Men who self‐harm—A scoping review of a complex phenomenon

1. Adamson and Braham (2011)

United Kingdom

- Seven men (24–44 years) with a history of repetitive deliberate self-harm. - High-secure hospital. - Qualitative design. - Audio-taped semi-structured interviews. - Grounded theory. Described as deliberate self-harm behaviours in which individuals engage in self-poisoning or self-injury, irrespective of the apparent purpose of the act and including previously used concepts such as attempted suicide, para suicide, self-poisoning, self-wounding, self-injury and self-mutilation as seen within the literature. - Ambivalent feelings. - Impulsive. - A lack of expression of self-hatred. - Hearing voices instructing one to self-harm or delusional thinking. - Cutting. - Overdoses. - Using prescribed medication. - Hanging. - Jumping. - Head-banging. - Stabbing oneself in the chest. - Drowning. - Electrocution. - Burning. - Gouging out ones’ eye. - Self-circumcise. - A relief. - An expression of self-hatred. - A response to mental health problems.

2. Andover et al. (2010)

United States of America

- 103 undergraduate students (men and women) participated. Nearly half were male (45.6%, n = 47). The majority was Caucasian (71.8%, n = 74). The mean age was 18.49 (SD 1.03). Forty-seven percent (n = 48) reported a history of non-suicidal self-injury; 39.6% of those were male (n = 19). - Non-clinical sample. - Quantitative design. - Self-mutilative behaviours interview. - Frequency of activities scale. - Symptom checklist-90-revised. - Statistical analysis. Defined as deliberate harm to the body without suicidal intent and can incorporate behaviours such as cutting, burning, carving, scratching or skin-picking. - The most common method reported among men was self-hitting. - Men were significantly more likely than women to report burning behaviours. - No gender differences in methods: carving, intervening with wound healing, needle sticking and self-hitting. - Subjective reporting of physical pain. - Men report a greater sense of control over non-suicidal self-injury than women.

3. Bennet and Moss (2013)

United Kingdom

- Four male prisoners (23–34 years) who had met the criteria for dangerous and severe personality disorder and had PCL-R scores in at least 95th percentile. - High-secure units. - Small-scale case study design. - In-depth interviews. - Interpretative phenomenological analysis. Defined as deliberate self-injury where an individual purposefully and directly injures themselves without the intention of ending their life. - Varying levels of insight into their deliberate self-injury. - Turbulent relationship within family. - Unstable family-life. - Family with violence and criminal behaviour. - Subjected to emotional, violent and sexual abuse. - Antisocial peers. - Children's home and foster placement. - Truanted from school. - Alcohol abuse. - Own criminal behaviour. - Chaotic lifestyle. - An unsettled lifestyle. - Scratching. - Cutting. - Swallowing objects. - Banging body parts. - Ingesting harmful objects. - Mutilating body parts. - Burning. - Object insertion into chest and penis. - Not eating. - To torment oneself with core-beliefs of worthlessness as emotional pain. - Punching oneself. - Deliberate self-injury increased in severity, frequency, and methods. - Used harm-minimization techniques to control the frequency and depth of cuts. - Fascinated by the sight of blood. - Being in a relationship reduced self-injury, equated to never being alone with problematic emotions. - Self-punishment as comfort. - As anger relief for mother's violence. - Self-hate. - Feeling no pain. - Telling oneself one is useless and worthless. - A limited amount of control when in prison, could only control deliberate self-injury as a private experience. - Feel comfortable with self-harm. - Deliberate self-injury as a valued possession, a cherished belonging. - Feeling better when relieving anger due to deaths in family. - An alternative to being aggressive toward people or objects when angered. - Attention seeking. - Sensation seeking, felt nice, an adrenaline kick, became addicted to it. - Proud of having status as a self-harmer.

4. Bresin and Schoenleber (2015)

United States of America

- 116 papers. - Included studies are from: United States of America, Europe, Canada, Australia, New Zealand, China, Japan and Indonesia. Defined as purposeful acts of self-inflicted physical harm with the potential to damage body tissue but performed without the intent to die. - Burning. - Banging one's head. - Pinching. - Punching. - Cutting - Biting - Scratching, - Hair pulling - Wound healing.

5. Carli et al. (2010)

Italy

- 1265 males. - Penitentiary institutions. - Quantitative design. - Diagnostic psychiatric interviews based on the Italian version of the structured Mini - International - Neuropsychiatric Interview to discriminate between - suicide attempters, suicide ideators and self-mutilators. - Barratt Impulsivity - Scale. - Childhood Trauma - Questionnaire. - Eysenck Personality - Questionnaire. - Connor-Davidson - Resilience Scale. - Brown-Goodwin - Assessment for - Lifetime History of - Aggression. - Buss and Durkee - Hostility Inventory. - Descriptive statistics and - Binary logistic regression

Self-mutilators were defined as those without a history of suicide attempt or suicide ideation.

