Influence of patient characteristics on duration of seclusion/restrain in acute psychiatric settings in Japan.
OBJECTIVE
The aim of this study was to investigate the current state of duration of seclusion/restraint in acute psychiatric settings in Japan and the effect of patient characteristics on duration of seclusion/restraint.


METHODS
During an 8-month period starting from November 2008, duration of seclusion/restraint and patient characteristics were investigated in 694 psychiatric inpatients who experienced seclusion/restraint in three emergency and three acute wards at four psychiatric hospitals. Reasons for starting seclusion/restraint were also assessed. Analysis was performed using generalized linear models, with the duration of seclusion/restraint as the dependent variable and patient characteristics and reasons for starting seclusion/restraint as independent variables.


RESULTS
Of the patients secluded/restrained, 58.6% had a primary diagnosis of schizophrenia (F20-F29) and a large proportion (37.9%) were secluded/restrained due to hurting others. Median hours ofseclusion/restraint were 204 and 82 h, respectively. The duration of seclusion was longer for patients with F20-F29 than those with disorders due to psychoactive substance use (F10-F19) or other diagnoses (F40-F99), and when the reason was danger of hurting others. In contrast, the duration of restraint in female patients and in patients with F10-F19 diagnosis was shorter.


CONCLUSIONS
The duration of seclusion/restraint at acute psychiatric care wards in Japan are much longer than those reported by previous overseas studies. Although Japanese structure issues such as more patients per ward and a lower ratio of nurses need to be considered, skills for dealing with patients with primary diagnosis of F20-F29 secluded due to danger posed to others should be improved.
Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan. toshie.noda@gmail.com
Toshie
T
Noda
Naoya
N
Sugiyama
Makiko
M
Sato
Hiroto
H
Ito
Eila
E
Sailas
Hanna
H
Putkonen
Raija
R
Kontio
Grigori
G
Joffe
D000328:Adult; D004636:Emergency Service, Hospital; D005260:Female; D005387:Finland; D006301:Health Services Needs and Demand; D006778:Hospitals, Psychiatric; D006801:Humans; D007297:Inpatients; D038801:International Classification of Diseases; D007564:Japan; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D008875:Middle Aged; D010356:Patient Isolation / Q000523:psychology* / Q000706:statistics & numerical data; D012149:Restraint, Physical / Q000523:psychology* / Q000706:statistics & numerical data; D012737:Sex Factors
acute psychiatry; generalized linear models; psychiatric inpatient; restraint; seclusion