Prevalence and risk factors for the use of restraint in psychiatry: a systematic review

Despite the poor evidence supporting the use of coercive procedures in psychiatry wards and their “psychological damage” on patients, the practice of restraint is still frequent (6-17%) and varies 10-20 times among centers. Methods. We searched the PubMed, Embase and PsychInfo databases for papers published between January 1 1990 and March 31 2010 using the key words “restraint”, “constraint”, “in-patient” and “psychiatry wards” and the inclusion criteria of adult samples (studies of selected samples such as a specific psychiatric diagnosis other than psychosis, adolescence or the elderly, men/women only, personality disorders and mental retardation were excluded), the English, French, Italian or German languages, and an acute setting. Results. The prevalence of the use of restraint was 3.8-20% (not different from previous data), despite the attempts to reduce the use of restraint. The variables most frequently associated with the use of coercive measures in the 49 studies included in this review were male gender, young adult age classes, foreign ethnicity, schizophrenia, involuntary admission, aggression or trying to abscond, and the presence of male staff. Conclusions. Coercive measures are still widely used in many countries (albeit to a greater or lesser extent) despite attempts to introduce alternatives (introduction of special protocols and nurses’ training courses) in some centers that should really be tested in large-scale multicentre studies in order to verify their efficacy.