School experiences and self-harm in the OxWell study.

Background: Schools are key for identifying challenges faced by young people who self-harm (SH). Understanding how school factors influence SH predictors is essential for developing effective school-based interventions. We aimed to conduct a secondary data analysis using the OxWell Student Survey to identify associations between young people's school experiences and SH. Methods: Using cross-sectional data from English secondary schools in the 2023 OxWell Student Survey, we conducted multi-level logistic regressions to analyse whether SH was associated with student age, gender, mental health (RCADS) and wellbeing (sWEMWBS). School experience measures included enjoyment, bullying, racism, extracurricular activities, school worry, and adults listening. Results: Individual students' perception that the school did not deal well with bullying were associated with a 38% increase in SH (OR = 1.38; CI 1.20-1.59) and schools not dealing well with racism was associated with a 20% increase in the likelihood of SH (OR = 1.20; CI 1.04-1.38). Similarly, the likelihood of SH was 30% higher in schools with students feeling unfairly picked on by their teacher (OR = 1.30; CI 1.14-1.47). Greater SH was associated with being female (OR = 1.15; CI 0.99-1.32), gender diverse (OR = 3.49; CI 2.38-5.12), or preferring not to say (OR = 2.02; CI 1.44-2.83) compared to males. Lower wellbeing scores (OR = 0.93; CI 0.93-0.95) and higher RCADS scores (OR = 1.12; CI 1.11-1.13) were also linked to higher SH likelihood. Conclusion: Interventions that address bullying, racism, teacher-pupil relationships as well as providing specific support for more vulnerable groups such as females and gender diverse young people are important components of public mental health interventions that might reduce levels of SH. Future research should explore these relationships longitudinally.