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Elevated Rates of Restraint and Seclusion in Child and Adolescent Psychiatric Inpatients in China and Their Associated Factors

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Abstract

To investigate the rate of restraint and seclusion (R&S) use in child and adolescent psychiatric inpatients in China and to examine factors associated with use of these interventions. As part of an official national survey, 41 provincial tertiary psychiatric hospitals in China were selected. Data from 196 youth inpatients discharged from these hospitals from March 19 to 31, 2019 were retrieved and analyzed. (1) The overall rate of R&S was 29.1% (N = 57) and the rate of restraint was 28.6% (N = 56), and seclusion was 11.7% (N = 23) respectively. (2) Compared to patients who did not require R&S, those who required R&S were more likely to have been hospitalized on an involuntary basis, more likely to present with either manic symptoms or aggressive behavior as primary reason for admission, had more frequent aggressive behaviors during hospitalization, and had a significantly longer length of stay. (3) A logistic regression showed that aggressive behaviors during hospitalization was significantly associated with the use of R&S (OR = 21.277, p < 0.001), along with three other factors: manic symptoms as a reason for admission, involuntary admission and a lower GAF score at admission (all p < 0.01). The rate of R&S is dramatically higher in child and adolescent psychiatric hospitalizations in China compared to other regions. Targeted training of staff, development of precise operational guidelines for appropriate use of R&S, and strict oversight are urgently needed to minimize the inappropriate use of R&S in child and adolescent patients.

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Acknowledgements

The authors thank the Beijing Medical and Health Foundation (MH180924), the National Clinical Key Specialty Capacity Building Project and Hefei 6th-Cycle Key Medical Specialty who funded this research project, and we also appreciate the efforts of the hospital administers who facilitated the survey.

Funding

This study was supported in part by the Beijing Medical, Health Foundation (Grant No. MH180924) and the National Clinical Key Specialty Capacity Building Project and Hefei 6th-Cycle Key Medical Specialty. Role of the Funder/Sponsor: The sponsor did not have a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Author notes

  1. Co-first author: Feng Geng, Feng Jiang

  2. Feng Geng and Feng Jiang contributed equally to this paper.

Authors and Affiliations

  1. Affiliated Psychological Hospital of Anhui Medical University, No. 316 Huangshan Road, Hefei, 230022, China

    Feng Geng

  2. Hefei Fourth People’s Hospital, No. 316 Huangshan Road, Hefei, 230022, China

    Feng Geng

  3. Anhui Mental Health Center, No. 316 Huangshan Road, Hefei, 230022, China

    Feng Geng

  4. Department of Psychiatry, Chaohu Hospital of Anhui Medical University, No. 64 Chaohu North Road, Chaohu District, Hefei, 238000, China

    Feng Geng & Huanzhong Liu

  5. Institute of Health Yangtze River Delta, Shanghai Jiaotong University, No. 1954 Huashan Road, Xuhui District, Shanghai, 200030, China

    Feng Jiang

  6. Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA

    Rachel Conrad

  7. Harvard Medical School Center for Bioethics, 641 Huntington Ave, Boston, MA, 02115, USA

    Rachel Conrad

  8. Institute for Hospital Management of Tsinghua University, Haidian District, Beijing, 100730, China

    Tingfang Liu

  9. School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 3 Dong Dan San Tiao, Dongcheng District, Beijing, 100730, China

    Yuanli Liu

  10. Department of Psychiatry and Behavioral Sciences, Emory University, 12 Executive Park Drive NE, Atlanta, GA, 30329, USA

    Yi-lang Tang

  11. Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA, 30033, USA

    Yi-lang Tang

Authors
  1. Feng Geng
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  3. Rachel Conrad
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Contributions

FG and FJ had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: FJ, HL and YT. Acquisition, analysis, or interpretation of data: FG, YT. Drafting of the manuscript: FG, HL and YT. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: FG, FJ and Y-lT. Obtained funding: FJ and HL. Supervision: HL, YT.

Corresponding authors

Correspondence to Huanzhong Liu or Yi-lang Tang.

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Geng, F., Jiang, F., Conrad, R. et al. Elevated Rates of Restraint and Seclusion in Child and Adolescent Psychiatric Inpatients in China and Their Associated Factors. Child Psychiatry Hum Dev 52, 939–944 (2021). https://doi.org/10.1007/s10578-020-01074-6

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