with internal distress, such as depression, anxiety, or trauma.

This type of behavior is not just an isolated symptom; it is a reflection of deep suffering that directly impacts the young person’s quality of life. Self-injury can affect self-esteem, interpersonal relationships, and school performance, and it increases the risk of suicide. Unsurprisingly, adolescent mental health has become a global concern in recent years, especially after the COVID-19 pandemic. Studies indicate that symptoms of depression increased by 26% and symptoms of anxiety increased by around 10% among young people up to age 19 during the health crisis. In Brazil, the number of self-harm cases among young people increased by 21% between 2011 and 2022.

In 2018, before the pandemic, Luiza Cesar Riani Costa, a psychologist and then a student at the Federal University of São Carlos (UFSCar) in the state of São Paulo, Brazil, carried out a scientific initiation project funded by FAPESP. It aimed to understand issues related to non-suicidal self-harm among young people. Specifically, it sought to understand how adolescents who experienced this self-harm conceptualized the phenomenon and why it occurred. The results revealed that adolescents viewed self-harm as a means of alleviating emotional suffering, underscoring the importance of a welcoming environment to cope with psychological pain.

“At the time, self-harm was a relatively new phenomenon in Brazil, but it gained prominence after some social media challenges encouraged many teenagers to cut themselves. A state school in São Carlos, where we had projects, noticed an increase in cases and encouraged us to research the issue,” says Professor Diene Monique Carlos, who now works at the University of São Paulo (USP) on the Ribeirão Preto campus.

After her undergraduate research, Costa continued her studies on self-harm among adolescents, during her master’s degree at the same university. Also funded by FAPESP, the study explored the meaning of non-suicidal self-harm in greater depth.

The research findings were transformed into the booklet What relieves my pain: photos and experiences of adolescents, which has been made available digitally to schools, health services, and professionals working with adolescents. The project was also presented at the 15th Ibero-American Congress of Qualitative Research (CIAIQ2025) in Spain and published in New Trends in Qualitative Research.

The origin of the booklet

To develop the booklet, Costa began a qualitative research project that did not require a large number of participants, as the aim was to gain a deeper understanding of the situation. Nine adolescents between the ages of 12 and 17 who were experiencing psychological distress, had a history of self-harm and had spontaneously volunteered to participate in the project were assessed.

One of the highlights was that all of the adolescents were female, which was a coincidence since boys were also invited to participate but showed no interest. “We noticed a strong gender issue present, so we came up with another project that focuses specifically on boys. Why don’t they seek help?” asked Professor Diene Carlos, the project supervisor.

Costa began by asking the following question: “What relieves your pain?” She then asked the teenagers to answer using photographs they had taken, showing other strategies they would use to cope with difficult situations that cause them pain, as long as they did not involve self-harm. The research used the Photovoice methodology to accomplish this. Photovoice is a technique widely applied in contexts of vulnerability in which images are used as a form of expression to address sensitive issues. “It’s a methodology often used by researchers in situations where it’s difficult to talk about a certain subject,” Carlos explains.

The participants had two weeks to photograph scenes that answered the question. At the end of the period, Costa received 50 images. The initial idea was to discuss the photos with the teenagers, but due to the pandemic, this was not possible (the interviews took place between March and July of 2021). For this reason, the material was analyzed individually. The photos served as a starting point for deeper reflection guided by questions such as: “What do you see in this photograph?” “What motivated you to take this photo?” “What does this image awaken in you?” and “How does this relate to self-harm?”

The images depicted scenes of nature, pets, and physical activities, such as skateboarding and cycling. They also depicted moments of cooking, art (with drawings, music, and films), affection, and spirituality. After a reflective analysis, the teenagers came up with the idea of jointly creating a booklet to showcase the photos and what they meant as a way of drawing attention to the issue and helping other teenagers who might also be suffering.

“Contact with the girls revealed that what they were doing was more complex and profound than merely creating coping strategies. They were showing in a totally creative way what sustained them,” wrote the author of the study in a letter to the reader presented with the public defense of her master’s degree.

According to Carlos, despite their individual particularities, it was possible to identify common elements in the photographs produced by the teenagers when analyzing them: a focus on nature, the importance of emotional relationships, the presence of family, affection for animals, music, films, and other forms of artistic expression. “We found many similarities among the images, so we concluded that they could resonate with other teenagers. For us, this was the most beautiful moment of the research since the original idea wasn’t to have a booklet,” says the advisor.

The publication is available in Portuguese and English and has the potential to be an important, low-cost, therapeutic, and educational tool, especially as it uses accessible language that resonates with adolescents. “Self-harm is still very present in the lives of these young people as a way of alleviating pain and suffering. That’s why this tool can be used to explore other ways of alleviating this pain,” says Carlos.

The article “‘What Relieves My Pain’: Research Experiences through Photovoice with Adolescents with Mental Disorders” is available at: publi.ludomedia.org/index.php/ntqr/article/view/1207/1188.