A systematic review identifying personally modifiable factors for self-harm recovery in young people and the barriers and facilitators to their implementation.

INTRODUCTION

While research has extensively examined self-harm prevention and risk factors, fewer studies have explored recovery processes. Personally modifiable factors - lifestyle, skill-based, or behavioural aspects an individual can influence - may support self-harm recovery. This review aimed to identify these factors for young people and, secondarily, the barriers and facilitators affecting their implementation.

METHODS

Recovery was defined symptomatically (reduction or cessation of self-harm) and personally, using the CHIME framework (Connectedness, Hope, Identity, Meaning, Empowerment). Five databases (Medline, CINAHL, PsycInfo, Embase, Web of Science) were searched in February 2025. Inductive coding identified personally modifiable factors, and the Consolidated Framework for Implementation Research (CFIR) guided analysis of barriers and facilitators.

RESULTS

From 16,900 screened records, 35 studies were included. Common factors for symptom-based recovery (ceasing self-harm) included activities or hobbies (such as exercise, art, or music), social engagement with friends/family, harm minimisation techniques (e.g., holding ice cubes, elastic bands), and distraction methods. Online engagement and harm minimisation were double-edged, offering support but sometimes posing risks. Online forums fostered connectedness and empowerment, and recovery stories promoted hope (i.e. personal recovery). Barriers and facilitators varied; stigma often hindered offline discussion but encouraged anonymous online support.

CONCLUSIONS

Young people identify diverse, personally modifiable factors that guide self-harm recovery alone or with support. These factors are context- and person-dependent, underscoring the need for flexible, individualized approaches. Future research should also include low- and middle-income countries and include stratified analyses by sex and gender to capture a broader range of experiences and recovery pathways.