Risk Factors for Seclusion and Restraint in a Pediatric Psychiatry Day Hospital

Abstract

The use of seclusion and restraints (SR) in acute hospital settings remains a controversial practice. Despite the focus on SR in the psychiatric services literature, data on SR use in pediatric day hospital settings is lacking. A case-control retrospective analysis for children admitted into a pediatric psychiatry day hospital in a 2-year span examined predictors of SR use. Demographic and clinical descriptors were examined in relation to SR events using univariate and multivariate regression models. Significant univariate risk factors for SR use were psychiatric morbidity, history of physical abuse, post-traumatic stress disorder, having any anxiety disorder, and younger age. Knowledge of risk factors for SR use in pediatric psychiatric day hospitals can avert use of SR and lead to improved safety in a trauma-informed care model.

Nurse and patient factors: Predicting seclusion in adolescent psychiatric units

“…Controlling for factors such as aggression, psychotic disorders, and anxiety disorders have been uniquely associated with greater use of seclusion (Duke et al, 2014; Dumais et al, 2011; Gullick et al, 2005; Timbo et al, 2016). But, contrary to our hypotheses, these disorders were not significantly associated with seclusion in univariate analyses.…”

“…However, we provided novel information regarding the use of seclusion in an adolescent unit, particularly through the investigation of nurse factors on adolescent units and determining the relative contribution of both inpatient and nurse factors to seclusion outcomes. Previous single‐site studies have also given valuable insights into seclusion (Duke et al, 2014; Muir‐Cochrane et al, 2014; Timbo et al, 2016; Vidal et al, 2020).…”

“…Many studies report on the combined risk of seclusion and restraint or a single category of “coercive measures” that includes seclusion, restraint, and pro‐re‐nata/involuntary‐medication (Husum et al, 2010; Steinert et al, 2007; Timbo et al, 2016; Ulla et al, 2012). Psychotic disorders and psychosis, depressive disorders, anxiety disorders, aggression (defined variously as history, risk, and aggressive behaviors), and lower global functioning have all been identified as risk factors for individuals (Doedens et al, 2017; Duke et al, 2014; Dumais et al, 2011; Georgieva et al, 2012; Happell & Koehn, 2010; Jury et al, 2019; Noorthoorn et al, 2015; Swadi & Bobier, 2012; Timbo et al, 2016; Vidal et al, 2020; Vruwink et al, 2012). However, some of these have also shown no effect or the opposite effects on seclusion rates, such as depression acting as a protective factor (Husum et al, 2010; Simpson et al, 2014; Vidal et al, 2020).…”

Methods and Strategies for Reducing Seclusion and Restraint in Child and Adolescent Psychiatric Inpatient Care

“…In a study from Iowa (2011), 70% of the adult inpatients who experienced the most instances of seclusions or restraints had experienced childhood abuse [18]. Another study found that children with post-traumatic stress disorder (PTSD) and/or a history of physical abuse had a significantly higher risk of being secluded or restrained in a U.S. pediatric day hospital [19].…”

“…The baseline rates of seclusions were 26% of patients or 67 per 1000 patient days, and the baseline rates of restraints were 29% of patients or 42.7 per 1000 patient days. Recent studies on child and adolescent psychiatric inpatient units reported rates of restraint between 6.5 and 29% of admitted patients; 6.5% restraint, Norway [25,26], 12% restraint or seclusion, the U.S. [19], 26.9% restraint or seclusion, Australia [27], 29% restraint or seclusion, the U.S. [28], 16.9% restraint or seclusion, the U.S. [29], 6.9% mechanical restraint only, Finland [30]. A review by Beghi et al (2013) reported a 3.8-20% prevalence of restraint utilization in adult psychiatric units [31].…”