Abstract
Purpose. The purpose of this dissertation is to examine the role of demographic, clinical, hospital, and medication variables in predicting seclusion/restraint episodes in adult and adolescent inpatient psychiatric patients. Method. This retrospective case control study was based on data collected from a medical chart review at a Los Angeles area free-standing psychiatric hospital for adolescent and adult patients. Demographic, clinical, hospital, and medication variables were collected for approximately 218 randomly selected adult and adolescent patients. The relationship of these variables was tested by Chi-Square analyses and Independent samples t-tests. Results. The Chi-square analyses revealed that adult patients with a diagnosis of Bipolar Disorder and history of violence towards others were more likely to be restrained. Substance use was more frequent in the non-restrained population. The results of the independent samples t-test indicated a significant difference in the mean age for restrained and non-restrained adolescent patients. Also, the Chi-square analyses indicated that restrained adolescents were more likely to be male and African-American with a diagnosis of Psychotic Disorder and a history of violence towards themselves and others. Hospital variables were not significantly related to being restrained. In addition, the results found that most adult restrained patients were prescribed medication. Adult and adolescent restrained patients did not have a medication change and were given a PRN (per request needed) medication prior to the incident. Type of PRN, specifically being given a combination of medication (cocktail), was found most often in adolescent restrained patients. Discussion. The findings demonstrate that demographic and clinical variables play a significant role in adult and adolescent seclusion/restraints. Despite the lack of significant relationship of hospital variables to seclusion/restraint, the present study provides some evidence for the interplay between medications and seclusion/restraint episodes. The controversy regarding the use of seclusion/restraints has been growing, and there has been a push to eliminate its use throughout facilities. In order to determine how to prevent occurrences, facilities need to take an active role in examining the variables specific to their populations. The results indicate that the factors related to seclusion/restraint are complex and should be further explored with special attention to local and on-site factors.