• Mairead Ann Hughes, Susan Frances Knowles, Katie Dhingra, Hannah Louise Nicholson, and Peter James Taylor.
• Department of Clinical Psychology, University of Liverpool, UK.
• Br J Clin Psychol. 2018 Nov 1; 57 (4): 491-513.

BackgroundRates of self-harm and suicide are increasing in young people. The literature suggests that individuals who identify with alternative subcultures (e.g., Goth) may be at a greater risk.ObjectiveTo explore the prevalence of self-harm and suicide in alternative subcultures and the factors that might contribute to this increased risk.MethodUsing a systematic strategy, the databases PsycINFO, Scopus, MEDLINE and Web of Science, and the E-Thesis online service (ETHOS) were searched for English language only papers, with no restrictions in terms of date of publication. Papers were selected that included data on the relationship between either alternative subculture identity (e.g., Goth) or preference for alternative music (e.g., Heavy Metal) and self-harm or suicide. Ten quantitative papers were included: seven cross-sectional, two longitudinal and one cross-sectional state-level comparison study. Two qualitative papers were also included. Studies were assessed by two reviewers for risk of bias.ResultsThe findings indicated that individuals who associated with alternative subcultures were at a greater risk of self-harm and suicide. Whilst qualitative papers identified potential mechanisms (e.g., exposure to self-harm and the way self-harm is presented or normalized), there remains limited support for these mechanisms.ConclusionsMore research is required to understand the association between self-harm, suicide and alternative subculture affiliation, and the factors underlying it. Longitudinal studies and studies focusing on mechanism are particularly important.Practitioner PointsThe review supports the suggestion that those who identify as belonging to an alternative subculture may be at a higher risk of self-harm and suicidal behaviour. It also presents preliminary evidence that alternative affiliation predicts self-harm over time, and that this effect holds whilst adjusting for a number of likely confounders. The findings highlight the importance of increasing the awareness of the victimization and potential risk that these groups hold and suggests areas for intervention in health, educational, and social services. The review does not, however, indicate specifically what it is about alternative subculture affiliation (or alternative music preference) that could contribute to the risk of self-harm. Consequently, studies with a greater focus on mechanisms are needed. Methodological limitations (e.g., cross-sectional studies, small sample of 'alternative' participants, westernized samples) restricted the reliability and validity of the results which impacted on the extent to which the findings could be generalized more widely.© 2018 The British Psychological Society.

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