Objective: The study aimed to evaluate the internalised stigma and self-esteem in adult outpatients with major depressive disorder (MDD) attending a psychiatric outpatient clinic in Iraq, and to explore the relationship between these variables. Methods: A cross-sectional correlational study among 120 adults with MDD who attended psychiatric outpatient clinics of Azadi Teaching Hospital in Kirkuk, Iraq. All participants filled out a sociodemographic and clinical questionnaire, the Internalised Stigma of Mental Illness Scale (ISMI), and the Rosenberg Self-Esteem Scale (RSES). Data were analysed using descriptive statistics, Pearson's correlation coefficient and simple linear regression. Results: The overall mean ISMI score was 2.90 (SD = 0.42), with the highest scores for stereotype endorsement (M = 3.16) and alienation (M = 3.14) and the lowest for stigma resistance (M = 2.19). The overall mean RSES score was 2.29 (SD = 0.38). There was a negative correlation between internalised stigma and self-esteem (r = −0.338, p < 0.001). Self-esteem was statistically associated with internalised stigma (β = −0.338, t = −3.897, p < 0.001), explaining 11.4% of the variance (R² = 0.114) in simple linear regression. Conclusions: In this single-centre sample of adults with MDD, internalised stigma and self-esteem were inversely related. Since the study is a cross-sectional design, the association observed cannot be considered a causal relationship. The results provide a basis for consideration of the psychosocial aspects of routine psychiatric care (stigma and self-esteem) and for further longitudinal and multicentre research to establish temporal relationships and to determine potentially modifiable factors.
Reading achievement is influenced by a variety of cognitive and affective elements, with reading motivation and metacognitive awareness identified as two of the most important. This study examined (1) the relationship of students' reading motivation and reading achievement, (2) the relationship between metacognitive awareness and reading achievement, and (3) the combined contribution of reading motivation and metacognitive awareness to reading achievement among eleventh-grade students at SMAN 1 Sungai Lilin. Employing a quantitative correlational research design, The population for this research comprised 344 students enrolled in the eleventh grade from ten classes. Cluster random sampling was then applied to obtain a sample of 106 students. Data were gathered through the Motivation for Reading Questionnaire (MRQ), the Survey of Reading Strategies (SORS), and a reading achievement test. The obtained data were processed and analyzed using IBM SPSS Statistics version 25, which included descriptive statistics, Pearson product-moment correlation, partial correlation, and multiple regression. The findings showed that a positive relationship of moderate strength was associated with reading achievement (r = .600, p < .001), whereas metacognitive awareness demonstrated a strong positive relationship with reading achievement (r = .791, p < .001). In addition, the partial correlation analysis revealed a significant but weak positive association between reading motivation and metacognitive awareness after controlling for reading achievement (r = .304, p = .002). Reading motivation and metacognitive awareness explained 64.5% of the variation associated with reading achievement (R² =.645), according to the multiple regression analysis. These findings underscore the important roles of both reading motivation and metacognitive awareness in supporting students' reading achievement and suggest that both factors should be explicitly integrated into reading instruction to enhance students' reading performance
The increasing use of computers, predominantly involving prolonged static sitting, may increase the risk of musculoskeletal disorders (MSDs). This study aims to examine workstation ergonomic risk and musculoskeletal disorders among computer users through a literature review based on the Rapid Office Strain Assessment (ROSA) and the Nordic Musculoskeletal Questionnaire (NMQ). A systematic search was conducted in PubMed and Google Scholar for articles published between 2020 and 2025, following PRISMA guidelines. A total of nine studies that met the inclusion criteria were analyzed narratively. The results indicate that most studies reported moderate to high levels of ergonomic risk, with chair-related factors as the dominant contributors. The prevalence of musculoskeletal complaints was also high, particularly in the neck, shoulders, and lower back. However, the relationship between ROSA scores and musculoskeletal complaints was inconsistent across studies, suggesting the influence of multifactorial determinants. Therefore, ROSA is more appropriately used as a screening tool for ergonomic risk, while NMQ complements it by capturing subjective complaints. The combined use of both instruments is essential to support a more comprehensive ergonomic assessment and the development of effective interventions.
