Parents’ and Caregivers’ Understanding of Self-Harm in Young People: A Systematic Review

Self-harm among young people is a global concern. Parents and caregivers play a central role in supporting young people who self-harm, however, many report difficulties in understanding the behaviour and its meaning. This systematic review, therefore, aimed to identify variations in how self-harm is defined within studies and synthesize qualitative evidence on parents’ and caregivers’ understanding of self-harm in young people. Four electronic databases were searched to December 2024, alongside hand-searching and citation tracking. Study quality was appraised using the CASP qualitative checklist. Data were synthesized using thematic synthesis, with confidence assessed using GRADE-CERQual. Of 4,238 studies screened, ten met inclusion criteria. Thematic analysis revealed four main themes for parents and caregivers understanding of self-harm: (1) self-harm as an emotional regulation strategy, (2) self-harm as a means of communication or expression, (3) self-harm within developmental and contextual narratives and (4) self-harm linked to mental health difficulties and life history. GRADE-CERQual indicated moderate confidence across all themes. Findings demonstrate that parents’ and caregivers’ interpretations are multidimensional, reflecting emotional, interpersonal, developmental and contextual processes. Integrating these perspectives provides a developmental informed framework for understanding how families construct meaning around self-harm. Trial registration This systematic review was prospectively registered with PROSPERO (Registration number. CRD42024548743). The preregistration specified the review objectives, eligibility criteria, search strategy, study selection process, data extraction methods, qualityassessmentandplannedmethodsfordatasynthesisand analysis. https://www.crd.york.ac.uk/PROSPERO/view/CRD42024548743 .