New Review Will Map How Teens Who Self-Harm Choose to Speak Up

Researchers at the Chongqing Mental Health Center in China have registered a detailed plan for a qualitative systematic review that will pull together, for the first time in a structured meta-aggregation, the first-person accounts of adolescents who have voluntarily told someone about their non-suicidal self-injury. The protocol, published in Frontiers in Public Health, lays out how the team will search, appraise, and synthesize qualitative studies describing what it feels like to disclose self-injury, what holds teenagers back, and what helps them go through with it. The review itself has not yet been conducted; formal searches had not been executed as of the protocol’s publication, and the registered plan describes methods rather than findings.

Non-suicidal self-injury, commonly abbreviated NSSI, refers to the intentional and direct damage of one’s own body tissue without suicidal intent and for purposes that are not socially sanctioned. Typical forms include cutting, hitting, and burning. Clinicians understand the behavior as a maladaptive strategy for regulating negative emotions, easing psychological distress, or punishing oneself. The DSM-5 lists NSSI as a condition proposed for further study, deliberately separated from suicidal behavior and from broader self-harm constructs, a distinction the review team treats as central to its eligibility rules.

The scale of the problem among young people is substantial. A global lifetime prevalence of approximately 17.7 percent has been reported for adolescents, with the behavior typically beginning around age 12, peaking during middle adolescence between 14 and 16, and often declining after 18. The consequences extend beyond visible wounds: NSSI commonly co-occurs with depression and substance use problems and is associated with later suicidal thoughts and behaviors. In a longitudinal meta-analysis cited by the protocol, a history of NSSI was associated with a weighted mean odds ratio of 4.27 for a subsequent suicide attempt. Despite this clinical weight, the behavior is frequently hidden behind secrecy, shame, and social stigma.

Disclosure, in principle, opens a door. Positive disclosure experiences have been linked in prior research to emotional relief, social connectedness, access to support, and motivation to reduce self-injury, and telling someone can also chip away at internalized stigma. Yet fewer than half of adolescents who engage in NSSI ever disclose the behavior, and an even smaller proportion seek professional help. That gap between potential benefit and actual disclosure is precisely what the Chongqing team wants to understand, treating disclosure not as a single event but as a complex, highly individualized process shaped by emotion and circumstance.

The theoretical backbone of the planned synthesis is the Disclosure Processes Model, which frames disclosure as a dynamic sequence of antecedent goals, the disclosure event itself, and post-disclosure outcomes. Applied to NSSI, the model suggests adolescents weigh approach-oriented goals, such as obtaining support, emotional relief, and understanding, against avoidance-oriented goals, such as dodging stigma, sparing others a burden, or keeping control over treatment decisions. How recipients respond, and how the adolescent experiences that response, may then shape whether, when, how, and to whom they disclose next. The authors note, however, that the model was built for concealable stigmatized information in general and was not designed specifically for adolescents, so it may not fully capture developmental needs, confidentiality worries, perceived loss of autonomy, or sociocultural context.

Quantitative studies have mapped associations between disclosure and variables such as NSSI frequency, severity, and demographics, but the protocol argues that such variables alone cannot capture the emotional trade-offs and interpersonal dynamics involved in telling a peer, a parent, or a clinician. A preliminary search of PubMed, the Cochrane Database of Systematic Reviews, and JBI Evidence Synthesis in March 2026 identified three relevant reviews, each with gaps. Simone and Hamza summarized disclosure rates, recipients, barriers, facilitators, functions, and outcomes across adolescent and young adult populations but integrated heterogeneous evidence narratively without synthesizing first-person adolescent accounts. Hon and colleagues mapped social-cognitive factors such as disclosure self-efficacy and outcome expectancies in a scoping review but did not critically appraise or meta-aggregate lived experiences. Lewis and Seko examined online NSSI activities, including emotional self-disclosure and peer interaction, but their broad digital focus did not examine voluntary disclosure across both online and offline settings.