Future orientation is an important developmental aspect for twelfth-grade senior high school students, who must decide on further study or careers after graduation. A preliminary study through interviews with the guidance and counseling teacher and an open-ended questionnaire administered to 50 twelfth-grade students of Sekolah Menengah Islam (SMI) Hidayatullah, Banjar Regency, showed that none of the respondents had clear future goals. This community service activity aimed to provide understanding and initial skills in setting future goals through the “Aku Bisa” (I Can) program, a psychoeducation-based activity consisting of an interactive lecture on goal setting, creating a “my aspirations” mind map, and a short film discussion. The one-day program was attended by 105 twelfth-grade students. Outcomes were evaluated through a pre-test and post-test based on a future orientation scale, observation during the activities, and a participant evaluation sheet. A paired sample t-test showed no significant difference between scores before and after the program (t(95) = 0.245; p = 0.807). Nevertheless, participants were able to write down their aspirations and plan how to achieve them in a mind map, and most participants rated their understanding of the material (78.10% good and very good) and the benefits of the activity (87.62% good and very good) favorably. This program can serve as an initial step in introducing future planning to students; however, longer implementation and follow-up evaluation are needed to detect meaningful changes in future orientation
This study aims to analyze the effect of using gamification-based Quizizz as a digital assessment on the learning motivation and engagement of grade X Building Construction and Housing Engineering students in the Basic Building Construction and Housing Engineering course at SMKN 3 Surabaya. This research examines how Quizizz assessments integrated with gamification influence motivation and learning engagement among 10th-grade students majoring in Building and Housing Construction Engineering in the Basic of Building and Housing Construction Engineering course at SMKN 3 Surabaya. A quantitative experiment was conducted using a single-group pretest–posttest design, and all 33 students in the population participated through total sampling. Data were collected via a Likert scale questionnaire and observation sheets, then analyzed using the paired t-test, the Wilcoxon signed-rank test, effect size calculations, and N-Gain. The research findings indicate that Quizizz combined with gamification did not result in a significant change in students’ learning motivation (Sig. = 0.769 > 0.05; effect size = 0.05), but it significantly increased learning engagement (Sig. = 0.027 < 0.05; effect size = 0.384). Observational data support this, showing an engagement rate of 86.67% (classified as very high). Therefore, Quizizz-based gamification appears to be more suitable for enhancing engagement than motivation in technical vocational subjects. Gamification-based Quizizz has proven to be more effective in enhancing learning engagement than learning motivation in technical vocational subjects. Teachers are advised to combine Quizizz with additional strategies, such as linking the material to real-world construction work contexts, in order to foster students’ learning motivation more comprehensively.
University students who live away from their families may experience loneliness and depressive symptoms, while perceived social support may alter this relationship. This study examined the associations among loneliness, perceived social support, and depressive symptoms and tested whether perceived social support moderated the loneliness-depressive symptoms relationship. A cross-sectional quantitative design involved 396 university students living in boarding houses in Yogyakarta. Data were analyzed using Pearson correlations and moderated multiple regression. Perceived social support was negatively associated with depressive symptoms. Loneliness was also significantly associated with depressive symptoms, but the direction was negative and therefore did not support the proposed positive hypothesis. The interaction between loneliness and perceived social support was significant, indicating that the loneliness slope differed across levels of support. The findings highlight the relevance of perceived social support for student mental health while also showing that the unexpected loneliness pattern requires cautious interpretation and replication.
This study examined the association between intolerance of uncertainty and psychological distress among emerging adults aged 18-29 years. A quantitative, cross-sectional correlational design was used with online convenience sampling. Of 181 survey submissions, one record was excluded because age was missing and one because the respondent was aged 17 years; a further 18 respondents who reported a previous mental-health diagnosis were excluded. The final analytical sample comprised 161 participants (M age = 23.60, SD = 3.09; 67.1% women). Intolerance of uncertainty was measured with the 12-item Intolerance of Uncertainty Scale (IUS-12), and nonspecific psychological distress with the Kessler Psychological Distress Scale (K10). Mean IUS-12 and K10 scores were 32.11 (SD = 9.44) and 24.31 (SD = 8.09), respectively. Internal consistency estimates were .887 and .913. Pearson's correlation indicated a positive association between IUS-12 and K10 scores, r(159) = .632, p < .001, 95% CI [.529, .717]. Spearman's correlation was also positive and significant (rs = .595, p < .001, 95% bootstrap CI [.475, .699]). Higher intolerance of uncertainty was associated with greater self-reported psychological distress in this sample. The cross-sectional design, convenience sampling, self-report measures, and diagnosis-based screening limit causal inference and generalisability.
