Different self-damaging behaviours, similar motives? Testing measurement invariance of motives for nonsuicidal self-injury, disordered eating and substance misuse.

OBJECTIVES: Theory and research suggest that distinct self-damaging behaviours (SDBs; e.g., nonsuicidal self-injury [NSSI], restrictive eating, binge eating, drug misuse, alcohol misuse) share similar motives. However, few studies have used a common self-report inventory to investigate the shared relevance and relative salience of motives for SDBs. Accordingly, the present study: (1) examined whether self-report scales assessing intrapersonal motives (i.e., relieving negative emotions, enhancing positive emotions, punishing oneself) and interpersonal motives (i.e., bonding with others, conforming with others, communicating distress, communicating strength, reducing demands) have invariant factor structures across SDBs; and (2) compared the salience of these motives across SDBs. METHODS: 1018 adults (54.6% men, Mage = 35.41 years) with a history of SDBs were allocated to the following groups: NSSI (n = 213), restrictive eating (n = 200), binge eating (n = 200), drug misuse (n = 200) or alcohol misuse (n = 205). Participants reported on their motives for engaging in their allocated SDB. Measurement invariance analyses compared the factor structures and latent means of the motive scales across SDBs. RESULTS: The motive scales had comparable factor structures across SDBs. Intrapersonal motives were most strongly endorsed for NSSI and drug misuse. Interpersonal motives were most strongly endorsed for drug and alcohol misuse. All motives were least salient to restrictive eating. CONCLUSIONS: Results suggest that common motives underlie distinct SDBs and that they can be adequately assessed using a single self-report inventory. However, certain motives are more relevant to some SDBs than others, with restrictive eating being the most motivationally distinct SDB. This knowledge can inform transdiagnostic models and interventions for SDBs.

Influence of perceived peer behavior on engagement in self-damaging behaviors during the transition to university.

As students transition to university, they experience significant social changes that can affect their behaviors, including self-damaging behaviors like disordered eating, problematic alcohol/drug use, suicidal thoughts, and non-suicidal self-injury (NSSI). Building on prior work, we examined the associations between (1) perceptions of peers' engagement in self-damaging behaviors predicting one's own subsequent engagement in such behaviors (i.e., socialization) and (2) one's own engagement in self-damaging behaviors predicting perceptions of peers' subsequent engagement in such behaviors (i.e., selection). We also examined whether these associations were moderated by the source of influence (close peer/acquaintance) and degree of social disconnection experienced by the student. First-year university students (N = 704) were asked to complete seven monthly surveys. Multilevel models indicated that when students perceived their close peers had engaged in NSSI or suicidal thinking, they had seven times greater odds of future engagement in the same behavior, implying that socialization increases the risk of these behaviors among university students. Perception of acquaintances' NSSI also predicted greater odds of a student's own NSSI the following month. Social disconnection increased the likelihood of matching own behaviors to perceptions of acquaintances' alcohol abuse, highlighting the importance of fostering connections/mentors to reduce self-damaging behaviors on college campuses. Furthermore, when students engaged in alcohol abuse, they had almost four times greater odds of reporting that their acquaintances abused alcohol the following month, emphasizing the importance of the wider social network in alcohol use behaviors.

Examining the components and stability of negative affect in disordered eating frequency.

OBJECTIVE: There is a limited understanding of the unique components of negative affect that are most important to disordered eating. Our study tested the contributions and stabilities of unique components of negative affect in the frequency of both binge eating and restricted eating. We examined if: (1) symptoms of depression, anxiety and stress share unique, concurrent associations with binge eating and restricted eating, respectively, and if (2) instability of depression, anxiety, and stress predict binge eating and restricted eating, respectively. METHOD: 627 first year undergraduate students completed 7 assessments of these constructs across their first academic year. Generalised multilevel modelling was employed. RESULTS: Higher than average anxiety, but not depression or stress, was concurrently associated with restricted eating. No concurrent associations between negative affect and binge eating were found. Instability of depression, but not anxiety or stress, predicted both binge and restricted eating. CONCLUSION: Anxiety may be a more salient predictor of restricted eating than depression or stress. However, larger monthly changes in depression may confer risk for more frequent binge eating and restricted eating.

Prevalence and Correlates of Suicidal Ideation and Deliberate Self-harm in Canadian Adolescents During the Coronavirus Disease 2019 Pandemic.

