The Prevalence and Predictors of Self‐Harm Among Young Women With Substance Use Disorder: A Cross‐Sectional Comparative Study

ABSTRACT Self‐harm is a significant public health concern, particularly among young women, and is closely associated with psychiatric comorbidities and risky behaviors. This study aimed to compare the prevalence and contributing factors of self‐harm among young women with and without substance use disorder (SUD). In this comparative cross‐sectional study, 200 women aged 18 to 30 years were recruited from a drop‐in center affiliated with the Welfare Organization, Mashhad, Iran. The sample included 100 women with clinically confirmed SUD and 100 age‐matched healthy controls. Participants completed structured assessments regarding self‐harm behaviors, educational level, depression, and anxiety. Self‐harm was significantly more prevalent in the substance abuse group (61%) compared to the control group (23%) ( p = 0.001). Women with substance abuse had lower educational attainment (85% had not completed high school vs. 50% in controls; p = 0.001), higher rates of moderate to severe anxiety (69% vs. 55%; p = 0.04), and elevated levels of depression ( p = 0.015). Multivariate logistic regression revealed that substance abuse independently increased the risk of self‐harm (adjusted OR = 5.05; 95% CI = 2.50–10.18, p < 0.001), even after controlling for education, depression, and anxiety. Notably, the association between substance abuse and self‐harm was strongest in individuals with moderate to severe depression. Young women with SUD are at significantly increased risk of self‐harm, particularly those with co‐occurring depression and anxiety. These findings highlight the urgent need for integrated mental health and substance abuse interventions that address the complex interplay of psychological and behavioral factors.