Effects of Seclusion and Restraint in Adult Psychiatry: A Systematic Review
Open accessAbstract
Background Determining the clinical effects of coercion is a difficult challenge, raising ethical, legal and methodological questions. Despite limited scientific evidence on effectiveness, coercive measures are frequently used, especially in psychiatry. This systematic review aims to search for effects of seclusion and restraint on psychiatric inpatients with wider inclusion of outcomes and study designs than former reviews. Methods A systematic search was conducted following PRISMA guidelines, primarily through Pubmed, Embase, CENTRAL. Interventional and prospective observational studies on effects of seclusion and restraint on psychiatric inpatients were included. Main search keywords were restraint, seclusion, psychiatry, effect, harm, efficiency, efficacy, effectiveness, quality of life. Results Thirty-five articles were included, out of 6854 records. Studies on the effects of seclusion and restraint in adult psychiatry comprise a wide range of outcomes and designs. The identified literature provides some evidence that seclusion and restraint have deleterious physical or psychological consequences. Estimation of Post-traumatic Stress Disorder incidence after intervention varies from 25 to 47%, and thus, is not negligible, especially for patients with past traumatic experiences. Subjective perception has high interindividual variability, mostly associated with negative emotions. Effectiveness and adverse effects of seclusion and restraint seem to be similar. Compared to other coercive measures (notably forced medication), seclusion seems to be better accepted, while restraint seems to be less tolerated, possibly because of the perception of seclusion as “non-invasive”. Therapeutic interaction appears to have a positive influence on coercion perception. Conclusion Heterogeneity of the included studies limited drawing clear conclusions, but the main results identified show negative effects of seclusion and restraint. These interventions should be used with caution and as a last resort. Patients’ preferences should be taken into account when deciding to apply these measures. The therapeutic relationship could be a focus for improvement of effects and subjective perception of coercion. In terms of methodology, studying coercive measures remains difficult, but in the context of current research on coercion reduction, is needed to provide workable baseline data and potential targets for interventions. Well-conducted prospective cohort studies could be more feasible than RCTs for interventional studies.
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BackgroundPsychiatric admission as a risk factor for posttraumatic stress disorder
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- Authors
- Chieze, M., Hurst, S., Kaiser, S., & Sentissi, O.
- Affiliations
- University Hospital of Geneva (CH)
- University of Geneva (CH)
- Corresponding author
- Chieze, Marie
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2019-07-16
- Volume
- 10
- Pages
- 491-491
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC6673758
- OpenAlex
- W2952719582
- Cited by
- 346
- References
- 88
- Citations by year
- 2026: 53 · 2025: 70 · 2024: 64 · 2023: 47 · 2022: 56 · 2021: 34 · 2020: 21 · 2019: 1
- FWCI
- 4.43
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Archive ouverte UNIGE (University of Geneva) (publishedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
- Funders
- Hôpitaux Universitaires de Genève
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Health Sciences › Medicine › Emergency Medicine › Restraint-Related Deaths
- Keywords
- seclusion, physical restraint, coercive measures, psychiatric inpatients, post-traumatic stress disorder, therapeutic relationship, forced medication, patient preferences
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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