OBJECTIVE: In light of recent evidence that the coronavirus disease 2019 (COVID-19) pandemic has resulted in marked increases in depression, anxiety, substance use, and other mental health concerns among Canadian adolescents, we investigated the rates of self-harm thoughts and behaviours in this population. Specifically, this study explored: (1) the demographic and geographic distributions of suicidal ideation (SI) and deliberate self-harm (DSH), and (2) the associations of mental health and substance use with SI and DSH. METHOD: A total of 809 Canadian adolescents, aged 12-18 years, completed an online survey between June 17, 2020 and July 31, 2020. RESULTS: 44% of adolescents reported experiencing SI since the pandemic began, while 32% reported engaging in DSH. SI and DSH were more common among youth who: identified as transgender, non-binary or gender fluid; who did not reside with both parents; and who reported psychiatric concerns or frequent cannabis use. CONCLUSION: Canadian adolescents appear to be experiencing higher rates of self-harm thoughts and behaviours relative to before the COVID-19 pandemic. It is important for adults who are likely to interact with distressed youth to be aware of potential warning signs that a youth is struggling with self-harm, and to refer youth to specialty mental health services where appropriate.

Daily associations of interpersonal and emotional experiences following stressful events among young adults with and without nonsuicidal self-injury.

OBJECTIVES: Emotional and interpersonal dysfunction appears central to nonsuicidal self-injury (NSSI), yet research examining the interplay of these factors among individuals with NSSI is limited. This study aimed to specify such associations before and after daily stressful events among individuals with (vs. without) NSSI. METHODS: Young adult participants (Mage = 20.4) with past-year (n = 56) or no history (n = 47) of NSSI completed daily diary assessments over a 2-week period. RESULTS: No differences in rates of positive or negative interpersonal experiences before or after stressful events were identified. NSSI participants, however, reported greater negative emotion following stressful events compared with non-NSSI participants. The presence (vs. absence) of a positive interpersonal experience following a stressful event was related to lower negative emotional responses only in the NSSI group. CONCLUSION: Positive interpersonal experiences may downregulate negative emotions following stressful events among individuals with NSSI, highlighting the potential relevance of interpersonal emotion regulation to this population.

A Two-Way Street? Reciprocal Associations Between Parental Warmth and Hostility with Substance Use Among Justice-Involved Adolescents.

Transactional developmental theories propose that poor parenting behaviors contribute to youth substance use, and youth substance use contributes to poor parenting behaviors. However, research aimed at testing these theories has not distinguished: (1) between- and within-person sources of variance; (2) maternal and paternal parenting behaviors; and (3) alcohol, marijuana, and other illicit drug use. This study addressed these limitations by investigating the reciprocal associations between maternal and paternal warmth and hostility with alcohol, marijuana, and other illicit drug use among justice-involved adolescents, an at-risk population for substance use. 1354 justice-involved adolescents (86.4% male; Mage = 16.04 [SD = 0.14], range = 14-17; 41.4% Black, 33.5% Hispanic, 20.2% White, 4.8% other race/ethnicity) completed self-reports assessing parental warmth, parental hostility, and substance use every six months for 36 months. Random-intercept structural equation models disaggregated between- and within-person associations. At the between-person level, maternal and paternal warmth were negatively associated with alcohol, marijuana, and other illicit drug use, whereas maternal and paternal hostility were positively associated with alcohol, marijuana, and other illicit drug use. At the within-person level, maternal and paternal warmth predicted decreases in marijuana and other illicit drug use, and paternal warmth predicted decreases in alcohol use six months later. Maternal hostility predicted increases in subsequent marijuana and other illicit drug use. Marijuana and other illicit drug use predicted decreases in subsequent paternal hostility. The results are partially consistent with transactional developmental models proposing recursive influences between parenting behaviors and youth substance use. Evocative effects were in the opposite direction than expected and specific to fathers, such that youth drug use was related to improvements in the father-youth relationship. The results support the potential utility of family-based interventions for substance use among justice-involved adolescents.

Personality correlates of eating pathology severity and subtypes in The National Comorbidity Survey Adolescent Supplement.

