A substantial number of college students reported self-injurious behaviors in their lifetimes. Many of the behaviors occurred among individuals who had never been in therapy for any reason and who only rarely disclosed their self-injurious behaviors to anyone. Single self-injurious behavior incidents were correlated with a history of abuse and comorbid adverse health conditions but less strongly than were repeat self-injurious behavior incidents. The reticence of these clients to seek help or advice renders it critical that medical and mental health providers find effective strategies for detecting and addressing self-injurious behaviors.

Yale for many helpful suggestions. We are grateful to Mike Chernew for the access to, and Tami Swenson for clarification of, the Medicare Current Beneficiary Survey data. All remaining errors are our own. Fang and Silverman gratefully acknowledge financial support from the Economic Research Initiative on the Uninsured. The views expressed herein are those of the author(s) and do not necessarily reflect the views of the National Bureau of Economic Research.

Gaudecker for helpful discussions and comments. This paper has also benefited from suggestions by the participants of seminars at several universities and conferences. Jelmer Ypma provided excellent research assistance.

for helpful conversations. We are grateful to the editor, Steve Levitt, and to an anonymous referee for comments and suggestions that greatly improved the paper. The views expressed herein are those of the author(s) and not necessarily those of the National Bureau of Economic Research.

for helpful conversations. We are grateful to the editor, Steve Levitt, and to an anonymous referee for comments and suggestions that greatly improved the paper. The views expressed herein are those of the author(s) and not necessarily those of the National Bureau of Economic Research.