Characteristics and predictors of self-mutilation among adolescents in out of home group care in Taiwan Yu-Wen Chen Paper presented at the 2008 Association of Children's Welfare Agencies Conference and the 2008 Management and Leadership Institute 18-20, August 2008

Sara’s Story I know I should not do this to myself, but I just cannot help… I hated to live here, because it was not my fault. Why should I be punished? I wanted to go out so desperately, but they won’t let me. I was mad, very mad, so I cut my self, only this could make me feel better.

Self-mutilation in Group Care In Taiwan, adolescents, especially those with problem behaviours, are generally placed in group homes or residential institutions. Previous traumatized experiences and the afterwards stressful living arrangements have made these residents at a higher risk for mental health problems.

Purposes of this Study 1)to examine the characteristics of self- mutilation, including prevalence, motivations, and the methods used, both before and after adolescents were placed in group homes or institutions. 2) to conduct multivariate analyses to identify factors associated with their self- mutilating behaviours.

Research Method Participants Adolescents aged 13 to 18 with at least 3 months of living in group homes. 588 residents agreed to participate in the study. Male: 44.3% ; Female: 55.7% Mean age: 15.3 years (SD = 1.7) The average length of placement was about 3 years (37 months).

Research Method Measures Using self-reported questionnaires the Function Assessment of Self-Mutilation the 2nd version of Beck Depression Inventory the Conflict Tactics Scale (child abuse) Satisfaction with Institutional Care Scale

Research Method Procedures & Analyses Time ： between February to July, 2006 Questionnaires were administrated in the group setting Data were analyzed by SPSS 13.0 Using the ordered logistic regression to test the multivariate model

Results Percentage of the Self-Mutilators Ever self-mutilated: 60.8%, and among them, 76.0% had done this more than once 56.3% did so before and after placement 22.6% did so after placement 21.1% did so before placement 20.1% (before placement) and 11.2% (after placement) reported they “often” did it

Results Methods Used Most frequently used methods include: 1) cutting the skin 2) banging head or fist against something 3) hitting 60% used more than one method 25% used 4 or more different methods

Results Motivations 67.2%/64.0%: to release tension or inner pain 56.9%/55.8%: to feel better or happier 53.4%/51.7%: to release anger 11.9%/8.6% : to get someone’s attention 9.5%/6.0% : to get someone agree upon their request

Results Gender Differences Girls (74.5%) engaged in more self-mutilating behaviours than boys (25.5%) (χ 2 = 74.47, p< 0.001). Before placement: cutting, severe scratching, & biting, females > males. After placement: cutting & biting Motivations: girls: to release negative feelings boys: influenced by others

Correlates of self-mutilation VariablesYX1X2X3X4X5 Self-mutilation after placement (Y) -- Self-mutilation before placement (X1).55**-- Depressive mood (X2).41**.35**-- Childhood abuse (X3).25**.34**.27**-- Institutional care (X4)-.24**-.16**-.25**-.13*-- Gender (X5)-.38**-.34**-.28**

Ordered Logistic Regression Variables Model 1 Model 2 bWald χ 2 b Intercept 1(never self-mutilate)- 0.56*** **9.83 Intercept 2(only once) Intercept 3(seldom) Intercept 4(sometimes) 2.01*** *6.43 Gender 1.13*** ***20.80 Self-mutilation before placement Never- 3.26*** ***58.44 Only once- 2.47*** ***23.08 Seldom- 1.28*** **7.11 Sometimes- 0.94** *4.79 Depressive mood 0.03***14.43 Childhood abuse Institutional care- 0.06**9.73 Model significanceχ 2 = 91.92*** χ 2 = *** Cox & Snell R 2 =.35 Cox & Snell R 2 =.39

Conclusion & Discussion Major findings: this study demonstrated quite similar results in terms of the characteristics and predictors of self-mutilation in regard to those in Western countries, but the prevalence rates are higher. For these adolescents, self-mutilation is: functional a sign of struggle a call for help

Conclusion & Discussion There were gender differences in the frequency, methods, and motivations of self-mutilation. Predictors of self-mutilation include: self-mutilation prior to placement depressive mood satisfaction with institutional care

Conclusion & Discussion For professionals in the group care system, we need to re-examine whether the placement environment had motivated or even facilitated self-mutilation. Interventions and treatments need to consider gender differences. Males: to learn to say no to peers Females: to learn alternatives to release their negative feelings.

Conclusion & Discussion Group care workers need to assess the mental health needs and self-mutilation history of residents upon admission. To improve the placement quality, so that residents’ satisfaction with the care they receive can increase. To teach them alternatives to regulate their negative emotions. To provide support, concern, and make residents feel loved and safe.