OBJECTIVE: We examined how personality traits are associated with eating pathology (EP) across a range of severities and symptom subtypes. METHOD: The National Comorbidity Survey Adolescent Supplement (N = 10,148) was used to compare personality across severities (i.e., clinical Eating Disorders [EDs], subclinical disordered eating, preclinical weight concerns, or no weight/EP [no W/EP]), subclinical subtypes (i.e., Binge Eating Only, Binge-Purge, Binge-Restrict, Restrict-Purge, or no W/EP), and clinical subtypes (i.e., Anorexia Nervosa [AN]), Bulimia Nervosa [BN], Binge Eating Disorder [BED], internalizing disorders, or no ED or internalizing disorder) of EP. RESULTS: More severe EP was associated with more extreme personality trait endorsements. Impulsivity-related traits did not consistently distinguish binge eating/purging from restricting subtypes, although behavioral disinhibition differentiated adolescents with BN or BED from AN. CONCLUSION: Personality traits related to affectivity and impulsivity were more consistently associated with severity rather than subtype of EP.

Chronic medical conditions and suicidal behaviors in a nationally representative sample of American adolescents.

PURPOSE: Chronic medical conditions are a risk factor for the onset of suicidal thoughts and behaviors in adults. However, few studies have examined this association in adolescents. The present study explored the association between chronic medical conditions and the emergence of suicidal thoughts and behaviors in an adolescent sample representative of the U.S.A. METHOD: Using data from the National Comorbidity Survey-Adolescent Supplement (10,148 Americans between ages 13-17), discrete-time survival analyses were performed to examine the odds of developing suicidal ideation, planning, and attempts, given prior presence of a chronic medical condition. Multivariate models controlled for sociodemographic factors and the presence of comorbid mental health conditions. Post-hoc sensitivity analyses examined associations between timing of chronic medical condition onset and later suicidal thoughts and behaviors. RESULTS: Multivariate analyses showed that dermatological conditions, asthma, allergies, headache, and back/neck pain were associated with elevated odds of suicidal ideation, while cardiovascular conditions were associated with increased odds of suicide attempts. Additionally, cardiovascular conditions were associated with increased risk of suicide planning and attempts among adolescents with suicidal ideation. Chronic medical conditions that began in adolescence were associated with the greatest risk of later suicidal thoughts and behaviors, compared to chronic medical conditions that began in early or middle childhood. CONCLUSION: Consistent with research in middle and older adults, physical health conditions are associated with increased risk for the onset of suicidal thoughts and behaviors in adolescents. Mental health screening for adolescents with chronic medical conditions may help parents and physicians identify suicidality early.

Non-suicidal self-injury prevalence, course, and association with suicidal thoughts and behaviors in two large, representative samples of US Army soldiers.

BACKGROUND: Non-suicidal self-injury (NSSI) prospectively predicts suicidal thoughts and behaviors in civilian populations. Despite high rates of suicide among US military members, little is known about the prevalence and course of NSSI, or how NSSI relates to suicidal thoughts and behaviors, in military personnel. METHODS: We conducted secondary analyses of two representative surveys of active-duty soldiers (N = 21 449) and newly enlisted soldiers (N = 38 507) from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). RESULTS: The lifetime prevalence of NSSI is 6.3% (1.2% 12-month prevalence) in active-duty soldiers and 7.9% (1.3% 12-month prevalence) in new soldiers. Demographic risk factors for lifetime NSSI include female sex, younger age, non-Hispanic white ethnicity, never having married, and lower educational attainment. The association of NSSI with temporally primary internalizing and externalizing disorders varies by service history (new v. active-duty soldiers) and gender (men v. women). In both active-duty and new soldiers, NSSI is associated with increased odds of subsequent onset of suicidal ideation [adjusted odds ratio (OR) = 1.66-1.81] and suicide attempts (adjusted OR = 2.02-2.43), although not with the transition from ideation to attempt (adjusted OR = 0.92-1.36). Soldiers with a history of NSSI are more likely to have made multiple suicide attempts, compared with soldiers without NSSI. CONCLUSIONS: NSSI is prevalent among US Army soldiers and is associated with significantly increased odds of later suicidal thoughts and behaviors, even after NSSI has resolved. Suicide risk assessments in military populations should screen for history of NSSI.

Does higher-than-usual stress predict nonsuicidal self-injury? Evidence from two prospective studies in adolescent and emerging adult females.

