By Alex Fradera

Every year three quarters of a million people take their own lives, and suicide is the leading cause of death in adolescents. Non-lethal self-harm is also prolific, leading annually to around 300,000 UK hospital visits, with even more going unreported. Knowing who is at most risk can inform support and prevention efforts. The higher rates of self-harm in LGBT and minority groups are well-established, and now a new review article in the British Journal of Clinical Psychology identifies other groups, including goths, emos and metalheads, who may also be at increased risk.

The British team, led by Mairead Anne Hughes at the University of Liverpool, searched both quantitative and qualitative papers on suicide and self-harm to find those that measured affiliation to a subculture – defined as marking oneself out through particular clothes, makeup, body art and musical preferences. They identified ten relevant papers, all but one involving people under 24.

In the quantitative research, a number of studies categorised participants based purely on their musical preferences (for example, based on subscriptions to Metal Edge magazine). These studies showed small associations between being a heavy metal fan and greater suicidal ideation and risk. However, in the one study that accounted for potential confounders, like having a negligent father and substance use, the link disappeared.

Looking at alternative subculture membership more generally, the team found two studies suggesting that moderate or stronger identification with a subculture is associated with a three times higher risk of self-harm and six times higher risk of suicide.

One explanation could simply be that people who self harm are more likely to gravitate to these subcultures. Consistent with this interpretation, the studies found associations between subculture membership and various pre-existing adversities, including bullying, difficult family relationships, and emotional and behavioural difficulties. On the other hand, several studies found that controlling for these pre-existing adversities did not eliminate the sub-culture/self-harm association.

Even stronger evidence comes from a longitudinal study of around 4,000 young people that found as participants became more affiliated with the subculture, their odds of self-harm increased, even after adjusting for factors like previous depression, victimisation, and history of self-harm. So this makes it unlikely that the sub-culture association with self-harm could be due entirely to selection effects.

This leaves two other major explanations. One is that self-harm is the consequence of the unasked for social consequences of being an emo, goth, or metaller – such as stigma, hate crime, and victimisation. The other is that subculture membership, by its very nature, encourages self-harm by modelling these behaviours in lyrics and through the example set by leading figures.

Two qualitative papers explored this latter possibility, based on analysis of internet forum comments and on interviews with emo adolescents. Their conclusions support the idea that self-harm and suicide are accepted and normalised in these subcultures, including praising of acts of self harm. But Hughes and her colleagues wondered if the data could have been interpreted differently, and they noted that online chat forums have a “performative quality” that doesn’t always give the best sense of what is really going on in people’s lives. Also, it’s worth noting that a fascination with suicide and self-harm can also be found in mainstream culture, such as in the recent Netflix hit 13 Reasons Why.

As someone who grew up in alternative subcultures I can see the reasons for concern about contagion and modelling. I remember the breathless reporting around Manic Street Preachers’ guitarist Richey Edward’s cutting, and the preoccupation with the destruction of the body found in my industrial music. But what resonates with me even more is when Hughes and her colleagues note how alternative culture uses morbid imagery and content in a self-aware, playful and even deflationary way. For instance, they may be dark, but the songs on From Here to Infirmary by punk/emo band Alkaline Trio, are as wry as the title. Talking about ugly or dangerous thoughts can put them into perspective, and to laugh at it can banish it. As we’ve reported before, there is evidence that having heavy metal in your life can actually be a protective factor.

Based on their current research review, Hughes and her team conclude that “there is currently not adequate evidence to draw conclusions that these alternative subcultures themselves are in any way harmful.” But being a member is associated with elevated risks, some of which accrue over time, which is enough of a reason to give it our attention. This could be through addressing stigmatisation; providing education for people who work with youth from these groups about warning signs and routes for accessing support; and providing psychology services that appeal to people who may be anti-establishment in temperament, but who could do with help in processing what they need to sort through.

—This corrosion: A systematic review of the association between alternative subcultures and the risk of self‐harm and suicide

Alex Fradera (@alexfradera) is Staff Writer at BPS Research Digest