| Summary: | This thesis focuses on the relationship between young people who affiliate with alternative subcultures and self-harm and/or suicide. Alternative subcultures can be described as groups that are distinct from 'mainstream' cultures. Affiliation with such groups can be broadly defined as having a strong collective identity to a group with specific values and tastes, typically centred around music preference, clothing, hairstyles, make-up, tattoos and piercings (Greater Manchester Police; GMP, 2013; Moore, 2005). Some alternative subcultures have also been associated with 'dark, sinister and morbid' themes, such as Goths, Emos, and Metallers (Young, Sproeber, Groschwitz, Preiss, & Plener, 2014). Self-harm can be defined as the deliberate act of harming oneself, with or without suicidal intent. This commonly involves cutting and self-poisoning (NICE, 2013). Other behaviours that can be described using this term include non-suicidal self-injury (NSSI; the intentional destruction of body tissue without suicidal intent) and suicidal behaviours such as suicidal ideation and attempts (self-harm with some intent to die; Klonsky & Muehlenkamp, 2007; Nock, Borges, Bromet, Cha, Kessler, & Lee, 2008). Some would argue that NSSI is distinct from self-harm, and as such it features as a disorder in the DSM-V as Non-Suicidal Self-Injury Disorder (NSSID; APA, 2013), however there remains some controversy over the latter (Kapur, Cooper, O'Connor, & Hawton, 2013). The associations between alternative subgroup affiliation and self-harm and/or suicide were explored through a systematic review and empirical research study using quantitative methodology. It is well documented in the literature that the prevalence of self-harm and suicide is particularly high in adolescents and young adults, with suicide being one of the leading causes of death in this population (Hawton, Saunders, & O'Connor, 2012; WHO, 2014). Self-harm has become a clinical and public health concern with up to 30,000 adolescents receiving hospital treatment each year (Hawton, Rodham, & Evans, 2006) and prevalence rates rising to between 7-14% for young people in the UK (Hawton & James, 2005; Skegg, 2005; Swannell, Martin, Page, Hasking, & St John, 2014). Minority groups are another population who appear to have elevated rates of self-harm, including Lesbian Gay Bisexual and Transgender (LGBT; Jackman, Honig, & Bockting, 2016), ethnic minorities (Bhui, McKnezie, & Rasul, 2007) and alternative subcultures (Young et al., 2014). However, there is a paucity of research into the latter population. This presented a gap to conduct a systematic review of the available literature in an attempt to understand the association between alternative subculture affiliation and self-harm and suicide. Chapter 1 describes the systematic process taken in an attempt to understand the links between alternative subculture affiliation and both self-harm and suicide. Ten studies were included which focused on self-harm and/or suicide and alternative identity through subculture affiliation (e.g. Goth) or music preference (e.g. Heavy Metal). The results indicated that there is an association between alternative subculture affiliation and self-harm and suicide, though the lack of research in the area and methodological limitations impact on the extent to which the underlying mechanisms can be understood. Leading on from the systematic review, Chapter 2 presents the empirical study which investigated the factors that might contribute to the increased risk of NSSI in alternative subcultures, specifically focusing on variables that have been found to be linked to NSSI in young people; emotion dysregulation, depression, identity confusion and exposure to self-harm. The aim of this study was to increase our understanding of the mechanisms involved that might explain this increased risk of NSSI. Alternative subcultures were found to be at a greater risk of NSSI in comparison to affiliations with other subcultures, though this association lessened when the other variables were accounted for. A key predictor of NSSI in this population was emotion dysregulation. The findings highlight the importance of raising awareness of the potential risk of self-harm/suicide in alternative subcultures in order to create a greater understanding and direct resources appropriately.
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