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

Abstract

Purpose - The current review focuses 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 employed, 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); 1.) Raised emotional reactivity and poor emotion regulation, 2.) Poor mental health, 3.) Traumatic experiences, 4.) Personality disorder diagnosis and associated traits, 5.) Increased use of outward aggression – dual harm, 6.) Constraints of a secure environment and lack of control, 7.) Previous self-harm and suicide attempts, and 8.) Hopelessness. Protective factors featured less, resulting in only three themes emerging (in order of occurrence); 1.) Positive social support and communication, 2.) Positive coping skills, and 3.) Hope/positive outlook.
Research 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.