BACKGROUND: Nonsuicidal self-injury (NSSI) is highly prevalent among adolescent and emerging adult females. Most studies examining the relationship between stress and NSSI largely have relied on aggregate self-report measures of stress and between-person models. Using data from two prospective samples, this manuscript tests the hypothesis that within-person models of NSSI provide better clinical markers of risk for NSSI than between-person models of NSSI. METHODS: Two samples (Sample 1: 220 high-risk girls, M age = 14.68, SD = 1.36, baseline assessment and 3-month follow-ups for 18 months; Sample 2: 40 emerging adult females with a history of NSSI, M age = 21.55, SD = 2.14, 14 days with daily retrospective reports) were followed prospectively and completed validated measures of stress and NSSI. Models were adjusted for age and depression. RESULTS: In Sample 1, a within-person model demonstrated that higher-than-usual (but not average) stress levels predicted NSSI within the same 3-month wave. In Sample 2, results from a within-person model with daily diary assessment data showed that higher-than-usual stress (but not average daily stress) predicted same-day NSSI. CONCLUSIONS: Together, our results suggest that higher-than-usual stress, relative to one's typical stress level, but not average stress levels, signals times of enhanced risk for NSSI. These results highlight the clinical utility of repeated assessments of stress.

Digital phenotyping of suicidal thoughts.

BACKGROUND: To examine whether there are subtypes of suicidal thinking using real-time digital monitoring, which allows for the measurement of such thoughts with greater temporal granularity than ever before possible. METHODS: We used smartphone-based real-time monitoring to assess suicidal thoughts four times per day in two samples: Adults who attempted suicide in the past year recruited from online forums (n = 51 participants with a total of 2,889 responses, surveyed over 28 days; ages ranged from 18 to 38 years) and psychiatric inpatients with recent suicidal ideation or attempts (n = 32 participants with a total of 640 responses, surveyed over the duration of inpatient treatment [mean stay = 8.79 days], ages ranged 23-68 years). Latent profile analyses were used to identify distinct phenotypes of suicidal thinking based on the frequency, intensity, and variability of such thoughts. RESULTS: Across both samples, five distinct phenotypes of suicidal thinking emerged that differed primarily on the intensity and variability of suicidal thoughts. Participants whose profile was characterized by more severe, persistent suicidal thoughts (i.e., higher mean and lower variability around the mean) were most likely to have made a recent suicide attempt. CONCLUSIONS: Suicidal thinking has historically been studied as a homogeneous construct, but using newly available monitoring technology we discovered five profiles of suicidal thinking. Key questions for future research include how these phenotypes prospectively relate to future suicidal behaviors, and whether they represent remain stable or trait-like over longer periods.

Fatigue Moderates the Relationship Between Perceived Stress and Suicidal Ideation: Evidence From Two High-Resolution Studies.

Theoretical models of self-harm suggest that high perceived stress and high fatigue (which might affect the ability to cope with stress) may interact to predict the short-term occurrence of suicidal ideation and nonsuicidal self-injury (NSSI). We tested 3 approaches to examining this interaction, each of which provided a different understanding of the specific nature of these associations: comparing each individual's daily stress/fatigue to the entire sample's overall average (i.e., grand-mean centering), comparing each individual's daily perceived stress/fatigue to his or her overall average (i.e., group- or participant-mean centering), and comparing each individual's average perceived stress/fatigue to the sample's overall average (i.e., centering participant means on overall grand mean). In 2 studies, adolescents (n = 30; 574 daily reports, M age = 17.3 years, range = 12-19; 87.6% female) and young adults (n = 60; 698 daily reports; M age = 23.25 years, range = 18-35; 85% female) completed daily measures of perceived stress, fatigue, suicidal ideation, and NSSI. In both samples, the interaction between high daily perceived stress and high daily fatigue predicted greater odds of daily suicidal ideation (but not NSSI). Only the model comparing each individual's daily stress/fatigue to the entire sample's overall average was consistently significant across the two studies. Participants were most likely to experience suicidal ideation on days when both perceived stress and fatigue were elevated relative to the average level experienced across people and time points. Studies should build upon these findings with more in-depth examination of the temporal nature of stability and change in these factors as they relate to sustained suicidal ideation.

Different Clinical Presentations in Eating Disorder Patients with Non-Suicidal Self-Injury Based on the Co-Occurrence of Borderline Personality Disorder.

