A systematic review of systematic reviews exploring the factors related to child and adolescent self-harm

Background: In recent years, the rates of young people presenting with self-harming have increased dramatically, with self-harm being a predictor of suicide. Despite evidence suggesting that self-harm is common in young people and that hospital admissions are increasing, research exploring the reasons behind young people’s motivations is not easily accessed. Systematic reviews have explored this from a range of perspectives, but none have drawn all this literature together. Methods: A systematic review of systematic reviews was conducted in accordance with PRISMA guidelines. Seven databases were searched using a peer reviewed search strategy, with a focus on the factors of child and adolescent self-harming. All English language articles, published between 2008 and 2021, were considered, and screened against inclusion criteria. References of included articles were also searched for eligible articles. Results: Twenty-two systematic reviews were included after screening against eligibility criteria. Narrative synthesis identified eight themes for motivation or reasons for self-harming: identity and subcultures, peer influences, educational stressors, mental ill health, cognitive and neuropsychological factors, trauma and attachment, internet influences and social media. Conclusion: Reasons for self-harming in adolescents are complex and multifactorial. Many studies focus on single causes or associations with self-harm rather than open-mindedly exploring a range of factors or the interactions between them. This leaves gaps in the research where hypothetical reasons for self-harm have not been systematically explored. The themes identified here could help in the clinical assessment process and guide future research in this area, including the development of potential differentiated prevention and treatment approaches