A Systematic Review of Perceived Risks and Risk Management Strategies in Non-Suicidal Self-Harm

Although the risks associated with non-suicidal self-harm (NSSH) have been widely described in the literature, evidence remains fragmented regarding how these risks are understood and managed by individuals with lived experience.

Our systematic review aimed to identify the risks perceived by those who engage in NSSH and the risk management strategies they utilized.

We searched five databases and performed a quality assessment and meta-synthesis of qualitative findings. We summarized the quantitative findings from one study because a narrative synthesis was not feasible.

We included 37 eligible studies (n = 34 qualitative only; n = 3 mixed methods), with only one presenting quantitative findings. Our meta-synthesis of qualitative findings highlighted three overarching themes: (1) Physical risks: understanding and managing injuries; (2) Interpersonal risks: impacts of and responses to self-harm; (3) Intrapersonal risks: a personal assessment. Individuals who self-harm showed a nuanced understanding of all overarching risks. Management strategies included damage limitation and concealment of scars. The perceived utility of risk management strategies varied from useful to counterproductive. Quantitative findings from one study showed that users of online self-harm communities perceive similar physical and interpersonal risks, including fears of judgment and stigma.

Views on self-harm risk management strategies were mixed. Incorporating lived experience perspectives can promote person-centered care for NSSH, enhancing peer support interventions and collaborative clinician-patient risk management plans.