Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Oct 19, 2021; 11(10): 854-863
Published online Oct 19, 2021. doi: 10.5498/wjp.v11.i10.854
Determinants of mechanical restraint in an acute psychiatric care unit
Khadija El-Abidi, Antonio R Moreno-Poyato, Alba Toll Privat, David Corcoles Martinez, Rosa Aceña-Domínguez, Victor Pérez-Solà, Anna Mané
Khadija El-Abidi, Alba Toll Privat, David Corcoles Martinez, Rosa Aceña-Domínguez, Victor Pérez-Solà, Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona 08003, Spain
Antonio R Moreno-Poyato, Public Health, Mental and Maternal and Child Health, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona 08907, Spain
Antonio R Moreno-Poyato, Alba Toll Privat, David Corcoles Martinez, Victor Pérez-Solà, Anna Mané, Biomedical Research, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
Alba Toll Privat, David Corcoles Martinez, Victor Pérez-Solà, Anna Mané, Biomedical Research, Center for Biomedical Research in Mental Health Network, Barcelona 08003, Spain
Anna Mané, Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Centre Fòrum, Barcelona 08019, Spain
Author contributions: El-Abidi K is the principal investigator of the study, and contributed to the data collection, write all the article, take the discussion and conclusions; Mané A is the study coordination, contributed to analysis of results; Moreno-Poyato AR bibliographic reviewed for the introduction; Toll Privat A helped with the data collection; Corcoles Martinez D contributed to the analysis and interpretation of results with SPSS; Pérez-Solà V and Aceña-Domínguez R contributed to the article review.
Institutional review board statement: The study was reviewed and approved by the Comité de Ética de la Investigación con Medicamentos del Parc de Salut Mar Institutional Review Board (Approval No.2019/8524/I).
Informed consent statement: The use of written informed consent in this study was not necessary given the nature of the study.
Conflict-of-interest statement: No conflict of interest has been declared by the authors.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at amane@parcdesalutmar.cat.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anna Mané, MD, MSc, PhD, Doctor, Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Centre Fòrum, Calle Llull, 410, Barcelona 08019, Spain. amane@parcdesalutmar.cat
Received: April 22, 2021
Peer-review started: April 22, 2021
First decision: June 17, 2021
Revised: June 28, 2021
Accepted: September 3, 2021
Article in press: September 3, 2021
Published online: October 19, 2021
Processing time: 175 Days and 23.1 Hours
Abstract
BACKGROUND

Despite numerous attempts to reduce the use of mechanical restraint (MR), this technique continues to be widely applied in many acute psychiatric care settings. In order to reduce MR, a better understanding of the variables associated with its use and duration in different clinical environments is essential.

AIM

To determine the proportion of patients subjected to MR and the duration thereof in two acute care psychiatric units; and to identify the variables associated with the use and duration of MR.

METHODS

Descriptive study of all patients admitted to the acute psychiatric units at the Parc de Salut Mar (Barcelona, Spain) in the year 2018. The number and percentage of patients subjected to MR, as well as the duration of each episode were assessed. The following data were also registered: sociodemographic characteristics, psychiatric diagnosis, and presence of cultural and/or language barriers. Multivariate analyses were performed to assess determinants of MR and its duration.

RESULTS

Of the 464 patients, 119 (25.6%) required MR, with a median of 16.4 h per MR. Two factors - a diagnosis of psychotic disorder [Odds ratios (OR) = 0.22; 95%CI: 0.06-0.62; P = 0.005] and the presence of a language barrier (OR = 2.13; 95%CI: 1.2-3.7; P = 0.007) - were associated with a significantly higher risk of MR. Male sex was associated with a longer duration of MR (B = -19.03; 95%CI: -38.06-0.008; P = 0.05).

CONCLUSION

The presence of a language barrier and a psychotic disorder diagnosis are associated with a significantly higher risk of MR. Furthermore, male sex is associated with a longer duration of MR. Individualized restraint protocols that include the required tools are necessary to ultimately limit the use of mechanical restraint.

Keywords: Mechanical restraint; Prolonged restraint; Determining factors; Psychiatric acute unit

Core Tip: The purpose of this descriptive study was to determine the proportion of patients subjected to mechanical restraint (MR) and the duration thereof in two acute care psychiatric units. Secondly, to identify the variables associated with the use and duration of MR. The most important highlights show that the MR remains frequent and with a median duration of more than 16 h. The diagnosis of psychotic disorder and the presence of a language barrier were associated with a significantly higher risk of MR. Furthermore, male sex was associated with a longer duration of MR.