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Introduction
Non-suicidal self-injury (NSSI), defined as the direct and deliberate damage to one's body tissue for reasons other than to end one's life (International Society for the Study of Self-Injury, 2018), is a significant public health issue among young people worldwide. The onset of NSSI peaks in adolescence around the age of 14–15 (Gandhi et al., 2018), with pooled lifetime prevalence rates estimated in the 15.1–22.7% range among 12–18-year olds (Gillies et al., 2018). Although NSSI is often episodic, the 12-month prevalence is estimated to be 2–14% among emerging adults (Benjet et al., 2017; Serras, Saules, Cranford, & Eisenberg, 2010; Whitlock et al., 2011; Wilcox et al., 2012). For approximately 70% of adolescents in high-income countries (BLS, 2017; Roser & Ortiz-Ospina, 2013), the transition to emerging adulthood (18–29 years) coincides with college entrance. The college years constitute a unique period for personal growth characterized by exploration and opportunities in identity development, interpersonal and romantic relationships, and excitement about future occupational prospects (Arnett, 2015, 2016; Magolda & Taylor, 2016; Shulman & Connolly, 2013). However, this is also a period of heightened instability and uncertainty. Academic pressure, identity confusion, relationship concerns, financial hardship, and uncertainty about future employment can all combine to make this a stressful time (American College Health Association, 2018; Arnett, Žukauskienė, & Sugimura, 2016; Cvetkovski, Reavley, & Jorm, 2012; Karyotaki et al., 2020). Research shows that college students are at risk for a broad range of mental health problems (Bruffaerts et al., 2018; Hunt & Eisenberg, 2010; Mortier et al., 2017), with 20–30% meeting criteria for at least one 12-month mental disorder (Auerbach et al., 2016, 2018). However, few students are willing to seek help (Ebert et al., 2019), and many do not find their way to treatment (Auerbach et al., 2016; Bruffaerts et al., 2019).
Accordingly, students may use emotion-regulating behaviors like self-injury to cope with college-related stressful experiences (Hamza, Goldstein, Heath, & Ewing, 2021). Researchers have observed that 25–63% of those with adolescent-onset NSSI continue to self-injure (Glenn & Klonsky, 2011; Hamza & Willoughby, 2014), and 7% begin repetitive NSSI during the college years (Kiekens et al., 2019). Recent studies also suggest that rates of NSSI among college students have increased over the past decade (Duffy, Twenge, & Joiner, 2019; Wester, Trepal,...