Past Issues

Background: After introducing the concept of “restraint-free environment” in a hospital, we intended to study the changes of restraint/seclusion (R/S) uses in psychiatric units and associations with other psychiatric diagnoses and adversities by the frequency of R/S in their histories. Methods: With four-year database (2012 - 2015) of Taiwan Clinic Performance Indicator (TCPI) in one psychiatric teaching hospital, we included 1,921 psychiatric inpatients and compared their clinical adversities including R/S, and analyzed them in three groups ‒ never-, infrequent- (less than or equal to twice) and frequent- (more than twice) R/S groups, namely, NR, IR, and FR groups. Results: About 80% of inpatients in TCPI records experienced R/S during this study period. A steady increasing trend of R/S uses was found over those study years. And the most frequent reason was electroconvulsive therapy (ECT)-related treatments (44%). FR group showed significantly higher prevalence in patients with schizophrenia, bipolar disorder, but significantly lower for those with adjustment disorder and major depression (all p < 0.001), and significantly higher risks of almost other TCPI indicators (all p < 0.001) except suicide attempt and against advice discharge. But the IR group were those more with adjustment disorder and major depression, and lowest prevalence of all other TCPI indicators than other groups. Conclusion: This study reconfirms the vigorous association between R/S and major psychiatric diagnoses and other TCPI indicators among psychiatric inpatients. But our findings first reveal that patients with less frequent R/S use may be more likely associated with depression and less likely with violence/aggression porn.