Stress arising from academic, professional and financial demands is common among students and young professionals, and the coping methods within easiest reach, such as listening to music, do not always suffice. This paper presents a survey-driven design for a virtual reality (VR) gadget that combines selectable immersive natural environments, environment-matched sound therapy and heart-rate biofeedback for short relaxation sessions. An online questionnaire completed by 24 respondents, mostly college students, supplies the user requirements. Among those who answer the relevant items, 65.2% report daily stress, 73.9% name academic or job pressure as the main cause, and 47.8% state that a busy schedule prevents regular yoga or meditation. Music is the most common coping method (63.6%). Asked about a 10–15 minute VR relaxation session described as free of side effects, 83.3% answer “yes, definitely” and 8.3% answer “maybe” if the price is under Rs. 5000. The findings yield design requirements, a system architecture, a session workflow and a protocol for comparing the gadget with guided breathing, meditation and relaxing music. That comparison is planned, not yet carried out: the prototype has not been tested with users, and the paper makes no claim of clinical effectiveness.
Student engagement positively influences academic achievement, yet instruments suited to the Indonesian cultural context remain limited. This study aimed to develop a valid, reliable, and user-friendly student engagement scale for high school students. Using a quantitative descriptive design, the study involved 295 male and female students aged 15–18 years recruited through convenience sampling. The scale comprised three dimensions: behavioral, emotional, and cognitive engagement. The results showed that the scale demonstrated a good model fit based on the goodness-of-fit indices (χ2/df = 1.60; CFI = 0.966; TLI = 0.962; SRMR = 0.074; RMSEA = 0.045) and good reliability, with Cronbach’s alpha values of 0.844 for emotional engagement, 0.753 for behavioral engagement, and 0.782 for cognitive engagement. The developed scale can be used by teachers, counselors, and educational researchers to identify students’ levels of engagement and inform the development of programs to improve student engagement.
Emotional contagion refers to the process through which people's emotions may be influenced by the emotional states and expressions of others. This study examined self-reported responses to stress in other people and explored their association with perceived stress. A quantitative, cross-sectional online questionnaire was completed between October 25 and 27, 2026. Of 33 submissions, 32 participants consented and were included in the emotional-response analysis; 31 had sufficient responses for the preliminary perceived-stress analysis. The questionnaire included 15 researcher-developed statements about responses to others' stress and 10 perceived-stress questions resembling the Perceived Stress Scale?10 (PSS-10). Descriptive results showed that 90.6% of participants agreed or strongly agreed that they could sense stress in people around them, while 75.0% reported that stress in family, workplace, or educational settings affected their emotional well-being. An exploratory Spearman correlation indicated a positive association between the emotional-response composite and perceived-stress scores (rs = .526, p = .002, n = 31). This association must be interpreted cautiously because the emotional-response questionnaire was not validated and the exact perceived-stress instrument requires confirmation. Findings provide preliminary descriptive insight but do not establish causation.
Research into collocation learning in second and foreign language environments has gained significant scholarly attention. Yet, cross-linguistic influence (CLI) on the use of collocations has received little attention from researchers, especially in the Tunisian context. Therefore, this study investigates how L1 Arabic influences the production of English lexical collocations among 50 third-year Tunisian EFL undergraduates at the Higher Institute of Human Sciences of Medenine. It also examines the relationship between learners’ vocabulary level and collocational errors. Data was gathered using a Vocabulary Levels Test (VLT), a collocation test, and semi-structured interviews. The results showed that the participants’ L1 Arabic exerted a negative influence on their use of collocations, leading them to produce erroneous collocations. Moreover, the inferential statistics yielded no significant relationship between learners’ vocabulary levels and collocational errors. By demonstrating that larger vocabulary size is not sufficient for mastering multi-word expressions in this specific learner profile, these results refine existing CLI models by emphasizing the dominant role of L1 transfer over lexical knowledge in collocation production. The findings suggest that EFL pedagogy in the Tunisian system must shift from isolated word learning to explicit, collocation-focused instruction.