The planned review will follow Joanna Briggs Institute guidance and has been prospectively registered in PROSPERO under identifier CRD420261355173. Eligible participants are adolescents aged 10 to 19, consistent with the World Health Organization definition, who have voluntarily disclosed their own NSSI at least once. Voluntary disclosure is defined broadly: an adolescent’s intentional communication about their self-injury to a person, group, or online audience without coercion, whether spontaneous or prompted, direct or indirect, verbal or nonverbal, face-to-face, digital, or anonymous. Prompted, observation-triggered, and research-interview disclosures count when communicative intent is clear, though research-context episodes will be coded separately. Accidental discovery, third-party reporting, and compelled acknowledgment are excluded, and findings with unresolved suicidal, mixed, or ambiguous intent will be filtered out.

On the evidence side, the team will accept primary qualitative studies, including phenomenology, grounded theory, ethnography, narrative inquiry, and descriptive qualitative work, as well as separately extractable qualitative components of mixed-methods research. Searches will span PubMed, Embase, APA PsycINFO, CINAHL, Scopus, and Web of Science Core Collection, plus the Chinese databases CNKI, Wanfang Data, and the Chinese Biomedical Literature Database, with coverage from database inception through 31 March 2026 and no language restrictions. Gray literature, reference lists, forward citations, and dissertation repositories round out the search. Two human reviewers will independently screen records, with calibration targets requiring at least 80 percent raw agreement and a Gwet’s AC1 of at least 0.80 before formal screening begins, and machine learning tools will not be allowed to prioritize records or recommend eligibility decisions.

Methodological quality will be appraised with the JBI Critical Appraisal Checklist for Qualitative Research, examining congruity, participant voice, researcher reflexivity, and ethics, though no study will be excluded solely for low quality. Findings will be rated Unequivocal, Credible, or Unsupported based on their fit with supporting participant illustrations, and only the first two categories will enter the JBI meta-aggregation, in which reviewers group findings by similarity of meaning and aggregate categories into synthesized findings while preserving context. Confidence in each synthesized finding will be graded with ConQual, starting at High and downgraded for dependability and credibility, with a floor of very low. Only after synthesis is complete will findings be mapped onto Disclosure Processes Model concepts for interpretation, a sequencing choice designed to keep the theoretical framework from distorting the underlying data.

The authors are candid about the protocol’s limitations. Studies that mix suicidal and non-suicidal self-injury without clear separability will be excluded, shrinking the available evidence base, and because eligibility requires at least one voluntary disclosure, the review will not capture the perspectives of adolescents who have never told anyone, arguably the group where barriers matter most. Differences across disclosure recipients, settings, and sociocultural contexts may limit comparability, translation may flatten culturally specific meanings, and notably, no adolescents with lived experience, family members, or service-user representatives were involved in developing the protocol, a gap the team acknowledges may limit how well the review reflects the priorities of the young people it studies. If the synthesis succeeds, the team hopes it will help clinicians, school personnel, families, and policymakers identify the conditions under which teenagers feel safe enough to speak, and generate questions for future qualitative and intervention research.

Subject of Research: A qualitative systematic review protocol on voluntary disclosure of non-suicidal self-injury among adolescents

Article Title: Lived experiences, barriers, and facilitators of voluntary non-suicidal self-injury disclosure among adolescents who have disclosed: a qualitative systematic review protocol

Article References: He, X., Xu, X., Huang, H., Peng, J., Yang, B., & Huang, J. (2026). Lived experiences, barriers, and facilitators of voluntary non-suicidal self-injury disclosure among adolescents who have disclosed: a qualitative systematic review protocol. Frontiers in Public Health, 14, 1964572. https://doi.org/10.3389/fpubh.2026.1964572

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1964572

Keywords: non-suicidal self-injury, adolescents, disclosure, qualitative systematic review, JBI meta-aggregation, ConQual, Disclosure Processes Model, mental health, stigma, PROSPERO, systematic review protocol, adolescent health