Experiences and Perceptions of Self-Harm in Rural-Dwelling Adults: A Rapid Review of Qualitative Evidence.

backgroundSelf-harm is associated with factors that are relevant to and exacerbated by rurality. Living in rural areas may intensify existing socio-economic disadvantages linked to service access, employment opportunities, transport conditions and risks from hazardous environments. Geographical isolation and fragmented social networks, particularly those related to family, are also common among rural residents. Rurality is therefore likely to shape experiences of mental health problems, including self-harm. However, this literature has not been synthesised.

aimTo synthesise current qualitative evidence on the experiences and perceptions of self-harm among rural-dwelling adults and care providers' perspectives and to identify knowledge gaps. APPROACH: Rapid review of qualitative evidence identified via relevant electronic literature databases. Thematic synthesis was used to compare findings on perceptions and experiences of self-harm in rural areas. Confidence in synthesis findings was assessed using GRADE-CERQual.

findingsSearches identified 1673 unique references, of which 14 were included in the final synthesis. Two themes were generated with high to moderate confidence: 'experiences of rural self-harm' with two subthemes 'reasons for self-harm' and 'perceptions of self-harm', and 'access to healthcare' with two subthemes: 'healthcare practitioners' perceptions of rural self-harm' and 'lack of support and resources'. Various reasons and motivations for self-harm were identified; stigma was commonly reported. Services for rural residents who self-harmed were difficult to access. Healthcare practitioners in these areas may lack adequate training, which may maintain stigmatised views.

conclusionThe review identified shared experiences and motivations for self-harm across different rural contexts globally. Perceptions of self-harm by people with lived experience, family and healthcare professionals reflected stigmatised views, which impacted access to and provision of care. Experiences and perceptions of self-harm reported in the literature are somewhat overshadowed by data on suicide and suicide behaviours. Methodological implications are noted in terms of the complexity of extracting data about self-harm. Future research would help inform intervention development for people who are at risk of self-harm, to support healthcare practitioners to improve awareness and identify best practices to support those who self-harm. PATIENT OR PUBLIC CONTRIBUTION: Patient and public involvement was integrated at various points throughout the study, including reviewing themes, supporting the writing up of findings and a review draft and final manuscripts.