Abstract Background Repetitive negative thinking (RNT) is a transdiagnostic process relevant to common mental health problems in primary care. RNT-ACT is a brief acceptance and commitment therapy-based protocol targeting RNT in two sessions. This pilot study assessed the feasibility of RNT-ACT compared with therapist-supported internet-based cognitive behavioural therapy (iCBT) in Swedish primary care. Methods Thirteen participants were randomised: 7 to RNT-ACT and 6 to iCBT. The primary feasibility outcomes were recruitment rate, intervention non-completion, and patient satisfaction measured with the Client Satisfaction Questionnaire (CSQ-8). Symptom and process measures were secondary outcomes. Secondary outcomes were assessed at baseline and at 1- and 3-month follow-ups. Analyses were descriptive and exploratory, based on available observations without imputation of missing data. Results Thirteen of 20 eligible individuals were enrolled (65%), corresponding to 35% of all 37 individuals screened. All participants in the RNT-ACT group completed the intervention, whereas 4 of 6 participants in the iCBT group did not complete the intervention. Mean CSQ-8 scores were 27.8 (SD 3.7; n = 5) in the RNT-ACT group and 23.0 (SD 0.0; n = 2) in the iCBT group. Conclusions The small sample size and high iCBT non-completion limit between-group comparisons. Further investigation of recruitment, treatment engagement, and patient and therapist experiences is needed before determining whether and how to proceed to a full-scale RCT. Trial registration ClinicalTrials.gov NCT05946382 registered July 14, 2023.
This study examined the relationship between innovative and inclusive teaching practices and student motivation and academic performance among Grade 5 and Grade 6 pupils in selected public elementary schools in Lutayan, Sultan Kudarat, Philippines, during the School Year 2025–2026. Specifically, it determined the level of innovative teaching practices in terms of teaching strategies, use of instructional materials and technology, and student engagement activities; assessed inclusive teaching practices in terms of respect for learner diversity, equal participation, and support for diverse learning needs; identified the level of student motivation; and examined the relationships between these variables and academic performance. A descriptive-correlational research design using a quantitative approach was employed. Data were gathered from 97 Grade 5 and Grade 6 pupils through a validated researcher-made questionnaire with a reliability coefficient of 0.892, indicating strong internal consistency. Descriptive statistics and correlational analysis were used to analyze the data. Findings revealed that School administrators should provide sustained professional development to strengthen teachers’ innovative and inclusive instructional approaches and allocate resources to enhance access to technology and learning materials. Teachers should consistently apply differentiated, student-centered strategies and foster welcoming, diversity-affirming classrooms to boost student motivation and equitable achievement further further. Parents and guardians should reinforce school learning at home by encouraging curiosity, effort, and consistent study habits, and maintaining open communication with teachers. Future researchers should conduct experimental or longitudinal studies to examine cause-and-effect relationships and explore additional factors influencing academic performance beyond those investigated in this study. Innovative teaching practices, inclusive teaching practices, and student motivation were rated at a high level, which means teachers effectively practice inclusive teaching by recognizing learner diversity, promoting equal participation, and providing support to students with different learning needs; teachers also frequently use innovative teaching practices, apply engaging teaching strategies, integrate instructional materials and technology, and promote active student engagement in classroom learning activities. Furthermore, significant positive relationships were found between innovative teaching practices and academic performance, inclusive teaching practices and academic performance, and student motivation and academic performance, with a moderate correlation coefficient (r = 0.57). Overall, the findings indicate that these educational variables are positively associated with academic performance among the respondents.
The present study investigated the predictive role of trait mindfulness in relation to depression, anxiety, and stress among Pakistani young adults. The following hypotheses were formulated: H1: Trait mindfulness will significantly and negatively predict depression among Pakistani young adults. H2: Trait mindfulness will significantly and negatively predict anxiety among Pakistani young adults. H3: Trait mindfulness will significantly and negatively predict stress among Pakistani young adults. A sample of 405 participants (189 males, 216 females; aged 18–30 years, M = 22.39, SD = 2.823) completed an online survey including the Mindful Attention Awareness Scale (MAAS) and the Depression Anxiety Stress Scale (DASS-21). Reliability and normality assessments confirmed the adequacy of the measures. Linear regression analyses revealed that trait mindfulness significantly and negatively predicted depression (R² = .237, p < .001), anxiety (R² = .210, p < .001), and stress (R² = .201, p < .001). These findings were consistent with the hypotheses formulated and the theoretical perspectives. The study adds value to global evidence in relation to the Pakistani context, highlighting trait mindfulness as a preventive factor against negative emotions and emphasizing the need for culturally adapted mindfulness-based interventions to enhance psychological resilience among young adults.
