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Leiv Sandvik Sonja Heyerdal Svein Friis Maria Knutzen Kjetil Hanssen-Bauer

Characteristics of Adolescents Subjected to Restraint in Acute Psychiatric Units in Norway

Psychiatric Services in Advance. | 2014


Characteristics of Adolescents Subjected to Restraint in Acute Psychiatric Units in Norway: A Case-Control Study

Objective: Use of restraint in psychiatric treatment is controversial. This
study compared social, mental health, and treatment characteristics of
restrained and nonrestrained adolescents in acute psychiatric inpatient
units. Methods: In a retrospective case-control design, we included all
adolescents restrained during 2008–2010 (N=288) in all acute psychiatric
inpatient units that accepted involuntarily admitted adolescents in Norway
(N=16). A control group (N=288) of nonrestrained adolescent
patients was randomly selected from the same units. Restraint included
mechanical restraint, pharmacological restraint, seclusion, and physical
holding. Data sources were electronic patient records and restraint
protocols. Binary logistic regression analyses were performed to predict
restraint use. Results: Compared with nonrestrained adolescents, restrained
adolescents were more likely to be immigrants, to live in institutions
or foster care, and to have had involvement with child protection
services. The restrained adolescents were more likely to have psychotic,
eating, or externalizing disorders and lower scores on the Children’s
Global Assessment Scale (CGAS). They had multiple admissions and
longer stays and were more often involuntarily referred. When the
analysis adjusted for age, gender, living arrangements, child protection
services involvement, and ICD-10 diagnoses, several variables were
significantly associated with restraint: immigrant background, low CGAS
score, number of admissions, length of stay, and involuntary referral.
Conclusions: Restrained and nonrestrained patients differed significantly
in social, mental health, and treatment characteristics. These
findings may be useful in developing strategies for reducing the use of
restraint in child and adolescent psychiatry. (Psychiatric Services in Advance,
July 1, 2014; doi: 10.1176/