Risk and protective factors for self-harm in secure mental health hospitals: a systematic review

Abstract

Purpose

The current review aims to focus on how risk and protective factors for self-harm in secure mental health hospitals are captured in the literature.

Design/methodology/approach

Fifty-seven articles were included in a systematic review, drawn from an initial 1,119 articles, post duplicate removal. Databases included Psycinfo, Psycarticles, Psycnet, Web of Science and EBSCO host. A thematic analysis was used, which included a meta-ethnographic approach for considering qualitative papers.

Findings

There was a clear focus on risk factors, with eight identified (in order of occurrence): raised emotional reactivity and poor emotion regulation; poor mental health; traumatic experiences; personality disorder diagnosis and associated traits; increased use of outward aggression – dual harm; constraints of a secure environment and lack of control; previous self-harm and suicide attempts; and hopelessness. Protective factors featured less, resulting in only three themes emerging (in order of occurrence): positive social support and communication; positive coping skills; and hope/positive outlook.

Research limitations/implications

This includes a proposal to move focus away from “risk” factors, to incorporate “needs”, in terms of individual and environmental factors. There is also a need for more attention to focus on developing high quality research in this area.

Originality/value

The research captures an area where a synthesis of research has not been comprehensively undertaken, particularly with regards to capturing protective as well as risk factors.

Citation

Steene, L.M.B., Gaylor, L. and Ireland, J.L. (2024), "Risk and protective factors for self-harm in secure mental health hospitals: a systematic review", Journal of Aggression, Conflict and Peace Research, Vol. 16 No. 2, pp. 189-218. https://doi.org/10.1108/JACPR-10-2023-0837