Non-suicidal self-injury (NSSI) and borderline personality disorder (BPD) features are common in patients with eating disorders (ED), yet little is known regarding the clinical presentation of ED patients who present with NSSI with and without BPD. The current study compared self-injurious, female ED inpatients with (n = 98; NSSI+BPD) and without BPD (n = 45; NSSI-only) on different self-reported clinical features. Results suggest that ED patients with NSSI+BPD differ from those with NSSI-only with regard to frequency of suicidal ideation, alcohol, drug or medication abuse, internalizing/externalizing psychopathology, interpersonal problems, and coping strategies, with the NSSI+BPD group demonstrating more impairment in each of these domains. Despite these differences in clinical presentation, however, groups did not differ in NSSI features. In sum, while self-injurious ED patients may present with similar NSSI behavior regardless of BPD diagnosis, those with NSS+BPD represent a group with much higher clinical complexity and greater treatment needs.

Are there sensitive periods when child maltreatment substantially elevates suicide risk? Results from a nationally representative sample of adolescents.

BACKGROUND: Although child maltreatment is a well documented risk factor for suicidal behavior, little is known about whether the timing of child maltreatment differentially associates with risk of suicidal ideation, suicide plans, or suicide attempts. The goal of this study was to examine whether a first exposure to physical or sexual abuse during specific developmental periods significantly elevated risk for suicidal behavior in adolescents. METHODS: Data came from the National Comorbidity Survey Adolescent Supplement, a population-based sample of US adolescents aged 13-18 years old (n = 9,272). Using discrete time survival analysis, we assessed the association between timing of first abuse (early childhood: ages 0-5; middle childhood: ages 6-10; adolescence: ages 11-18) and suicidal ideation, plans, and attempts. RESULTS: Exposure to either physical or sexual abuse increased the odds of reporting suicidal ideation (odds ratio [OR] = 5.06 and OR = 3.56, respectively), plans (OR = 3.63 and OR = 3.58, respectively), and attempts (OR = 5.80 and OR = 4.21, respectively), even after controlling for sociodemographic covariates and psychiatric disorders. However, the timing of physical and sexual abuse exposure was unassociated with suicidal behavior (all p values >.05). CONCLUSIONS: Exposure to child maltreatment is strongly associated with risk for adolescent suicidal behaviors, though this association did not vary based on the developmental timing of first exposure. These findings suggest that prevention efforts should be implemented throughout early development and target all children, regardless of when they were first exposed.

Non-suicidal self-injury in patients with eating disorder: associations with identity formation above and beyond anxiety and depression.

In the present study, we investigated the association between non-suicidal self-injury (NSSI) and problems in identity formation among patients with eating disorder (ED). NSSI is highly prevalent in ED, and problems with identity formation are characteristic of both NSSI and ED. Few studies, however, have investigated identity formation in patients with ED with and without NSSI while taking into account comorbid psychopathology (e.g. anxiety and depression). Therefore, we investigated the relationships between NSSI characteristics, identity confusion/synthesis, and anxiety/depression in 99 female patients with ED by means of self-report questionnaires. The results showed that 58.6% of the patients with ED engaged in at least one type of NSSI (most frequently cutting), with no significant differences in rates of NSSI or identity problems among ED subtypes. Presence, versatility and automatic negative reinforcement functions of NSSI were each significantly and positively related to identity confusion and negatively related to identity synthesis. Even after controlling for age, anxiety, and depression, lack of identity synthesis remained a significant predictor of NSSI in patients with ED. Given that NSSI may constitute an effort to deal with identity confusion/synthesis in patients with ED, therapists should take this developmental task into account while treating patients with ED with NSSI.

Average ages of onset and time to transition between self-injurious thoughts and behaviors: Retrospective evidence from two developmentally distinct samples.

BACKGROUND: Suicidal thoughts and behaviors often emerge in a predictable sequence, with suicidal ideation (SI) preceding planning, and planning preceding actions. Few studies, however, have considered the timing and duration of non-suicidal self-injury (NSSI) in these transitions. Accordingly, this study examined: 1) the developmental sequencing of NSSI, SI and suicide attempts, and 2) whether age of onset or duration predict transitions from NSSI to other SITB, and from SI to NSSI. METHODS: 704 first-year students from a mid-sized Canadian university (Sample 1) and 2095 adults from an online research volunteer panel (Sample 2) completed the Self-Injurious Thoughts and Behaviors Interview self-report, which assessed the presence, age of onset, and recency of SITB. RESULTS: NSSI and SI typically onset before age 15, while suicide planning and attempt usually began at or after age 15. Transition from NSSI to SI was likeliest in the first year after NSSI onset. Transition from NSSI to suicide attempt was likeliest in the second and third year after NSSI onset in Sample 1, and up to four years after NSSI onset in Sample 2. Early (before age 13) and late (after age 16) onsets of NSSI predicted higher odds of transitioning from NSSI to SI or attempt. Transition from SI to NSSI was likeliest in the first two years after SI onset and when SI began before age 13. CONCLUSIONS: The first year after NSSI or SI onset are critical for transitions to other SITB. Targeted prevention and monitoring should be considered for people who recently initiated NSSI.

