Friendships May Shape Self-Harm Risk and Support in Youth

Friendships can strengthen well-being and provide vital support during emotional distress, but a systematic review finds that peer relationships may also shape self-harm risk and affect the mental health of young supporters.

Can a friendship protect a young person from self-harm or unintentionally deepen vulnerability? Research suggests both possibilities, depending on the quality of the relationship, exposure to a peer’s distress and access to responsible adult or professional support.

Psychological research has long associated stable, supportive friendships with better well-being, lower depression risk and healthier responses to stress. For adolescents and young adults, friends are also often the first people trusted with difficult thoughts or disclosures.

A systematic review published in The Lancet Psychiatry shows why this closeness matters. Friends can provide vital emotional support, but peer relationships may also influence self-harm thoughts and behaviour, while young supporters can experience serious emotional strain themselves.

Healthy Friendships Can Buffer Stress and Depression

An American Psychological Association report summarising friendship research describes high-quality social connections as important contributors to well-being across the lifespan. Supportive friends can offer companionship, emotional validation and practical help during stressful periods.(1^✔ ✔Trusted Source
Effectiveness of psychological interventions in prison to reduce recidivism: a systematic review and meta-analysis of randomised controlled trials

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Research cited by the APA also suggests that the presence of a supportive friend can reduce physiological responses to stress. During adolescence, close friendships can help young people practise empathy, self-disclosure, help-seeking and the exchange of social support.

“Having a close friend to turn to seems to be a buffer or protective factor.” – says Catherine Bagwell, PhD, Davidson College

These benefits are not automatic. Relationship quality matters, and a friendship can become strained when one person is expected to carry more emotional responsibility than they can safely manage.

Review Examines 90 Articles on Friendship and Self-Harm

Researchers searched 11 academic databases from their inception to April 2024 for studies linking friendships or peer relationships with self-harm thoughts and behaviour among people aged 11 to 25 years. The final synthesis included 90 articles, with most evidence coming from adolescents aged 11 to 18 years.

The included samples involved mixed genders but were predominantly White. The studies also differed widely in design and in how they defined or measured friendship, self-harm, non-suicidal self-injury, suicidal thoughts and suicidal behaviour.

Self-harm and suicide attempts are not interchangeable. The review used a broad umbrella because definitions vary between countries and studies; every disclosure of self-harm, however, warrants a serious and compassionate response.(1^✔ ✔Trusted Source
Effectiveness of psychological interventions in prison to reduce recidivism: a systematic review and meta-analysis of randomised controlled trials

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Peer Support Can Be Protective and Complicated

Across the reviewed literature, friends and peers were important sources of support for young people experiencing self-harm thoughts or behaviour. Their attitudes toward self-harm and suicide often shaped whether they responded with understanding, avoidance, judgement or help-seeking.

The review also found that characteristics of friends, including their own self-harm thoughts or behaviour, were associated with and sometimes predicted self-harm outcomes in the individual being studied. Possible explanations include peer influence and the tendency for young people with similar experiences to become friends.

However, clustering within friendship groups does not prove that one young person caused another’s behaviour. The authors found limited evidence on causal mechanisms and called for research capable of separating peer selection from direct social influence.

Young Supporters May Carry a Hidden Mental Health Burden

Friends who support a young person who self-harms can feel frightened, responsible, helpless or uncertain about what to do. Studies of friend supporters and young people bereaved by a friend’s suicide reported symptoms of depression, anxiety, post-traumatic stress and grief, alongside difficult emotions.(1^✔ ✔Trusted Source
Effectiveness of psychological interventions in prison to reduce recidivism: a systematic review and meta-analysis of randomised controlled trials

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“Self-harm often starts during adolescence.” – says Delfina Bilello, lead review author

Women and girls appeared more likely to be exposed to friends’ self-harm, to take on a support role and to report negative outcomes. The researchers cautioned that underreporting among boys, men and gender-minority groups could partly explain this pattern.

The findings support a simple but often missed principle: when a young person tells an adult that a friend is self-harming, support should extend to the person making the disclosure as well as to the friend at risk.

Peer Support Cannot Replace Professional Help

A caring friend can listen without judgement, encourage the young person to speak with a trusted adult or mental-health professional and remain supportive during help-seeking. They should not be expected to diagnose risk, provide therapy, monitor someone continuously or keep dangerous information secret.

World Health Organization guidance emphasises early identification, assessment, follow-up care and support for everyone affected by suicide and self-harm. Teachers, health workers and other trained gatekeepers can help connect a distressed young person with appropriate care.

If a young person is in immediate danger or has a serious injury, local emergency services should be contacted. For non-immediate concerns, a parent or guardian, school counsellor, doctor or qualified mental-health professional should be involved as soon as possible.

Schools Should Build Safer Peer-Support Systems

As young people frequently confide in friends before approaching adults, schools and community programmes need clear pathways for safe disclosure and referral. Peer-support initiatives should include training, adult supervision, confidentiality boundaries and routine check-ins for the supporter.

The review did not formally test interventions, but it identified promising directions such as universal programmes on healthy relationships and peer support, targeted help for young supporters and structured care for friends bereaved by suicide.

Peer involvement can strengthen prevention when it connects young people to care. It becomes unsafe when friendship is treated as a substitute for professional assessment or when supporters are left alone with responsibility for another person’s safety.

Findings Show Associations, Not Proven Causation

The review organizes a large and complex body of evidence, but it does not show that friendship characteristics directly cause or prevent self-harm. Differences in study methods, measures and populations limit the strength and generalizability of the conclusions.

Most evidence came from adolescents and predominantly White samples, leaving important gaps involving younger children, young adults, diverse cultures, boys and men, gender-minority groups and low- and middle-income settings.

Future studies will need longitudinal designs, social-network methods and carefully evaluated interventions to determine which friendship processes increase risk, which provide protection and how both members of a friendship can be supported safely.

Friendship Helps, but Professional Care Remains Essential

Healthy friendships can create belonging, reduce isolation and make it easier for a young person to disclose distress. The new synthesis also shows why friends need reliable adults and services behind them when self-harm enters the relationship.

The most effective response is not to discourage close friendships, but to strengthen them with mental-health literacy, clear referral routes and support for the supporter. Friendship can open the door to help; trained care must take responsibility for assessment and treatment.

References:

1. Effectiveness of psychological interventions in prison to reduce recidivism: a systematic review and meta-analysis of randomised controlled trials- (https://www.sciencedirect.com/science/article/pii/S221503662100170X)

Source-Medindia