What Do We Mean by Self-Harm Ideation? A Scoping Review of More Than 30 Years of Evidence.

OBJECTIVE: Attention has been given on the terminology used for suicidal behaviors, however, there is paucity of research on the terminology used for those with thoughts of self-harm and this is imposing a risk of overlooking sub-groups within the suicidality spectrum. This review therefore aimed to map the existing evidence on the conceptualization and measurement of self-harm ideation. METHOD: A two-stage search strategy was employed. In stage one, MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science Core Collection were searched were searched in June 2020 for records published from database inception onwards, using database-specific index terms and title/abstract keywords related to self-harm ideation/thoughts. In stage two (2020-2025), a targeted title only search was conducted to identify studies explicitly foregrounding self-harm ideation. Data were synthesized using descriptive narrative methods. RESULTS: The majority of studies (68%) used standardized instruments, most commonly items embedded within broader mental health scales, particularly item 9 of the Patient Health Questionnaire-9 (PHQ-9) and item 10 of the Edinburgh Postnatal Depression Scale (EPDS) in female perinatal samples. A smaller number of studies used the Self-Injurious Thoughts and Behaviors Interview (SITBI) items assessing non-suicidal self-injury thoughts. Publication output increased substantially after 2013 and was largely concentrated in high-income Western countries. Across all years examined, explicit use of the terms self-harm ideation or thoughts in titles remained consistently low (10%). CONCLUSIONS: Future research should prioritize participatory approaches involving clinicians and individuals with lived experience to refine the terminology surrounding self-harm ideation and support more accurate identification and targeted prevention strategies.