Children and adolescents at risk for seclusion and restraint in inpatient psychiatric treatment: a case control study

Abstract Background: To reduce coercion in acute inpatient child and adolescent psychiatric units, a better understanding of individuals at risk for seclusion and/or restraint (S/R) is needed. We report data on the proportion of patients secluded/restrained and factors associated with higher risk of S/R. Methods: A case-control study included all admissions (n=782) to a department of child and adolescent psychiatry within 36 months between 2019 and 2022. Data on age, gender, out of home care, primary and comorbid ICD-10 diagnoses, length of stay, prior/multiple admissions were compared between admissions with and without S/R using chi square tests for categorical and t-tests for continuous variables. Uni- and multivariate binary logistic regression models were computed. Results: The overall proportion of S/R was 12.8% (n=100). Females (p=.001), patients in out of home care (p<.001), with prior admission (p<.001), Post-traumatic stress disorder (PTSD; p<.001) and Borderline personality disorder (BPD; p<.001) were at a significantly higher risk of S/R. Length of stay in days (OR 1.01), out of home care (OR 3.85), PTSD (OR 6.20), BPD (OR 15.17), Attention deficit hyperactivity disorder (ADHD)/conduct disorder (OR 4.29), and manic episode/bipolar disorder (OR 36.41) were significantly associated with S/R in multivariate regression. Conclusions: Child and adolescent psychiatric staff should consider risk factors when using coercive measures. Patients with PTSD and/or BPD are the most vulnerable subgroup. Clinical practice needs to be adapted in order to prevent the use of S/R and its potential hazards.