Experience coercion, post‐traumatic stress, and satisfaction with treatment associated with different coercive measures during psychiatric hospitalization

Guzmán‐Parra, José; Aguilera-Serrano, Carlos; García‐Sánchez, Juan Antonio; García-Spínola, Edgar; Torres‐Campos, Daniel; Villagrán, José M.; Moreno‐Küstner, Berta; Mayoral-Cleries, Fermín

doi:10.1111/inm.12546

Cited by 35 publications

(34 citation statements)

References 30 publications

(69 reference statements)

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“…Nine studies compared secluded versus non-secluded patients. Guzmán-Parra et al compared restraint versus forced medication (57), and Wallsten et al compared restraint versus non-exposure (37). Two additional studies provided data on secluded or restrained patients (without distinction) (66, 67), two examined only restrained patients (35, 55), and 10 studies examined only secluded patients.…”

Section: Resultsmentioning

confidence: 99%

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Effects of Seclusion and Restraint in Adult Psychiatry: A Systematic Review

et al. 2019

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Background: Determining the clinical effects of coercion is a difficult challenge, raising ethical, legal, and methodological questions. Despite limited scientific evidence on effectiveness, coercive measures are frequently used, especially in psychiatry. This systematic review aims to search for effects of seclusion and restraint on psychiatric inpatients with wider inclusion of outcomes and study designs than former reviews. Methods: A systematic search was conducted following PRISMA guidelines, primarily through Pubmed, Embase, and CENTRAL. Interventional and prospective observational studies on effects of seclusion and restraint on psychiatric inpatients were included. Main search keywords were restraint , seclusion , psychiatry , effect , harm , efficiency , efficacy , effectiveness , and quality of life . Results: Thirty-five articles were included, out of 6,854 records. Studies on the effects of seclusion and restraint in adult psychiatry comprise a wide range of outcomes and designs. The identified literature provides some evidence that seclusion and restraint have deleterious physical or psychological consequences. Estimation of post-traumatic stress disorder incidence after intervention varies from 25% to 47% and, thus, is not negligible, especially for patients with past traumatic experiences. Subjective perception has high interindividual variability, mostly associated with negative emotions. Effectiveness and adverse effects of seclusion and restraint seem to be similar. Compared to other coercive measures (notably forced medication), seclusion seems to be better accepted, while restraint seems to be less tolerated, possibly because of the perception of seclusion as “non-invasive.” Therapeutic interaction appears to have a positive influence on coercion perception. Conclusion: Heterogeneity of the included studies limited drawing clear conclusions, but the main results identified show negative effects of seclusion and restraint. These interventions should be used with caution and as a last resort. Patients’ preferences should be taken into account when deciding to apply these measures. The therapeutic relationship could be a focus for improvement of effects and subjective perception of coercion. In terms of methodology, studying coercive measures remains difficult but, in the context of current research on coercion reduction, is needed to provide workable baseline data and potential targets for interventions. Well-conducted prospective cohort studies could be more feasible than randomized controlled trials for interventional studies.

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Section: Resultsmentioning

confidence: 99%

“…Overall, evidence for negative effects have consistently been found across studies: PTSD (47, 57–59), medication need (46), increased length of stay (34, 50–54), deep vein thrombosis (DVT) (55). One study suggested a beneficial effect on quality of life (48).…”

Section: Resultsmentioning

confidence: 99%

Effects of Seclusion and Restraint in Adult Psychiatry: A Systematic Review

et al. 2019

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“…As more studies continue to contribute to the large body of evidence, it has become clearer that longer stays are usually associated with more negative outcomes. These include deterring social and communityrelated skills (8), increased suicidal ideation related to stigma(9), social functioning(10), post-traumatic stress (11), productivity and nances (12). Although an ideal LOS remains uncertain, current international recommendations advocate for an early discharge as soon as stabilization is successful, in order to continue their management in a less restrictive environment (13).…”

Section: Introductionmentioning

confidence: 99%

Predictors of the Length of Stay of Psychiatric Inpatients: Protocol for a Systematic Review and Meta-Analysis

