El-Badri Selim M, Mellsop Graham
Health Waikato, Hamilton, New Zealand.
Aust N Z J Psychiatry. 2002 Jun;36(3):399-403. doi: 10.1046/j.1440-1614.2002.01003.x.
In recent years, increased attention has been paid to significantly restrictive practices taking place in psychiatric services in New Zealand. The aim of this study was to prospectively examine the frequency of use of seclusion and the factors associated with its use in the acute general adult psychiatric wards serving the Waikato area.
Information on the use of seclusion and relevant demographic data were collected over a 9-month period in 2000. The patterns of locked seclusion use and the characteristics of patients who had been secluded were examined. Analysis compared patients requiring one or more episode of seclusion (n = 84) with those never secluded (n = 455).
Of a total of 539 patients admitted to the general adult unit during our study period, 84 (16%) were secluded in 129 seclusion episodes. About two-thirds of the seclusion events were initiated in the first week of the patient's admission, and three-quarters of secluded patients had only one episode. The median duration of seclusion was 14 hours. Comparison of gender and race revealed significant differences between the groups. Diagnosis, but not age, had a significant effect on whether a patient would be secluded. Seclusion was mainly associated with risk of, or actual, violence toward staff, patients or property.
This study shows that seclusion is regularly practiced in the psychiatric wards of the Waikato area. In the majority of cases, its use was related to actual or threatened violence. Male, non-European patients and patients with certain diagnoses were at particular risk for seclusion. More research is required to examine the most effective use of seclusion and also the development and use of alternative strategies in controlling aggressive behaviour.
近年来，新西兰精神科服务中显著的限制性措施受到了更多关注。本研究的目的是前瞻性地调查怀卡托地区成人急性普通精神科病房中隔离措施的使用频率及其相关因素。
2000年，在9个月的时间里收集了隔离措施使用情况及相关人口统计学数据。对封闭隔离措施的使用模式以及接受隔离患者的特征进行了检查。分析比较了需要一次或多次隔离的患者（n = 84）和从未接受隔离的患者（n = 455）。
在我们研究期间，共有539名成人普通病房患者入院，其中84人（16%）经历了129次隔离事件。约三分之二的隔离事件发生在患者入院的第一周，四分之三接受隔离的患者只经历了一次隔离。隔离的中位时长为14小时。性别和种族比较显示两组之间存在显著差异。诊断而非年龄对患者是否会被隔离有显著影响。隔离主要与对工作人员、患者或财产的实际暴力风险或暴力行为有关。
本研究表明，怀卡托地区精神科病房经常使用隔离措施。在大多数情况下，其使用与实际的或潜在的暴力行为有关。男性、非欧洲裔患者以及某些诊断的患者接受隔离的风险尤其高。需要更多研究来考察隔离措施的最有效使用方式，以及控制攻击性行为的替代策略的开发和使用情况。