The number of depressed Malaysian university students has sharply increased over the past ten years. What started as a localized academic issue has now become a major national mental health crisis, but the true experiences of those affected remain elusive. Therefore, the purpose of the research is to comprehend the authentic experiences of students in Malaysian universities who are experiencing depression. This research employed a qualitative methodology via a phenomenological framework involving five participants female university students who are diagnosed clinically with depression. Information was accessed via semi-structured interviews that were digitally audiotaped, transcribed verbatim and translated to English to analyse the information. The results indicate that there are six major themes that describe the experience of having depression. They are high-achieving students losing their academic identity because they entered the survival mode, a bitter fight between seeking the help of professional assistance and turning to drug use or self-harm in order to cope, the pressure of being a normal, fearing to be seen as a burden, the contradiction between familial beliefs and attributing depression to lack of spirituality, the physically isolated nature of staying in the room because of the need to avoid social interaction, and the impact of past sexual abuse as an underlying factor of psychological trauma. The themes indicate that student depression is not just a medical problem but they are very much influenced by intrapersonal, social, cultural, and spiritual demands. It is thus recommendable to provide necessary support that will alleviate the deep-seated experience of depression, especially in the university.
Background: Body image dissatisfaction (BID) is an emerging public health concern among college students due to its association with depression, anxiety, and low self-esteem. Sociocultural pressures during the transition to adulthood increase vulnerability. Evidence from Western Gujarat remains limited. Objectives: To determine the prevalence of BID and identify its sociodemographic and psychological predictors among undergraduate students in Western Gujarat. Methods: A cross-sectional study was conducted among 297 undergraduate students (18–24 years) from a medical college in Western Gujarat. Data were collected using a structured questionnaire, including MBSRQ-AS, BDI-II, HAM-A, and RSES. BMI was calculated using standard anthropometric measurements. Data were analyzed using SPSS v25 with chi-square tests, independent t-tests, and binary logistic regression. Statistical significance was set at p < 0.05. Results: The prevalence of BID was 58.2%. Females reported significantly higher dissatisfaction than males (66.1% vs. 48.5%, p < 0.001). Higher BID was observed among overweight/obese students (75.4%) and underweight students (66.7%). Multivariate analysis identified female gender (AOR = 1.95, 95% CI: 1.13-3.37), overweight/obesity (AOR = 3.59, 95% CI: 1.85-6.97), higher depression scores (AOR = 1.05 per unit), and lower self-esteem (AOR = 0.89 per unit) as independent predictors (Nagelkerke R² = 0.398). Conclusion: BID is highly prevalent among undergraduate students in Western Gujarat, particularly among females and those with higher BMI, depression, and low self-esteem. Targeted campus-based interventions promoting body positivity, self-esteem, and mental well-being are warranted.
The article substantiates the feasibility of adaptive foreign language phonetics teaching, enhanced by artificial intelligence technologies, as an alternative to traditional standardized methods that fail to account for higher education students' individual articulatory features and lead to persistent phonetic errors. The study is interdisciplinary, combining the methodology of specialties A4 Secondary Education (A4.021 English Language and Literature), A5 Vocational Education (A5.39 Digital Technologies), and F7 Computer Engineering. The purpose of the study is to develop and justify a model of an adaptive learning platform for improving higher education students' phonetic skills through the integration of speech formant synthesis with machine learning algorithms. A formant synthesizer model based on parallel digital filters has been developed, generating reference vowel sounds by simulating the resonant frequencies of the vocal tract. An approach to personalizing learning is proposed based on a Long Short-Term Memory (LSTM) neural network, which analyzes a student's error history and dynamically adjusts formant parameters in real time. Technical validation of the model demonstrated high accuracy of formant frequency correction, with a root-mean-square error of 45 Hz for the first formant and 78 Hz for the second, enabling objective assessment of pronunciation quality and adaptation of exercise difficulty to the individual student's level. A pilot quasi-experimental verification of the platform involving experimental and control groups of higher education students confirmed its pedagogical potential for implementing differentiated learning principles based on objective acoustic data. The conclusions confirm the platform's prospects for modernizing linguistic education. Further research directions include expanding empirical validation on a larger sample and conducting perceptual evaluation of synthesized speech quality by native speakers to confirm its naturalness and suitability for learning purposes.
