Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Child and Adolescent Psychiatry and Mental Health
Published in: Child and Adolescent Psychiatry and Mental Health 1/2017

Open Access 01-12-2017 | Research article

Characteristics of adolescents frequently restrained in acute psychiatric units in Norway: a nationwide study

Authors: Astrid Furre, Ragnhild Sørum Falk, Leiv Sandvik, Svein Friis, Maria Knutzen, Ketil Hanssen-Bauer

Published in: Child and Adolescent Psychiatry and Mental Health | Issue 1/2017

Login to get access

Abstract

Background

The 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.

Methods

In 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.

Results

We 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.

Conclusions

As 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.
Literature
1.
Day DM. Examining the therapeutic utility of restraints and seclusion with children and youth: the role of theory and research in practice. Am J Orthopsychiatry. 2002;72(2):266–78.CrossRefPubMed
2.
Kalogjera IJ, Bedi A, Watson WN, Meyer AD. Impact of therapeutic management on use of seclusion and restraint with disruptive adolescent inpatients. Hosp Community Psychiatry. 1989;40(3):280–5.PubMed
3.
Mohr WK, Petti TA, Mohr BD. Adverse effects associated with physical restraint. Can J Psychiatry. 2003;48(5):330–7.PubMed
4.
LeBel J, Stromberg N, Duckworth K, Kerzner J, Goldstein R, Weeks M, et al. Child and adolescent inpatient restraint reduction: a state initiative to promote strength-based care. J Am Acad Child Adolesc Psychiatry. 2004;43(1):37–45.CrossRefPubMed
5.
Caldwell B, Albert C, Azeem MW, Beck S, Cocoros D, Cocoros T, et al. Successful seclusion and restraint prevention effort in child and adolescent programs. J Psychosoc Nurs Ment Health Serv. 2014;52(11):30–8.CrossRefPubMed
6.
Beghi M, Peroni F, Gabola P, Rossetti A, Cornaggia CM. Prevalence and risk factors for the use of restraint in psychiatry: a systematic review. Riv Psichiatr. 2013;48(1):10–22.PubMed
7.
Bowers L, van der Werf B, Vokkolainen A, Muir-Cochrane E, Allan T, Alexander J. International variation in containment measures for disturbed psychiatric inpatients: a comparative questionnaire survey. Int J Nurs Stud. 2007;44(3):357–64.CrossRefPubMed
8.
Kalisova L, Raboch J, Nawka A, Sampogna G, Cihal L, Kallert TW, et al. Do patient and ward-related characteristics influence the use of coercive measures? Results from the EUNOMIA international study. Soc Psychiatry Psychiatr Epidemiol. 2014;49(10):1619–29.CrossRefPubMed
9.
Raboch J, Kalisova L, Nawka A, Kitzlerova E, Onchev G, Karastergiou A, et al. Use of coercive measures during involuntary hospitalization: findings from ten European countries. Psychiatr Serv. 2010;61(10):1012–7.CrossRefPubMed
10.
Way BB, Banks SM. Use of seclusion and restraint in public psychiatric hospitals: patient characteristics and facility effects. Hosp Community Psychiatry. 1990;41(1):75–81.PubMed
11.
LeBel J, Huckshorn KA, Caldwell B. Restraint use in residential programs: why are best practices ignored? Child Welfare. 2010;89(2):169–87.PubMed
12.
De Hert M, Dirix N, Demunter H, Correll CU. Prevalence and correlates of seclusion and restraint use in children and adolescents: a systematic review. Eur Child Adolesc Psychiatry. 2011;20(5):221–30.CrossRefPubMed
13.
Sourander A, Ellila H, Valimaki M, Piha J. Use of holding, restraints, seclusion and time-out in child and adolescent psychiatric in-patient treatment. Eur Child Adolesc Psychiatry. 2002;11(4):162–7.CrossRefPubMed
14.
Siponen S, Maritta V, Riittakerttu KH. The use of coercive measures in adolescent psychiatric inpatient treatment: a nation-wide register study. Soc Psychiatry Psychiatr Epidemiol. 2012;47(9):1401–8.CrossRef
15.
Furre A, Sandvik L, Friis S, Knutzen M, Hanssen-Bauer K. A nationwide study of why and how acute adolescent psychiatric units use restraint. Psychiatry Res. 2016;237:60–6.CrossRefPubMed
16.
Angold A, Pickles A. Seclusion on an adolescent unit. J Child Psychol Psychiatry. 1993;34(6):975–89.CrossRefPubMed
17.
Baeza I, Correll CU, Saito E, Amanbekova D, Ramani M, Kapoor S, et al. Frequency, characteristics and management of adolescent inpatient aggression. J Child Adolesc Psychopharmacol. 2013;23(4):271–81.CrossRefPubMedPubMedCentral
18.
Earle KA, Forquer SL. Use of seclusion with children and adolescents in public psychiatric hospitals. Am J Orthopsychiatry. 1995;65(2):238–44.CrossRefPubMed
19.
Goren S, Singh NN, Best AM. The aggression-coercion cycle: use of seclusion and restraint in a child psychiatric hospital. J Child Fam Stud. 1993;2(1):61–73.CrossRef
