The lived experiences of primary caregivers supporting adolescents with non-suicidal self-injury: a qualitative systematic review and meta-aggregation

Objectives To systematically identify, appraise, and synthesize qualitative evidence on the lived experiences, caregiving challenges, and support needs of primary caregivers of adolescents engaging in non-suicidal self-injury (NSSI). Methods We searched PubMed, Embase, CINAHL, PsycINFO, Web of Science, CNKI, Wanfang Data, and CBM for English- and Chinese-language studies published through December 31, 2025. Two reviewers independently screened studies, appraised methodological quality using the JBI Critical Appraisal Checklist for Qualitative Research, and extracted findings with supporting illustrations. Evidence was synthesized using JBI meta-aggregation, and confidence in the synthesized findings was assessed using ConQual. Results 17 studies conducted across 5 countries and involving 395 primary caregivers were included. 77 findings were aggregated into 11 categories and 5 synthesized findings (1): Emotional shock, persistent distress, and stigma following NSSI discovery (2); Disruption of family relationships, functioning, and everyday life (3); Difficulties understanding NSSI and developing caregiving competence (4); Barriers to support and unmet needs for coordinated services; and (5) Adaptation, reflective change, and the emergence of resilience. Conclusion The evidence portrays caregiving for adolescents with NSSI as a context-dependent and evolving process in which substantial emotional and practical burdens may coexist with gradual adaptation. These findings support evaluating non-blaming, family-centered care that strengthens caregiver well-being and competence and improves cross-sector coordination. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420251113508.