Peer support for borderline personality disorder: A critical review of its feasibility, acceptability, and alignment with concepts of recovery.

Many organizations have adopted peer support to increase service alignment with recovery-oriented principles. Yet, few studies have scrutinized borderline personality disorder (BPD)-specific concepts of "recovery" and "recovery-oriented practice," nor evaluated the extent to which existing peer support services (PSS) align with these concepts. We addressed these knowledge gaps in four phases: (a) a literature review to understand BPD-specific concepts of "recovery" and "recovery-oriented practice," (b) a literature review and open web search to describe the implementation, feasibility, or effectiveness of PSS for people with BPD, (c) a landscaping survey of program administrators regarding their BPD-PSS programs, and (d) a critical review of the extent to which current peer support for BPD aligns with "recovery" and "recovery-oriented practice." We identified 40 published sources that defined "recovery" or "recovery-oriented practice" as it pertains to BPD, and narratively summarize these results, nine sources that described PSS for people with BPD, and received survey responses from seven BPD-PSS program administrators. Our critical review highlighted the distinctive but overlapping concepts of "clinical recovery" versus "personal recovery" and underscored the alignment of BPD-PSS with personal recovery goals, including increased self-knowledge and -acceptance, hope, engagement in meaningful social roles and relationships, and self-determination. While peer support is experienced positively by service users, peer supporters, and clinicians, challenges include setting boundaries, minimizing dual roles, and ensuring adequate training, supervision, and personal support to reduce burnout. Peer support appears to be a feasible avenue for meeting the personal recovery goals of people with BPD; however, formal program evaluations are needed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

From facts to feelings: Navigating the complexities of COVID-19 restrictions, perceptions, and mental well-being.

Objectives of the present study were to 1) examine accuracy of COVID-19 public health restriction knowledge and the impact of information source, 2) assess the effect of perceived level of restriction on perceived infection risk of COVID-19 infection and level of compliance with restrictions, and 3) investigate the relationship between mental health outcomes and perceived as well as actual level of restriction. Canadians (n = 5,051) completed an online survey between December 2020 and March 2021 assessing public health restriction knowledge, accuracy of this knowledge, information sources about COVID-19, perceived infection risk, compliance with restrictions, loneliness, anxiety, and depressive symptoms. Approximately half of our sample had accurate knowledge of the restrictions in their region/province, which significantly differed by province. Individuals who perceived restriction levels to be higher than they were, reported significantly greater perceived infection risk, more compliance with restrictions, worse mental health, and greater loneliness. Individuals living under moderate restrictions had better mental health and experienced less loneliness compared to minor, significant and extreme restriction levels. Findings suggest that while restrictions are beneficial for compliance, stronger and clearer restrictions should be coupled with mental health supports to remediate the negative effects of restrictions and uncertainty on mental health and loneliness.

Testing a diathesis-stress model during the transition to university: Associations between self-criticism, stress, and internalizing problems.

ObjectiveTo test a diathesis-stress model whereby self-criticism interacts with monthly perceived stress to predict same-month or next-month internalizing problems, including depression, anxiety, nonsuicidal self-injury (NSSI), and suicidal ideation, in students transitioning to university. Participants: 704 students (73% female, Mage = 17.97) were recruited during their first month of university in 2017 and 2018. Methods: Students completed surveys assessing self-criticism, perceived stress, and internalizing problems from September to April. Results: Self-criticism predicted higher depression and anxiety, as well as odds of NSSI and suicidal ideation, in students' first month on campus. Consistent with a diathesis-stress model, self-criticism strengthened the associations between stress and same-month depression and anxiety. Conclusions: Self-critical students are at elevated risk of internalizing problems during the transition to university, particularly when they feel more stressed than usual. These findings elucidate which students should be targeted in interventions and when interventions should be delivered to curtail internalizing problems.