Suicide attempt was defined as an act of self-harm with intent to die that was not self-mutilatory in nature.

Suicide ideators were defined as a separate group of people, the ones who had thoughts about committing suicide.

High-impulsive subjects were:

- Younger. - More often single. - More prominent psychoticism, extraversion, aggression, hostility and resilience capacity. - More frequently diagnosed with substance use disorders and engaged in self-mutilating behaviour. - More prone to suicidal behaviour.

6. Claes et al. (2012)

Spain

- 130 male patients with eating disorders. - Mean 26.10 years.

Department of Psychiatry, University Hospital of Bellvitge, Barcelona.

- Quantitative design. - Listing of 10 impulse-control problems (including non-suicidal self-injury). - The eating disorder inventory. - The symptom checklist-90-revised. - The temperament and character inventory. - Statistical analysis/multivariate analysis of variance and Chi-square test statistic. Defined as any socially unaccepted behaviour involving deliberate and direct injury to one's own body surface without suicidal intent, such as cutting, carving and burning of the skin. - Cutting. - Carving. - Burning of the skin.

7. Evren et al. (2012)

Turkey

- 200 male substance-dependent inpatients. - Bakirkoy state hospital for psychiatric and neurological diseases, alcohol and drug research treatment and training centrer in Istanbul. - Quantitative design. - Interviews conducted after detoxification period, 3 to 4 weeks after the last day of alcohol use and 2 to 3 weeks after the last day of drug use. - Self-mutilative Behaviour Questionnaire. - Childhood Trauma Reports. - Buss-Perry's Aggression Questionnaire. - State-Trait Anger Expression Inventory. - Beck Depression Inventory. - State-Trait Anxiety Inventory. - Descriptive statistics and backward logistic regression. Defined as self-mutilation: deliberate self-injury to body tissue without the intent to die. - Anger control. - Physical aggression. - History of childhood trauma such as physical abuse, emotional abuse, and sexual abuse. - Substance use (alcohol). - Self-cutting. - Hitting hard places with fist or head. - Burning with cigarette. - Pulling hair. - Emotional regulation - Reducing anxiety. - Control of anger and aggression - Self-punishment.

8. Gardner et al. (2016)

United Kingdom

- 179 adult male offenders. Mean age 37.7 and in prison between 1–10 years. - Prisons. - Quantitative design. - Self-report measures of non-suicidal self-harm. - Inventory of Statements About Self-injury comprises two sections which measures (1) the frequency of a range of non-suicidal self-harm behaviours over the person's lifetime, and (2) the function of non-suicidal self-harm. - Items from the Personality Diagnostic Questionnaire 4th Edition. - Suicide Behaviours Questionnaire-Revised. - Centrer for Epidemiologic Studies Depression Scale. - Descriptive Statistics. Defined as any deliberate self-injurious behaviour that does not involve suicidal intent, irrespective of degree of lethality. The definition included direct methods of self-injury vis-à-vis the skin and body, and self-poisoning, referred to as non-suicidal self-harm.

Intrapersonal:

- Affect regulation (releasing emotional pressure, reducing anxiety, frustration and anger). - Anti-dissociation. - Anti-suicide. - Marking distress. - Self-punishment (punishing oneself, expressing anger toward oneself, reacting to feeling unhappy or disgusted with oneself). - Autonomy. - Interpersonal: - Interpersonal boundaries (creating a boundary between oneself and others). - Interpersonal Influence (letting others know the extent of one's emotional pain, seeking care or help from others). - Peer bonding. - Revenge. - Self-care (creating a physical injury that is easier to care for). - Sensation seeking. - Toughness (seeing if one can stand the pain). - Banging or hitting self. - Hair pulling. - Pinching. - Cutting. - Biting. - Wound picking. - Severe scratching. - Rubbing skin against rough surfaces. - Burning. - Needle sticking. - Carving. - Swallowing dangerous substances. - Other.

9. Green et al. (2018)

United States of America

- 912 emerging adults, aged 18–24 years of which 32% were male.

Two college campus in the Northeastern United States.

- Quantitative design. - Deliberate Self-Harm Inventory. - Conformity to Masculine Norms Inventory–22-Item - Version. - Number of self-injurers known. - Positive and Negative Affect Schedule. - Harvard Department of Psychiatry/National Depression - Screening Day Scale. - Hierarchical logistic regression. Defined as the deliberate and self-inflicted damage to one's body tissue (e.g., cutting, burning) with the absence of suicidal intent. - A stronger adherence to masculine norms predicted chronic non-suicidal self-injury. - Cutting. - Punching a wall or object. - Burning with lighter/cigarette. - Carving pictures or design into skin. - Severely scratching. - Sticking sharp objects into skin. - Banging head against something. - Preventing wounds from healing.

