Determinants of seclusion in a psychiatric institution: a naturalistic and exploratory study
background Seclusion of a psychiatric patient is a multifactorial process in which patient, staff and ward variables all play a role. So far, few studies have investigated to what extent these variables in combination can be the determinants of seclusion.
aim To investigate, in a multivariate study, what influence certain patient, staff and ward variables had on the decision to seclude a psychiatric patient and to use the findings to support specific interventions which could reduce the total number of seclusions in our institution.
method We based our study on 78 secluded patients and 96 similar control-patients (not secluded at that time) and we collected data from these patients with regard to some quantified patient, staff and ward variables. In this retrospective cross-sectional study we performed a multivariate logistic regression analysis on the data. This enabled us to study associative links but not causal links.
results Seclusion was found to be a multifactorial process which revealed significant associations with several patients variables (nosie-variables irritability and motor retardation) and one staff variable (subjective feeling of safety among nursing staff on the day of the patient’s seclusion). We also found many more non-significant associations.
conclusion Interventions that might reduce the number of seclusions (in our institution) should perhaps be directed towards the irritability and motor retardation of the patient and towards feelings of safety among the nursing staff.