Mechanical Restraint in Inpatient Psychiatric Unit: Prevalence and Associated Clinical Variables
Open accessAbstract
Background and Objectives: mechanical restraint (MR) is a controversial issue in emergency psychiatry and should be better studied to implement other alternative therapeutic interventions. The aim of this study was to estimate the prevalence of MR in an Italian psychiatric unit and identify the sociodemographic and clinical characteristics as well as the pharmacological pattern associated with MR. Materials and Methods: all subjects (N = 799) consecutively admitted to an Italian psychiatric inpatient unit were recruited. Several sociodemographic and clinical characteristics were recorded. Results: The prevalence of MR was 14.1%. Males, a younger age, and a single and migrant status were associated with the MR phenomenon. MR was more prevalent in patients affected by other diagnoses and comorbid illicit substance use, in patients with aggressive behaviors, and those that were involuntary admitted, leading significantly to hospitalization over 21 days. Furthermore, the patients that underwent MR were taking a lower number of psychiatric medications. Conclusions: Unfortunately, MR is still used in emergency psychiatry. Future research should focus on the dynamics of MR development in psychiatry, specifically considering ward- and staff-related factors that could help identify a more precise prevention and alternative intervention strategies.
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Involuntary treatment is often used for people with more severe illness or with conditions such as psychosis that take a greater period of time to resolve.
“This may be in part because involuntary treatment is often used for people with more severe illness or with conditions such as psychosis that take a greater period of time to resolve (89,118,119), although other factors such as logistical and bureaucratic issues or bed availability may also affect length of stay for involuntary patients (64,68,120).”
From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [89]
The Discussion (page not available in our copy) links involuntary admission with more severe symptoms and poor insight, and identifies psychotic disorders among factors associated with involuntary admission. It does not say that psychosis takes longer to resolve; its finding about long hospitalization concerns mechanical restraint, not the time needed to resolve psychosis. (LLM, conf=0.82)
Experimental — accuracy not yet measuredInvoluntary patients may be more likely to display aggressive behaviours.
“A similar cycle of coercive care provision may also be evident during admission, with the available literature indicating that once a person was admitted as an involuntary patient they were more likely to be subject to use of coercive treatment modalities such as restraint and seclusion than people admitted on a voluntary basis (34,76–88), and may be more likely to display aggressive behaviours (”
From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [89]
Involuntary treatment was generally associated with longer length of stay than was voluntary care.
“Involuntary treatment was generally associated with longer length of stay than was voluntary care (58,68,89,117–120), with the exception of one study (121).”
From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [89]
The Results section reports that involuntary admission and hospitalization over 21 days were each associated with mechanical restraint, but it does not compare length of stay between involuntary and voluntary patients. A search for that comparison found no passage in our copy that establishes the claimed relationship. (LLM, conf=0.76)
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References 49 · Cited by 13
- Authors
- Aguglia, A., Corsini, G. P., Berardelli, I., Berti, A., Conio, B., Garbarino, N., Gnecco, G. B., Magni, C., Venturini, E., Costanza, A., Amerio, A., Amore, M., & Serafini, G.
- Affiliations
- Ospedale Policlinico San Martino (IT)
- Azienda Ospedaliera Sant'Andrea (IT)
- University of Genoa (IT)
- University of Geneva (CH)
- Corresponding author
- Costanza, Alessandra
- ORCID
- Venue
- Medicina
- Publisher
- MDPI AG
- Published
- 2023-10-17
- Volume
- 59
- Issue
- 10
- Pages
- 1847
- ISSN
- 1010-660X (ISSN-L)
- 1648-9144
- PMC
- PMC10607962
- OpenAlex
- W4387707334
- Cited by
- 13
- References
- 49
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 4
- FWCI
- 3.78
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Medicina (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, cc-by)
- 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
- mechanical restraint, psychiatric inpatients, prevalence, sociodemographic factors, illicit drug use, aggression, involuntary admission, length of hospital stay, psychiatric medication, psychiatric emergency care, migrant patients, alternative interventions
- MeSH terms
- Aggression, Mental Disorders, Hospitalization, Humans, Inpatients, Male, Prevalence
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