10. Kimbrel et al. (2014)

United States of America

- 214 treatment-seeking male U.S. - Iraq/Afghanistan-era veterans. The sample consisted of Caucasian (55.1%, n = 118), African American (39.7%, n = 85), and Latino (5.6%, n = 12). - On average, participants were 32.99 years of age (SD 8.91). - The Durham Veterans Affairs Medical Centrer PTSD Clinic. - Cross-sectional study. - Habit Questionnaire. - Analyses were limited to the 4-item Deliberate Self Harm (DSH) subscale of the Habit Questionnaire, which included the following items: (1) “Have you ever scratched or picked at skin so that it left a mark?” (2) “Have you ever deliberately cut yourself in any way?” (3) “Have you ever hit yourself?” and (4) “Have you ever burned yourself with a cigarette, match or other way?” - Clinician-Administered PTSD Scale. - Beck Depression Inventory-II. - Combat Exposure Scale. - Descriptive statistics, and logistic regression. Defined as deliberately destroying one's own body tissue without conscious suicidal intent. - Any type of deliberate self-harm. - Scratching/picking oneself. - Hitting oneself. - Burning oneself. - Cutting oneself.

11. Kimbrel, Calhoun, et al. (2017)

United States of America

Defined as the act of deliberately destroying one's own body tissue without conscious intent

to die and for reasons that are not socially sanctioned. Common methods include cutting, scratching, and burning oneself.

Most common but often not included/mentioned in risk assessment with questionnaires or interviews:

Sometimes used:

- Cutting - Burning - Scratching.

12. Kimbrel, Wilson, et al. (2017)

United States of America

- 140 males from a previously used dataset (in total 186 recruited through mailings, advertisements, and recruitment by Veteran's Administration healthcare providers) of Iraq/Afghanistan-era veterans. On average, participants were 40.2 (SD 10.0) years of age.

The majority was White (68%) and non-Hispanic (85%).

Instruments:

- Adult ADHD Self-Report Scale. - Deliberate Self-Harm Inventory. - Clinician-Administered PTSD Scale for DSM-IV. - Diagnostic interview: - Mini International Neuropsychiatric - Interview for DSM-IV. - Chi-square tests and logistic regression. Defined as the act of intentionally destroying one's own body tissue without suicidal intent for reasons that are not socially sanctioned. - Attention deficit hyperactivity disorder symptoms were independently associated with increased risk for non-suicidal self-injury in male veterans, above and beyond the effects of post-traumatic stress disorder, depression and alcohol-use disorder.

13. Mackie et al. (2017)

Canada

- 7 adult men with intentional self-harm were included and 6 of them participated in the interview. Between 19–41 years of age (M = 27). - Hospital emergency department in Ottawa. - Mixed method. - Semi-structured qualitative interviews. - Patient Health Questionnaire (PHQ-9). - Recorded any adverse events including further episodes of self-harm during the therapy. - Thematic grounded theory approach. - Descriptive statistics. Defined according to the National Institute for Health and Care Excellence guidelines, referring to any act of self-poisoning or self-injury carried out by a person, irrespective of their motivation. - Cutting. - Overdose of medication. - Substance abuse. - Computerized therapy: 6–10-week face-to-face therapy with a smartphone. - Baseline intake appointment had a mean PHQ-9 score of 18.3 (SD 5.5), indicating moderately severe depression. - At their final face-to-face PST session, participants reported a mean PHQ-9 score of 13.7 (SD 10.0). - At the final study visit, three participants had improved by 50% or more or scored less than 10 on the PHQ-9. - There were no repeat presentations to hospital with self-harm during the study.

14. Marzano et al. (2015)

United Kingdom

- 15 officers, 13 nurses (4 general nurses, 6 mental health nurses, 2 substance misuse nurses, 1 substance misuse and mental health nurse), and 2 doctors (general practitioners). - A local prison in the Southeast of England (large and overcrowded local establishment, with a predominately male staff sample). - Qualitative design. - Semi-structured face-to-face interviews. - Thematic analysis. Defined as repeated self-harm, without apparent suicidal intent. - Attention seeking. - A cry for help. - Manipulate staff. - Lack of resources and skills. - Feeling powerless: Not being able to decide how to respond to their behaviour. - Medication/ medicalization. - Lack of ability and understanding. - Intolerance; staff angry, cynical and blasé.

15. Morales and Guarnero (2014)

United States of America

- 42 adult males of which 40% were Hispanic (n = 17) and 60% were non-Hispanic (Caucasian n = 15, African American n = 6, American Indian n = 4). Mean age 36.9 years. - Three New Mexico prisons. - Quantitative design. - Deliberate self-harm inventory. - Self-injury motivational scale-II. - Demographic questionnaire. - Descriptive statistics. Defined as synonymous with self-mutilation, which is defined as the deliberate destruction or alteration of body tissue without conscious suicidal intent. - Self-stimulation.

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