Psychological Experience and Coping Strategies of Caregivers for Chinese Adolescents With Non-Suicidal Self-Injury: A Meta-Synthesis of Qualitative Studies.
Abstract
BACKGROUND AND AIMS: Non-suicidal self-injury (NSSI) among adolescents, including those with comorbid affective disorders, imposes substantial psychological distress and caregiving burden in mainland China. This qualitative meta-synthesis aimed to systematically synthesize evidence regarding the psychological experiences, coping strategies, and support needs of caregivers of adolescents with NSSI in mainland China to inform culturally adapted, family-centered interventions. METHODS: Guided by ENTREQ and PRISMA 2020 guidelines, seven English and Chinese databases (PubMed, Embase, Web of Science, Scopus, CNKI, CBM, Wanfang Data) were systematically searched from inception to July 29, 2026. Qualitative studies examining caregivers of adolescents (aged 8-18 years) with NSSI in mainland China were included. Quality was appraised using the Joanna Briggs Institute checklist, and data were synthesized using Thomas and Harden's thematic synthesis approach. RESULTS: Twenty studies involving 322 caregivers were synthesized. Caregivers of adolescents with NSSI in mainland China were interpreted as undergoing a dynamic, iterative pattern of psychological distress across three analytical themes: (1) Moral panic and self-attribution of blame, where initial crisis and moral self-blame induced stigma and delayed formal help-seeking; (2) The tug-of-war between safety surveillance and family autonomy, characterized by hypervigilance and a fear-driven coping cycle involving verbal aggression, coercive restraint, and blind indulgence; and (3) Institutional isolation and relapse trauma, marked by school rejection, service fragmentation, and survival achieved by recalibrating goals to negotiated, limited stability. CONCLUSION: Caregivers navigate a trajectory of accumulating distress shaped by moral reasoning, fear-based reactivity, and institutional invalidation. Clinical pathways should integrate routine caregiver assessments, phase-matched psychoeducation and skills training, and cross-sector collaboration to address caregiver isolation.
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