What helps people to reduce or stop self-harm? A systematic review and meta-synthesis of first-hand accounts

Abstract

Background Self-harm is an important public health problem but therapeutic interventions, particularly for people who have a history of multiple repetition, are not always taken up or effective when they are. The aim of this review is to explore first-hand accounts of what helps outside therapy and identify actions and processes, which can support the reduction or cessation of self-harm. Methods A systematic review and thematic meta-synthesis of the first-person accounts of what has helped to reduce or stop self-harm reported in primary studies. Results The meta-synthesis combined 546 participant excerpts from 56 studies. Two over-arching themes were identified: (i) breaking the chain incorporated actions taken to break the link between a person’s current psychological or social state and the act of self-harm and (ii) building a new foundation for change captured actions over the longer-term, focusing on practical changes in relationships and in a person’s way of life, such as work or living arrangements. Conclusions The results emphasize the importance of interpersonal change in reducing or stopping self-harm. While interpersonal factors are acknowledged as important reasons behind self-harm, they are often under-represented in self-management advice and therapeutic interventions that focus on individual psychopathology.

Accessing psychological therapies following self-harm: qualitative survey of patient experiences and views on improving practice

“…Most participants were patients (128/151, 84.8%), and the remainder were carers (23/151, 15.2%). Patients were aged between 18 and 75 years, and their median age was 32 (interquartile range (IQR): [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]. Carers were aged between 52 and 73 years, with a median age of 50 (IQR: 38-59).…”

“… 37 , 42 Future research is needed to understand contextual barriers in these areas and to improve access to evidence-based healthcare services for marginalised groups. Brennan et al 43 suggest addressing societal, social and interpersonal aspects in interventions to reduce repeat self-harm frequency. However, given the individual nature of self-harm episodes, they caution against blanket recommendations in the development of any supportive interventions to reduce repetition.…”

The qualitative study of intentional self-harm in Thailand: Focusing on predisposing child-rearing environments and self-harm cessation

“…Congruently, this study described finding life purposes as an internal factor related to the cessation of self-harm. It tended to be one way to re-orient to a more positive future, as reported by Brennan et al (2022). Moreover, Rissanen et al (2013) studied the factors contributing to the cessation of self-cutting among 13-18-yearold Finnish adolescents by using self-rating questionnaires and asking the participants to write their own descriptions of how they had been able to stop self-cutting.…”

“…In addition, Brennan et al ( 2022 ) conducted a systematic review and a meta-synthesis of 56 studies regarding what helps people to reduce or stop self-harm. They reported two meta-themes that were breaking the chain of self-harm and building a new foundation for change.…”

“They have more than enough to do than patch up people like me.” Experiences of seeking support for self‐harm in lockdown during the COVID‐19 pandemic

“…Participants acknowledged the lack of alternative strategies to coping with lockdown beyond self‐harm, leading to a reluctance among some individuals to disclose their feelings to others in case someone tried to stop them. Previous studies have emphasized the role of interpersonal relationships on self‐harm, with concerns about other people serving as a mechanism for cessation (Brennan et al, 2022 ). Although existing literature advocates for modifying a person's social environment to counteract such issues, it is important to acknowledge that such changes may be harder to enact given the instability of many individual's circumstances during the pandemic.…”