Prevalence and Precursors of the use of Restraint and Seclusion in a Private Psychiatric Hospital: Comparison of Child and Adolescent Patients

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• 作者：David L. Pogge (1) (2)
  Stephen Pappalardo (2)
  Martin Buccolo (2) (3)
  Philip D. Harvey (4)
  
• 关键词：Seclusion ; Restraint ; Child ; Adolescent ; Inpatient
• 刊名：Administration and Policy in Mental Health and Mental Health Services Research
• 出版年：2013
• 出版时间：May 2013
• 年：2013
• 卷：40
• 期：3
• 页码：224-231
• 全文大小：303KB
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• 作者单位：David L. Pogge (1) (2)
  Stephen Pappalardo (2)
  Martin Buccolo (2) (3)
  Philip D. Harvey (4)
  
  1. Fairleigh Dickinson University, Teaneck, NJ, 07666, USA
  2. Four Winds Hospital, Katonah, USA
  3. Albert Einstein School of Medicine, Bronx, USA
  4. Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1450, Miami, FL, 33136, USA
  
• ISSN：1573-3289

文摘

The use of restraint and seclusion is highly regulated in psychiatric inpatient settings. However, the majority of studies of restraint and seclusion are based on public hospitals serving adult patients, with some limited data available on adolescents and children. This paper presents prospectively collected data on restraint and seclusion over a 2-year period at a private psychiatric hospital whose patients include large numbers of both adolescents and pre-adolescent children. 2聽years of restraint and seclusion data were analyzed on a total of 2,411 unique patients. Types of seclusion included in-room seclusion on the treatment unit and off-unit seclusion in a separate seclusion annex. Restraints consisted solely of short term (<15聽min) and longer term (>14聽min) manual restraints. The use of IM medication was also recorded. The precipitants of these events were examined. These included physical and verbal threats, stabbing or throwing objects, attempts to elope, attempts to hurt one鈥檚 self or another, or property destruction. Out of 2,411 child and adolescent in-patients admitted during the period under review, only 703 (29%) experienced restraint or seclusion. Among these, the modal number of events per patient was one (n聽=聽156), but the maximum number of occurrences was 163. Child patients had a much higher frequency of events (n聽=聽396, 53%) than adolescents (n聽=聽307, 19%). There were notable differences in the types of seclusion events, with children typically experiencing in-room seclusion on the unit. When age was examined as a continuous variable, younger patients had a higher prevalence of restraint and seclusion, significantly more restraint and seclusion, and these restraint and seclusion events were significantly shorter than those seen in older patients. Multiple other potential determinants of these events were examined, including diagnosis, symptom severity at admission, age, and gender, but none of these predicted these events. Restraint and seclusion events were more common for children and less so for adolescents, with robust age effects for the likelihood of any seclusions, the number of seclusions and restraints, and the duration of seclusions and restraints. Patients who experienced restraint or seclusion typically required it only once during their hospitalization. Only age was found to be a predictor of the restraint and seclusion variables. Given these findings, it appears that management of agitated behavior in children and adolescents may be a qualitatively different phenomenon. Future research should be directed at understanding the determinants of high frequency agitated behavior and developing alternatives to seclusion or restraint.