Furre Astrid, Falk Ragnhild Sørum, Sandvik Leiv, Friis Svein, Knutzen Maria, Hanssen-Bauer Ketil
Division of Mental Health and Addiction, Centre for Forensic Psychiatry, Oslo University Hospital, Oslo, Norway ; Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.
Oslo Centre for Epidemiology and Biostatistics, Oslo University Hospital, Oslo, Norway.
Child Adolesc Psychiatry Ment Health. 2017 Jan 12;11:3. doi: 10.1186/s13034-016-0136-1. eCollection 2017.
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.
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.
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.
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.
在青少年精神科环境中使用约束措施需要特别的专业、伦理和法律考量。本研究的目的是调查每位患者的约束事件数量是否与青少年的若干特征中的任何一项相关。
在这项全国性研究中，我们纳入了2008年至2010年期间在挪威青少年急性精神科住院单元接受约束的所有青少年（N = 267）。他们占同期在这些单元住院的青少年的6.5%。我们收集了他们在研究期间经历的约束事件数量的数据；然后使用泊松回归分析性别、社会、心理健康和治疗特征对约束频率的影响。我们制定了一个经历多次约束事件可能性的风险指数。
我们发现约束事件的分布存在偏差，一小部分（18%）受约束的青少年经历了大部分（77%）的约束事件。很大比例（36%）的受约束青少年仅经历过一次约束事件。多次约束事件的风险因素包括女性性别、较低的心理社会功能（儿童总体评估量表低于35分）、更多且更长时间的住院、以及同时使用药物约束。除性别外，我们使用这些变量制定了一个与多次约束事件中度相关的风险指数。
由于一小部分患者占约束事件的很大比例，未来的研究应进一步调查青少年急性精神科单元患者多次约束事件的原因和后果，并评估旨在降低他们受约束风险的预防方法。