20.
Pogge DL, Pappalardo S, Buccolo M, Harvey PD. Prevalence and precursors of the use of restraint and seclusion in a private psychiatric hospital: comparison of child and adolescent patients. Adm Policy Ment Health. 2013;40(3):224–31.CrossRefPubMed
21.
Delaney KR, Fogg L. Patient characteristics and setting variables related to use of restraint on four inpatient psychiatric units for youths. Psychiatr Serv. 2005;56(2):186–92.CrossRefPubMed
22.
23.
World Health Organization. Multiaxial classification of child and adolescent psychiatric disorders: The ICD-10 classification of mental and behavioural disorders in children and adolescents. Cambridge: Cambridge University Press; 1996.
24.
Shaffer D, Gould MS, Brasic J, Ambrosini P, Fisher P, Bird H, et al. A children’s global assessment scale (CGAS). Arch Gen Psychiatry. 1983;40(11):1228–31.CrossRefPubMed
25.
Hanssen-Bauer K, Aalen OO, Ruud T, Heyerdahl S. Inter-rater reliability of clinician-rated outcome measures in child and adolescent mental health services. Adm Policy Ment Health. 2007;34(6):504–12.CrossRefPubMed
26.
Cameron AC, Trivedi PK. Microeconometrics using Stata: Stata Press; 2009.
27.
SPSS Inc. PASW Statistics for Windows. In: Version 18.0 edn. Chicago: SPSS Inc.;2009.
28.
StataCorp. Stata Statistical Software: Release 13. In: College Station edn. Tx: StataCorp LP; 2013.
29.
Whitehead PD, Liljeros F. Heavy-tailed distribution of seclusion and restraint episodes in a state psychiatric hospital. J Am Acad Psychiatry Law. 2011;39(1):93–9.PubMed
30.
Miller L, Riddle MA, Pruitt D, Zachik A, dosReis S. Antipsychotic treatment patterns and aggressive behavior among adolescents in residential facilities. J Behav Health Serv Res. 2013;40(1):97–110.CrossRefPubMedPubMedCentral
31.
dosReis S, McCulloch JR, Colantuoni E, Barnett SR, Pruitt D, Zachik A, et al. Early identification of seclusion and restraint patterns during adolescents’ course of residential treatment. Resid Treat Child Youth. 2010;27(3):160–74.CrossRef
32.
Martin A, Krieg H, Esposito F, Stubbe D, Cardona L. Reduction of restraint and seclusion through collaborative problem solving: a five-year prospective inpatient study. Psychiatr Serv. 2008;59(12):1406–12.CrossRefPubMed
33.
Knutzen M, Bjørkly S, Eidhammer G, Lorentzen S, Mjøsund NH, Opjordsmoen S, et al. Characteristics of patients frequently subjected to pharmacological and mechanical restraint—a register study in three Norwegian acute psychiatric wards. Psychiatry Res. 2014;215(1):127–33.CrossRefPubMed
34.
Furre A, Sandvik L, Heyerdahl S, Friis S, Knutzen M, Hanssen-Bauer K. Characteristics of adolescents subjected to restraint in acute psychiatric units in Norway: a case-control study. Psychiatr Serv. 2014;65(11):1367–72.CrossRefPubMed
35.
Leidy BD, Haugaard JJ, Nunno MA, Kwartner JK. Review of restraint data in a residential treatment center for adolescent females. Child Youth Care Forum. 2006;35(5–6):339–52.CrossRef
36.
Donovan A, Plant R, Peller A, Siegel L, Martin A. Two-year trends in the use of seclusion and restraint among psychiatrically hospitalized youths. Psychiatr Serv. 2003;54(7):987–93.CrossRefPubMed
37.
Hottinen A, Valimaki M, Sailas E, Putkonen H, Joffe G, Puukka P, et al. Mechanical restraint in adolescent psychiatry: a finnish register study. Nord J Psychiatry. 2013;67(2):132–9.CrossRefPubMed
Metadata
Title
Characteristics of adolescents frequently restrained in acute psychiatric units in Norway: a nationwide study
Authors
Astrid Furre
Ragnhild Sørum Falk
Leiv Sandvik
Svein Friis
Maria Knutzen
Ketil Hanssen-Bauer
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Child and Adolescent Psychiatry and Mental Health / Issue 1/2017
Electronic ISSN: 1753-2000
DOI
https://doi.org/10.1186/s13034-016-0136-1

Other articles of this Issue 1/2017

Child and Adolescent Psychiatry and Mental Health 1/2017 Go to the issue

Research article

Risk and protective factors for mental health problems in preschool-aged children: cross-sectional results of the BELLA preschool study

Research Article

A program of family-centered care for adolescents in short-term stay groups of juvenile justice institutions

Research Article

Low mood in a sample of 5–12 year-old child psychiatric patients: a cross-sectional study

Research article

Marital relationship, parenting practices, and social skills development in preschool children

Research Article

Serious juvenile offenders: classification into subgroups based on static and dynamic charateristics

Research Article

Does parent–child agreement vary based on presenting problems? Results from a UK clinical sample