Background: Rates of self-harm and suicide are increasing in young people. The literature suggests that individuals who identify with alternative subcultures (e.g. Goth) may be at a greater risk. Objective: To explore the prevalence of self-harm and suicide in alternative subcultures and the factors that might contribute to this increased risk. Method: Using a systematic strategy, the databases PsycINFO, Scopus, MEDLINE and Web of Science and the E-Thesis online service (ETHOS) were searched for English language only papers, with no restrictions in terms of date of publication. Papers were selected that included data on the relationship between either alternative subculture identity (e.g. Goth) or preference for alternative music (e.g. Heavy Metal) and self-harm or suicide. Ten quantitative papers were included; seven cross-sectional, two longitudinal and one cross-sectional state level comparison study. Two qualitative papers were also included. Studies were assessed by two reviewers for risk of bias Results: The findings indicated that individuals who associated with alternative subcultures were at a greater risk of self-harm and suicide. Whilst qualitative papers identified potential mechanisms (e.g. exposure to self-harm and the way self-harm is presented or normalised) there remains limited support for these mechanisms. Conclusions: More research is required to understand the association between self-harm, suicide and alternative subculture affiliation, and the factors underlying it. Longitudinal studies and studies focusing on mechanism are particularly important.