Carranza

Tamayo

Álvarez

et al. 2020

Preprint

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Abstract Background : Length of stay (LOS) for inpatient psychiatric services is an important factor with serious drawbacks when it is extended more than needed. Impacts on economy, social functioning and stigma can hamper improvement and affect the patients’ experiences on future mental healthcare. Prediction of which patients have a higher risk for prolonged LOS has been extensively researched. Previous systematic reviews found consistent predictors of both longer and shorter LOS. However, they do not provide an estimate from the pooled effect sizes. Furthermore, to our knowledge, there are no meta-analysis on the influence of these factors. The primary objective of this study will be to provide point estimates on the effect sizes of all studied predictors of the LOS of psychiatric inpatients. Methods : We will conduct a systematic search in PubMed, MEDLINE, EMBASE and PsycINFO for observational studies evaluating the effect size of independent factors on the length of stay of psychiatric inpatients. Prospective and retrospective cohorts that assess the influence of risk factors through the reporting of standardized regression coefficients will be included. We will provide a qualitative synthesis of the findings from each study and perform a meta-analysis from pooled regression coefficients that were adjusted for other variables or confounders in order to obtain a point estimate and confidence interval for all factors extracted from the included studies. Discussion : The results from this study may provide more accurate predictions for mental health institutions, psychiatrists, mental health service providers, patients, and families on the prognosis regarding the length of stay for needed inpatient care. This information may be used to anticipate individuals at a higher risk for prolonged hospitalization to plan the necessary interventions for these specific situations. Considering both the benefits and disadvantages of longer and shorter stays, the pooled estimates for independent factors may be used by mental healthcare providers and patients for informed decision-making. The results from this study will also update results presented in previous studies and identify the strengths and limitations from the current available evidence. Systematic Review Registration : PROSPERO ID CRD42020172840

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“…Since the previous review was undertaken, the use of RIs has received more attention internationally and this has resulted in further research into the patient experience (e.g., Fish, ; Fugger et al, ; Guzmán‐Parra et al, ; Spinzy, Maree, Segev, & Cohen‐Rappaport, ). Therefore, an updated systematic review of patient experiences of seclusion is necessary in order to widen knowledge, which will help inform future practice.…”

Section: Introductionmentioning

confidence: 99%

What are adult psychiatric inpatients' experience of seclusion: A systematic review of qualitative studies

Askew

Fisher

Beazley

2019

Psychiatric Ment Health Nurs

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Accessible summary What is known on the subject? Seclusion involves isolating a patient in a room away from other patients in order to contain aggressive behaviour, and it is used in psychiatric hospitals. Research has found that seclusion is often viewed by patients as negative; however, there is limited in‐depth understanding of the deeply personal experience. What this paper adds to existing knowledge? This systematic review found that the published research may have flaws with the quality of analysis, mainly due to limited researcher reflexivity. The review of qualitative research revealed that during seclusion, patients feel vulnerable, neglected and abused, disconnected from the experience and that it is dangerous to their mental health. What are the implications for practice? For clinicians facilitating the seclusion process to use their therapeutic skills to provide patients with a sense of being cared for. For clinical supervision to allow space to explore interpersonal dynamics during seclusion in order to enhance therapeutic staff–patient interaction. Abstract IntroductionThere is limited understanding of patients' seclusion experience. A 2013 systematic review provides some insight; however, more knowledge is required in order to improve patient care. This is a systematic review of qualitative research into the patient experience of seclusion. The qualitative focus enables the phenomena to be the central focus. Question“What are adult psychiatric inpatients' experience of seclusion?” and “What is the quality of the applicable research?” MethodElectronic searches for qualitative research published between 2006 and 2017 were undertaken. Data were excluded if it was not explicitly related to seclusion. Research was appraised using three standardized appraisal criterion. Themes were generated through thematic synthesis. ResultsEight papers met inclusion criteria; four had been translated into English. Four themes were identified: “feeling vulnerable,” “feeling neglected and abused,” “disconnecting” and “seclusion is dangerous to mental health.” Participants felt vulnerable and without control. They experienced staff and room as neglectful and abusive. Participants mentally disconnected. The experience threatened participants' mental health. DiscussionParticipants' experience is an amalgamation of interpersonal experience and the environment. Disconnecting may be a coping strategy. Implications for practiceThe findings have implications for seclusion practice, staff training and clinical supervision. Specific attention needs to be paid to the staff–patient interaction.

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Experience coercion, post‐traumatic stress, and satisfaction with treatment associated with different coercive measures during psychiatric hospitalization

Cited by 35 publications

References 30 publications

Effects of Seclusion and Restraint in Adult Psychiatry: A Systematic Review

Effects of Seclusion and Restraint in Adult Psychiatry: A Systematic Review

Predictors of the Length of Stay of Psychiatric Inpatients: Protocol for a Systematic Review and Meta-Analysis

What are adult psychiatric inpatients' experience of seclusion: A systematic review of qualitative studies

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