More than one in 10 teenagers have considered self-harm or overdosing on prescription medication, and nearly one-third of teens report feeling mental or emotional anguish at some point in the past year, according to a new survey.

The teenage years are often the most fragile years in any person’s life. Unfortunately, due to social pressure and feelings of inadequacy, coupled with a confusing mix of newfound hormones, many teens reflect their stress inward, rather than seeking external support. They punish themselves instead of letting their problems be heard. And sadly, it’s their health that ends up paying the price.

"Although mental health campaigns have for some time attempted to de-stigmatize mental ill-health, by far the most likely reason why young people self-harm remains self-punishment,” explained Dr. Dirk Schubotz, professor at Queen’s University and Director of the Young Life and Times Survey (YLT), in a statement.

Schubotz and his colleagues from Queen’s University carried out the study in conjunction with Mental Health Awareness Week. Drawing from data in the YLT, they looked at 1,367 16-year-olds across Northern Ireland. The survey was designed to measure the teenagers’ responses to financial hardships, senses of belonging in the community, and their mental health, including self-harm.

Overall, they found 28 percent of respondents had felt serious personal, emotional, or mental health problems in the past year, and just over a third of those people sought help for their problems. The team also found 13 percent of people had genuinely considered taking an overdose or hurting themselves, with six percent of those people having thought about it in the past month. Likewise, 13 percent said they followed through with self-harm, five percent only once and eight percent more than once. Most often it was because they “wanted to punish themselves.”

“This suggests that young people with mental health problems keep blaming themselves for these,” Schubotz said, “rather than appreciating external stressors such as pressures arising from school work or financial difficulties." Particularly alarming to Schubotz is the fact that over the last five years, since the most recent survey was administered, there’s been little no to difference in the rate of self-harm thoughts or actions. This is despite heavy financial injections into the mental health services in Northern Ireland.

The findings may point to a larger challenge involving mental health, as especially in the United States physical illness takes priority over mental illness in the mainstream. Bruises and bleeding can be seen; depression cannot. People may understand what physical symptoms of depression look like, but the underlying chemical imbalance in the brain and the person’s abstract sense malaise are invisible to the naked eye. And since we can’t rely on our vision to trust the illness’ presence, we fail to respect its importance.

The majority of self-harm cases arise from one, or a combination, of a few factors. These include mental illness, environmental factors, genetics, and substance abuse. Teens suffering from autism spectrum disorders, borderline personality disorders, depression, and certain phobias may turn to self-harm as a means to feel more alive or to achieve a sense of calm. Other factors, such as traumatic experiences, genetic cases (like that of Lesch-Nyhan syndrome), or drugs and alcohol use, can spur self-harm as well.

Overcoming these hurdles requires a mix of individual and public health changes. Parents and school officials must encourage students to be open about their mental health woes, while particular governments must rush to treat widespread illness before it turns physical. By the time there’s blood, it’s already too late.