Emerging adulthood is a transitional period involving exploration of identity, education, work, and relationships. During this period, purpose in life and relationship quality are important aspects of flourishing. The purpose of this study is to examine the role of self-concept clarity in predicting flourishing among emerging adults. A quantitative cross-sectional correlational design involved 206 participants aged 18–29 years who were students and/or workers recruited through convenience sampling. Data were collected online using the Self-Concept Clarity Scale and Flourishing Scale and analyzed through simple linear regression with 5,000 bootstrap resamples. The results showed that self-concept clarity positively and significantly predicted flourishing, B = .297, β = .374, t = 5.762, p < .001. The model explained 14% of the variance in flourishing, and the bootstrap analysis confirmed this association, 95% CI [.219, .388]. These findings indicate that clearer self-concept is associated with higher flourishing among emerging adults.
Purpose: This study assessed the prevalence of sleep disturbance and associated factors in patients with hepatocellular carcinoma (HCC) receiving hepatic arterial infusion chemotherapy (HAIC) combined with targeted therapy and immunotherapy. Patients and Methods: A cross-sectional survey enrolled 230 patients undergoing HAIC combined with targeted therapy and immunotherapy at Sun Yat-sen University Cancer Center (July–November 2025). Sleep, psychological distress, pain, appetite, and quality of life were assessed using the PSQI, HADS, NRS, VAS, and EORTC QLQ-C30, respectively, along with prior HAIC cycles. Logistic regression identified factors associated with sleep disturbance. Results: The prevalence of sleep disturbance (PSQI > 5) was 72.6% (167/230). Univariate analysis identified a greater number of prior HAIC cycles, higher levels of depressive and anxiety symptoms, and lower quality of life and appetite as significant factors. In multivariate analysis, four factors remained independently associated with sleep disturbance: prior HAIC cycles (OR = 1.66, 95% CI: 1.25– 2.20, P < 0.001), anxiety symptoms (OR = 1.27, 95% CI: 1.12– 1.44, P < 0.001), depressive symptoms (OR = 1.23, 95% CI: 1.03– 1.47, P = 0.021), and appetite sensations (OR = 0.93, 95% CI: 0.91– 0.96, P < 0.001), which showed an inverse association with sleep disturbance. The model showed an apparent area under the ROC curve of 0.92 (95% CI 0.87– 0.96), with an optimism-corrected AUC of 0.91 after bootstrap resampling. Conclusion: Sleep disturbance was highly prevalent and was independently associated with cumulative treatment burden, psychological distress and impaired appetite. These cross-sectional findings support routine sleep screening together with psychological and nutritional assessment in this population; whether modifying these factors improves sleep quality requires prospective interventional studies. Keywords: hepatocellular carcinoma, sleep disturbance, hepatic arterial infusion chemotherapy, immunotherapy, targeted therapy
Background and Purpose: Non-suicidal self-injury (NSSI) is a global concern in adolescent mental health. Rural boarding middle school students, as a unique and vulnerable population, remain understudied regarding the potential heterogeneity and longitudinal trajectories of NSSI. This study aimed to identify latent classes of NSSI among this group, examine their transition patterns over time, and evaluate the effectiveness of an emotion management group intervention. Methods: Study 1 cross-sectionally surveyed 927 adolescents; we split samples into non-NSSI and NSSI subgroups and ran latent profile analysis (LPA) only among participants with NSSI ( n =285). Study 2 conducted a 6-month follow-up of 550 participants and applied latent transition analysis (LTA) to examine class shifts and predictive factors. Study 3 was a randomized controlled trial in which 30 students from the High-NSSI received an 8-week emotion-management group intervention. Intervention effects were evaluated using repeated-measures ANCOVA with demographic covariates. Results: Within the NSSI subgroup ( n = 285), two classes were identified: a High-NSSI class ( n = 21, 7.4%) and a Low-NSSI class ( n = 264, 92.6%). Poor sleep quality and bullying victimization independently predicted High-NSSI membership. Longitudinal analysis revealed high stability in the Low-NSSI class (91%) and high fluidity in the High-NSSI class (83% transitioning to low-risk). The emotion-management intervention significantly reduced both NSSI frequency and negative affect. Discussion: These findings demonstrate that clinically meaningful NSSI subtypes exist among rural boarding adolescents and that sleep quality and bullying are key modifiable risk factors. The results support a stepped-care approach in school settings, where the High-NSSI class requires intensive intervention and the Low-NSSI class may benefit from less intensive, universal supports. The emotion-management group intervention is an effective school-based program for the most severe NSSI subtype. Keywords: non-suicidal self-injury, latent profile analysis, latent transition analysis, emotion management, group intervention
