The role of perceived social norms in non-suicidal self-injury and suicidality: A systematic scoping review

Abstract

Social norms are an important influence on health-related behaviours and intention formation. As both suicidal behaviour and non-suicidal self-injury (NSSI) can be motivated by intentions, perceived social norms may have an important role in suicide and NSSI outcomes, although no existing reviews of this association exist. Following the PRISMA Scoping Review extension guidance, a scoping review based on systematic searches of key databases was conducted to identify published English language studies investigating the role of perceived social norms in suicidality and NSSI. Information regarding the types of social norms studied, their relationship to suicidality/NSSI outcomes, study samples and designs was charted. Thirty-six eligible studies (31 quantitative, 4 qualitative, 1 mixed methods) sampling various populations across mostly non-clinical settings were identified and narratively synthesised. Studies varied in how social norms were operationalised, measured, and investigated/explored. Most studies focused on the role of conformity to perceived masculine social norms or to some form of subjective, descriptive, or injunctive norms; there were limited studies on female/feminine norms, pro-social/protective norms, or broader gender/sexuality norms. Most studies (n = 31) were cross-sectional (quantitative) in design, few were based on existing theories of suicide/NSSI or social norms, and none concurrently tested theories of social norms and NSSI/suicidality. Perceived social norms and stronger conformity to norms were generally associated with worse NSSI/suicidality, although some pro-social norms appeared to be protective (e.g., perceived parental norms for adolescents). Whilst conformity to restrictive perceived social norms may be related to poorer suicide and NSSI outcomes, there is a lack of consistency in the literature in how social norms are defined and measured, a lack of theory-based hypothesis testing, and few longitudinal studies. There is a need for more nuanced, theory-based, investigations of how, when, where, why, and for whom, perceived norms have a causal role in NSSI and suicidality outcomes.

News Media Framing of Suicide Circumstances and Gender: Mixed Methods Analysis

“…The proportion of articles in our sample attributing legal and social or relationship problems as circumstances to each gender is opposite of the proportions of disclosed circumstances in the National Violent Death Reporting System [ 6 ]. Increased stigmatizing language in reports of women experiencing legal problems and men experiencing relationship problems may be attributed to their perceived deviation from social norms [ 39 ]. Reports of female deaths not attributed to any circumstance were more linguistically similar to the stigma attitude than reports of male deaths—demonstrating the presence of discernable stigmatizing language even without specifying the circumstances of suicide.…”

The influence of peer non-suicidal self-harm on young adults’ urges to self-harm: experimental study

“…Our findings from a sample of people who all had a history of self-harm would be consistent with this. There has been little research investigating the influence of perceived social norms of NSSH (including anticipation of social approval/ sanctions and misperceptions of others' NSSH rates) on own NSSH (Dempsey et al, 2023), and more work is needed to understand how these modify the effects of direct exposure to peer NSSH. Our findings regarding the wash-out are consistent with evidence that adolescents demonstrate sensitivity to the quality of social information, integrating safe social information into their decision-making (Ciranka & Van Den Bos, 2019).…”

Does the need for uniqueness lead to non-suicidal self-injury? The mediation of depression and the moderation of gender

“…However, compared to suicidal ideation, NSSI leaves physical traces on the body, such as cuts and cigarette burns, which implies that NSSI is easier to be discerned than is suicidal ideation (12). Previous studies have demonstrated that NSSI can significantly predict suicidal ideation (96)(97)(98). Therefore, to improve the precision of discerning suicidal intent, clinical practitioners can pay specific attention to NSSI in adolescents.…”