Abstract
BackgroundThe use of restraints in adolescent psychiatric settings requires particular professional, ethical, and legal considerations. The purpose of this study was to investigate whether the number of restraint episodes per patient was related to any of several characteristics of the adolescents.MethodsIn this nationwide study, we included all adolescents restrained during the period 2008–2010 (N = 267) in Norwegian adolescent acute psychiatric inpatient units. They constitute 6.5% of the adolescents hospitalized in these units in the same period of time. We collected data on the number of restraint episodes they experienced during the study period; Poisson regression was then used to analyze the impact of gender, social, mental health, and treatment characteristics on the frequency of restraint. We developed a risk index for the likelihood of experiencing multiple restraint episodes.ResultsWe found a skewed distribution of restraint episodes in which a small group (18%) of restrained adolescents experienced a majority (77%) of the restraint episodes. A large percentage of the restrained adolescents (36%) experienced only one restraint episode. Risk factors for multiple restraint episodes were female gender, lower psychosocial functioning (Children’s Global Assessment Scale below 35), more and longer admissions, and concomitant use of pharmacological restraint. Except for gender, we used these variables to develop a risk index that was moderately associated with multiple restraint episodes.ConclusionsAs a small group of patients accounted for a large percentage of the restraint episodes, future research should further investigate the reasons for and consequences of multiple restraint episodes in patients at acute adolescent psychiatric units, and evaluate preventive approaches targeted to reduce their risk for experiencing restraint.
Highlights
The use of restraints in adolescent psychiatric settings requires particular professional, ethical, and legal considerations
A recent review of 49 studies of adult inpatient mental health services estimated that the prevalence of restraint was 3.8–20% and most frequently associated with male gender, younger age, foreign ethnicity, schizophrenia, involuntary admission, aggression or trying to abscond, and the presence of male staff [6]
Setting We collected data from all of the Norwegian adolescent acute psychiatric inpatient units that are approved for involuntary admissions (N = 16), which included a total of 126 beds
Summary
The use of restraints in adolescent psychiatric settings requires particular professional, ethical, and legal considerations. The use of restraint against adolescents requires particular professional, ethical, and legal considerations. Studies of restraint use in child and adolescent mental health services report relatively high rates, often at similar or higher levels compared to adult mental health services, and, again, the extent of the use varies considerably [11, 12]. One Finnish national study reported that about 40% of the adolescent inpatients had been restrained in some way during their admission [13] Another Finnish study reported that 27% of the involuntary treatment periods in an 8-year period included the use of restraint and that there was considerable regional variation in the use of restraint [14]. In a previous paper based on the present study, we found that 267 (6.5%) of the 4099 adolescents admitted (voluntarily or involuntarily) to acute psychiatric units in Norway in 2008–2010 were restrained [15]
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