title: Characteristics of adolescents frequently restrained in acute psychiatric units in Norway: a nationwide study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Mental Health and Addiction, Centre for Forensic Psychiatry, Oslo University Hospital, Oslo, Norway ; Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.
authors.forename: Astrid
authors.initials: A
authors.lastname: Furre
authors.affiliation: Oslo Centre for Epidemiology and Biostatistics, Oslo University Hospital, Oslo, Norway.
authors.forename: Ragnhild Sørum
authors.initials: RS
authors.lastname: Falk
authors.affiliation: Oslo Centre for Epidemiology and Biostatistics, Oslo University Hospital, Oslo, Norway.
authors.forename: Leiv
authors.initials: L
authors.lastname: Sandvik
authors.affiliation: Division of Mental Health and Addiction, Department of Research and Development, Oslo University Hospital, Oslo, Norway.
authors.forename: Svein
authors.initials: S
authors.lastname: Friis
authors.affiliation: Division of Mental Health and Addiction, Centre for Forensic Psychiatry, Oslo University Hospital, Oslo, Norway.
authors.forename: Maria
authors.initials: M
authors.lastname: Knutzen
authors.affiliation: Division of Mental Health Services, Akershus University Hospital, Lorenskog, Norway ; Division of Health Service Research and Psychiatry, University of Oslo, Oslo, Norway.
authors.forename: Ketil
authors.initials: K
authors.lastname: Hanssen-Bauer
keywords: Adolescence; Health care research; Inpatient; Restraint