Physical restraint of children and adolescents in mental health inpatient services: A systematic review and narrative synthesis

Abstract

<jats:p> Physical restraint is regularly used in children and adolescent mental health care, often as a reactive behaviour management strategy. Physical restraint has been associated with physical injury, but psychological consequences are poorly understood. The aim of this systematic review was to examine physical restraint of children and adolescents in inpatient mental healthcare services. Healthcare databases were searched to identify English language publications discussing anyone aged ≤18 years who had experienced physical restraint as a mental health inpatient. No date restrictions were applied. Sixteen quantitative studies are included within this review. Most studies are retrospective in nature. Publications were appraised using the Critical Appraisal Skills Programme quality assessment tool. Common characteristics associated with children and adolescents who experience physical restraint include age, gender, diagnosis, and history. Most studies associate physical restraint with the management of aggression. Findings suggest that it may be a combination of patient (intrinsic) and environmental (extrinsic) factors which ultimately lead to children and adolescents experiencing restraint. This review confirms that little is known about children and adolescents’ first-hand experiences of physical restraint. Future research should address children and adolescents’ perceptions and first-hand experiences of physical restraint. </jats:p>

Traumatic stress symptoms predict restraint incidents in children and adolescents in psychiatric residential treatment

“…Comparatively, the observed association between the presence of an anxiety disorder and a reduced risk for restraint is consistent with earlier research (Persi et al., 2008). However, in contrast, another study identified the presence of internalizing disorders as a risk factor for restraint (Nielson et al., 2020).…”

“…Additionally, children diagnosed with neurodevelopmental disorders, many with attention‐deficit/hyperactivity disorder, were more likely to experience at least one restraint relative to their nondiagnosed peers, whereas children diagnosed with anxiety disorders were less likely. A diagnosis of a neurodevelopmental disorder is a common risk factor for restraint in the extant literature (Nielson et al., 2020). Comparatively, the observed association between the presence of an anxiety disorder and a reduced risk for restraint is consistent with earlier research (Persi et al., 2008).…”

“…Collectively, idiographic predictors associated with increased frequency of restraint identified in initial studies include younger age, male gender identification, the presence of specific psychiatric diagnoses (e.g., developmental, psychotic, externalizing, or internalizing disorders), multiple comorbidities, multiple previous inpatient admissions, a history of self‐harm, and aggressive behavior (see Nielson et al., 2020, for a current review). Racial and ethnic minority youth, particularly African American children, are also at increased risk for restraint (Braun et al., 2020; dosReis et al., 2010; Leidy et al., 2006; Matte‐Landry & Collin‐Vézina, 2020).…”

“…For example, male youth are generally restrained more frequently than female youth, although neither gender was found to be predictive of restraint or seclusion outcomes in one analysis (Pogge et al., 2013). Additionally, female youth appear to be at greater risk for multiple restraints across studies (Nielson et al., 2020). Research regarding the association between psychiatric disorders and restraint likelihood is similarly convoluted.…”

Nurses' responses to adolescent distress in an acute child and adolescent mental health inpatient unit: A qualitative interpretive descriptive study

“…Factors associated with the use of coercive interventions (seclusion and physical restraint)-interventions that occur commonly in adolescent inpatient units (Neilsen et al, 2020)-include the length of stay, diagnostic variables, clinical measures, and a history of aggression (Furre et al, 2017). The long-term effects of coercive interventions on both young people and nurses are well documented (Magnowski & Cleveland, 2019).…”