Factors Associated with Self-Harm Attempts Among Female Adolescents with Self-Reported Reclusive Tendencies in Republic of Korea

Background/Objectives: Self-harm attempts among adolescents represent a major public health concern, often associated with depression, low self-esteem, and social withdrawal. While excessive smartphone use is generally linked to internalizing distress, digital engagement might play complex roles among socially isolated youth. This study examined factors associated with self-harm attempts among female adolescents with self-reported reclusive tendencies in South Korea, with a specific focus on evaluating the exploratory role of smartphone overdependence. Methods: Secondary data analysis was conducted on 893 female adolescents with self-reported reclusive tendencies who utilized or were admitted to crisis youth support organizations, drawn from the nationwide Survey on the Living Conditions of Users of Crisis Youth Support Organizations. Statistical procedures incorporated complex-sample descriptive statistics, Rao–Scott chi-square tests, and complex-sample hierarchical logistic regression. Results: In univariate analyses, economic status, self-esteem, self-control, depression, and parent–child relationships differed significantly according to self-harm history. In multivariable hierarchical logistic regression, higher self-esteem (OR = 0.44, p < 0.001) and positive parent–child relationships (OR = 0.57, p = 0.004) were associated with lower odds of self-harm attempts, whereas depression (OR = 2.23, p = 0.001) and lower self-control (OR = 1.40, p = 0.009) were associated with higher odds. The inclusion of smartphone overdependence in Step 3 (yielding a modest increase in explanatory power, ΔR2 = 0.02) revealed that being in the smartphone overdependence risk group was associated with lower odds of self-harm attempts (OR = 0.55, p = 0.003). Conclusions: Self-harm attempts in this service-using population are strongly associated with core psychological and familial distress. The inverse multivariable association regarding smartphone overdependence is preliminary and hypothesis-generating; it may reflect statistical suppression, unmeasured confounding, or indirect digital connection among isolated youth, rather than a direct protective function. Findings apply specifically to crisis-service-using female youth and underscore the need for longitudinal research with refined clinical measures.