"Disruptive Behavior" or "Expected Benefit" Are Rationales of Seclusion Without Prior Aggression

Area of Science:

• Psychiatry
• Mental Health Care
• Clinical Psychology

Background:

• Seclusion is a restrictive measure in psychiatric care, typically used in emergencies.
• Aggression is a common factor preceding seclusion, but non-aggressive reasons may also exist.

Purpose of the Study:

• To investigate the non-aggressive reasons for seclusion in psychiatric patients.
• To identify factors associated with seclusion events that occur without preceding aggression.

Main Methods:

• Analysis of seclusion records and aggression incident reports (SOAS-R, inspectorate forms, patient files) for all admitted patients in a Dutch psychiatric hospital (2008-2009).
• Logistic regression used to analyze determinants of seclusion with vs. without prior aggression.
• Qualitative analysis of non-aggressive seclusion reasons.

Main Results:

• 17% of admitted patients were secluded; 14% of these had no recorded aggression.
• Seclusion without aggression was associated with later hospitalization days and nighttime, contrasting with aggression-related seclusion (earlier, daytime).
• Qualitative themes for non-aggressive seclusion included "disruptive behavior" and "beneficial to patient" (reduced stimuli).

Conclusions:

• Understanding diverse reasons for seclusion, including non-aggressive ones, is crucial for reducing its use.
• Interventions should target aggression prevention and management, but also address disruptive behavior and the therapeutic benefits of reduced stimulation.
• Future research should differentiate interventions based on whether seclusion is preceded by aggression.