Mapping the Landscape of Acute-phase Interventions After Self-harm: A Scoping Review of Underrepresented Strategies

Self-harm (SH) is a global public health crisis, with individuals who engage in SH facing a significantly increased risk of subsequent suicide, particularly in the immediate post-SH period. Although systematic reviews and meta-analyses have established the efficacy of interventions like Problem-Solving Therapy and Brief Intervention and Contact, many potentially valuable approaches are often excluded from quantitative synthesis due to a limited number of randomized controlled trials (RCTs). This scoping review, an extension of a comprehensive systematic review, aims to qualitatively map the landscape of under-represented early interventions for SH (defined as occurring within one month prior to enrollment) that were not meta-analyzable. Interventions including psychodynamic therapy, Safety Planning, family interventions, and pharmacological approaches, focusing on their theoretical models, delivery formats, target populations, and methodological limitations, are descriptively mapped. Significant conceptual diversity and persistent evidence gaps are identified. Safety Planning, despite its widespread clinical use, shows mixed results in recent meta-analyses, especially in adolescents. Psychodynamic and pharmacological interventions remain limited and heterogeneous. This review highlights a critical research gap, underscoring the need for larger, well-designed RCTs for these under-represented interventions, as well as a focus on standardizing outcomes and understanding mechanisms of change to inform clinical practice and improve outcomes for at-risk individuals.