Hottinen Anja, Välimäki Maritta, Sailas Eila, Putkonen Hanna, Joffe Grigori, Puukka Pauli, Noda Toshie, Lindberg Nina
Department of Nursing Science, University of Turku, Finland.
Nord J Psychiatry. 2013 Apr;67(2):132-9. doi: 10.3109/08039488.2012.699552. Epub 2012 Jul 5.
Little is known of the use of mechanical restraint in adolescent psychiatry.
To investigate the frequency and features of mechanical restraint in the field of Finnish adolescent psychiatry.
The data were collected in the metropolitan area of Helsinki, Finland, with seven closed and eight open wards for Finnish-speaking 13-17-year-old adolescents. The official restraint reports and the hospital files of the restraint patients from January 2009 to December 2009 were collected and analyzed.
Among adolescents hospitalized in closed wards, the 1-year prevalence of mechanical restraint was 9.5%. Among all hospitalized adolescents, the prevalence was 6.9%. The number of mechanically restrained individuals per 100,000 13 to 17-year -old Finnish-speaking inhabitants was 57.1. The median duration of the restraint episode was 4 h and 50 min, but almost half of the mechanical restraint episodes lasted 8 h or more. A quarter of restraint episodes were not based on reasons mentioned in the Finnish Mental Health Act. The most frequent diagnostic categories of mechanically restrained adolescents were mood disorders followed by schizophrenia-related as well as behavioral and emotional disorders. Suicidality preceded 40% and violence 61% of restraint episodes. Boys were restrained during the first days of hospital treatment significantly more often than were girls, whereas one in four girls experienced her first episode of restraint after 1 month of hospitalization.
Reducing the number and shortening the length of mechanical restraint episodes requires education of staff as well as projects focusing on reducing coercion. The clinical guidelines must be followed at grassroots level.
青少年精神病学中机械约束的使用情况鲜为人知。
调查芬兰青少年精神病学领域中机械约束的频率及特征。
在芬兰赫尔辛基大都市区收集数据，设有七个封闭式病房和八个开放式病房，收治13至17岁讲芬兰语的青少年。收集并分析了2009年1月至2009年12月期间约束患者的官方约束报告及医院档案。
在封闭式病房住院的青少年中，机械约束的1年患病率为9.5%。在所有住院青少年中，患病率为6.9%。每100,000名13至17岁讲芬兰语居民中机械约束个体的数量为57.1。约束事件的中位持续时间为4小时50分钟，但几乎一半的机械约束事件持续8小时或更长时间。四分之一的约束事件并非基于芬兰《精神卫生法》中提及的原因。机械约束青少年最常见的诊断类别是情绪障碍，其次是精神分裂症相关以及行为和情绪障碍。40%的约束事件之前有自杀倾向，61%的约束事件之前有暴力行为。男孩在住院治疗的头几天比女孩更频繁地受到约束，而四分之一的女孩在住院1个月后经历了她的首次约束事件。
减少机械约束事件的数量并缩短其持续时间需要对工作人员进行培训，以及开展侧重于减少强制手段的项目。必须在基层遵循临床指南。
