Debt repayment problems, financial strain, and self-harm and suicidal behaviour among Norwegian students in higher education: A national cross-sectional study

Background Financial strain is associated with poor mental health, but debt repayment problems remain underexamined as correlates of self-harm and suicidal thoughts and behaviours among students. We examined associations between debt repayment problems, difficulties meeting ongoing expenses, and past-year self-harm and suicidal thoughts and behaviours among Norwegian students in higher education. Methods We analysed cross-sectional data from 49,198 participants in the 2026 Students’ Health and Wellbeing Study. Financial indicators were assessed using four-level frequency measures. Outcomes were past-year thoughts of self-harm, non-suicidal self-harm, suicidal ideation without attempt, and suicide attempt. Prevalence ratios (PRs) with 95% confidence intervals (CIs) were estimated using modified Poisson regression with robust standard errors, adjusting for sociodemographic factors. Sensitivity analyses additionally adjusted for psychological distress and mutual financial indicators. Results Both indicators showed graded associations with all outcomes. Compared with no difficulties, debt repayment problems most of the time were associated with suicide attempt (PR 8.57, 95% CI 5.10 to 14.40) and suicidal ideation without attempt (PR 3.48, 95% CI 3.01 to 4.03). Corresponding estimates for difficulties meeting ongoing expenses were 7.16 (95% CI 4.55 to 11.28) and 3.33 (95% CI 3.00 to 3.71). Associations were attenuated but generally persisted at the highest exposure levels after additional adjustment. Conclusions Debt repayment problems and difficulties meeting ongoing expenses were associated with higher prevalence of self-harm and suicidal thoughts and behaviours. Financial strain may be an important marker of elevated vulnerability in student welfare and prevention-oriented support.