Characteristics of adolescents frequently restrained in acute psychiatric units in Norway: a nationwide study.
Characteristics of adolescents frequently restrained in acute psychiatric units in Norway: a nationwide study.
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DOI：
10.1186/s13034-016-0136-1
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发表时间：
2017
影响因子：
5.6
通讯作者：
Hanssen-Bauer K
中科院分区：
文献类型：
--
作者：
Furre A;Falk RS;Sandvik L;Friis S;Knutzen M;Hanssen-Bauer K
在青少年精神科环境中使用约束措施需要特别的专业、伦理和法律方面的考虑。这项研究的目的是调查每个患者的束缚发作次数是否与青少年的几个特征中的任何一个有关。在这项全国性研究中，我们纳入了2008-2010年期间在挪威青少年急性精神病住院病房中被拘禁的所有青少年(N=267)。他们占同期在这些单位住院的青少年的6.5%。我们收集了他们在研究期间经历的约束事件的数量的数据；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。我们开发了一个风险指数，用来衡量经历多次束缚发作的可能性。我们发现约束事件的分布是不对称的，其中一小群(18%)受约束的青少年经历了大多数(77%)的约束事件。很大一部分受约束的青少年(36%)只经历过一次约束。多重束缚发作的危险因素是女性、较低的心理社会功能(儿童全球评估评分低于35)、更多和更长的住院时间，以及伴随使用药物束缚。除了性别，我们使用这些变量来开发一个与多次束缚发作适度相关的风险指数。由于少数患者占约束发作的很大比例，未来的研究应进一步调查急性青少年精神病室患者多次约束发作的原因和后果，并评估有针对性的预防方法，以降低他们经历约束的风险。
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.