Predictors of the Use of Seclusion on an Inpatient Child Psychiatric Unit

Millstein, Kathleen Hannigan; Cotton, Nancy S.

doi:10.1097/00004583-199003000-00015

Cited by 57 publications

(47 citation statements)

References 19 publications

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“…After applying the inclusion criteria, 13 publications were excluded: 6 did not meet the time-frame [2,10,20,23,31,35]; 2 papers did not report original research [8,13] and 5 did not present prevalence data for seclusion or restraint use [8,19,28,26,33] Four of the 7 included studies had a pre-intervention/post-intervention design (n=1,302) [6,17,18,21], two were descriptive studies (n=590) [9,15], and the last one was a cross-sectional survey (n=504) [32] (Table 1). …”

Section: Search Resultsmentioning

confidence: 99%

“…The reference lists of identified papers were used to find additional publications. We restricted our search to English language papers published between 2000 and 2010 because review papers on earlier research up until 1999 were already available [1,4,10,15,23]. Both the title and abstract of retrieved papers were screened.…”

Section: Methodsmentioning

confidence: 99%

“…The literature prior to the year 2000 reports rates ranging from 28% to 60% [1,4,10,15,23]. A survey of 25 US child and adolescent units found 6-fold higher SRU rates compared to adult services in the same state [18].…”

Section: Introductionmentioning

confidence: 99%

“…Dangerous behaviours, towards oneself or others, and agitation or aggression are the most frequently cited reasons for SRU [1,3,4,11,23,27,30].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and correlates of seclusion and restraint use in children and adolescents: a systematic review

Hert

Dirix

Demunter

et al. 2011

Eur Child Adolesc Psychiatry

101

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Seclusion and restraint are frequent procedures to intervene in aggressive and potentially dangerous patients in psychiatric settings. However, little is known about their utilization and effectiveness in paediatric populations. We aimed to examine the prevalence and determinants of seclusion and restraint utilisation in children and adolescents in psychiatric settings. Using PubMed, PsychInfo and Cinahl, we performed a systematic literature review of studies published in the last 10 years reporting on the prevalence of seclusion and restraint use in psychiatrically ill youth (<21 years old) treated in psychiatric settings. Only seven publications addressed the topic. Primary outcomes were prevalence rates, reported either as the proportion of patients restrained/secluded or as the number of restraints/seclusions per number of patient days. All studies found relatively high baseline rates of seclusion (26% of patients; 67/1.000 patient days), and restraints (29% of patients; 42.7/1,000 patient days). In four studies an intervention, implemented to reduce seclusion and restraints, resulted in a dramatic weighted mean reduction in the more restrictive use of restraints by 93.2%, with a 54.2% shorter duration. There was a small, weighted mean reduction in the use of less restrictive seclusions (-0.6%), but results were heterogeneous (-97.2% to +71.0%), with the only increase in seclusions being reported in one study in which the intervention-based padded seclusion room was utilized more frequently instead of more restrictive measures.Otherwise, seclusion episodes reduced by 74.7%, including a 32.4%. shorter duration. Few studies reported on risk-factors and predictors, consisting of past or current aggression and/or violence, suicidal behaviour, more severe psychopathology, non-White ethnicity, emergency admissions, out-of-home placement, and poorer family functioning, while findings regarding age were inconsistent Except for duration, data about the effectiveness of seclusion and restraints were missing, although there is some indication that seclusion and restraints can lead to severe psychological and physical consequences. Future research should focus on indications, predictors, preventive and alternative strategies, as well as on clinical outcomes of seclusion and restraints in psychiatrically ill youth. In addition, there is a clear need for transparent policies and guidelines.

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Section: Search Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Dangerous behaviours, towards oneself or others, and agitation or aggression are the most frequently cited reasons for SRU [1,3,4,11,23,27,30].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prevalence and correlates of seclusion and restraint use in children and adolescents: a systematic review

Hert

Dirix

Demunter

et al. 2011

Eur Child Adolesc Psychiatry

101

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“…6 Other factors with predictive value include a history of incarceration, 2 drug or alcohol abuse and being a victim of child abuse. 7 The present study has three main objectives: (i) to evaluate the prevalence of aggressive behaviors before and after the admission to an acute psychiatric inpatient unit; (ii) to identify clinical and sociodemographic factors associated with physically aggressive behavior in the month before admission to the psychiatric unit; and (iii) to identify clinical and sociodemographic factors associated with physically aggressive behavior during hospitalization.…”

mentioning

confidence: 99%

Predictors of violent behavior among acute psychiatric patients: Clinical study

Amore

Menchetti

Tonti

et al. 2008

Psychiatry Clin Neurosci

149

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Aim: Violence risk prediction is a priority issue for clinicians working with mentally disordered offenders. The aim of the present study was to determine violence risk factors in acute psychiatric inpatients. Methods:The study was conducted in a locked, short-term psychiatric inpatient unit and involved 374 patients consecutively admitted in a 1-year period. Sociodemographic and clinical data were obtained through a review of the medical records and patient interviews. Psychiatric symptoms at admission were assessed using the Brief Psychiatric Rating Scale (BPRS). Psychiatric diagnosis was formulated using the Structured Clinical Interview for DSM-IV. Past aggressive behavior was evaluated by interviewing patients, caregivers or other collateral informants. Aggressive behaviors in the ward were assessed using the Overt Aggression Scale. Patients who perpetrated verbal and against-object aggression or physical aggression in the month before admission were compared to non-aggressive patients, moreover, aggressive behavior during hospitalization and persistence of physical violence after admission were evaluated.Results: Violent behavior in the month before admission was associated with male sex, substance abuse and positive symptoms. The most significant risk factor for physical violence was a past history of physically aggressive behavior. The persistent physical assaultiveness before and during hospitalization was related to higher BPRS total scores and to more severe thought disturbances. Higher levels of hostility-suspiciousness BPRS scores predicted a change for the worse in violent behavior, from verbal to physical. Conclusion:A comprehensive evaluation of the history of past aggressive behavior and psychopathological variables has important implications for the prediction of violence in psychiatric settings.

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Involuntary Commitments

Kaltiala-Heino¹

2018

Encyclopedia of Adolescence

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Predictors of the Use of Seclusion on an Inpatient Child Psychiatric Unit

Cited by 57 publications

References 19 publications

Prevalence and correlates of seclusion and restraint use in children and adolescents: a systematic review

Prevalence and correlates of seclusion and restraint use in children and adolescents: a systematic review

Predictors of violent behavior among acute psychiatric patients: Clinical study

Involuntary Commitments

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