Introduction

Restraints, a highly regulated and contentious measure in pediatric psychiatry, have significant negative impacts on children. The application of international human rights standards, such as the Convention of the Rights of the Child (CRC) and the Convention of the Rights of Persons with Disabilities (CRPD), has spurred global efforts to reduce or eliminate the use of restraints. However, a lack of consensus on definitions and terminology, as well as quality indicators in this field, hinders the ability to compare studies and evaluate interventions consistently.

Aim

To systematically map existing literature on restraints imposed upon children in inpatient pediatric psychiatry against a human rights perspective. Specifically, to identify and clarify gaps in literature in terms of publication trends, research approaches, study contexts, study participants, definitions and concepts being used, and legal aspects. These aspects are central to assess whether published research is contributing to achieve the CRPD and the CRC in terms of interpersonal, contextual, operational, and legal requirements of restraints.

Methods

A systematic mapping review based on PRISMA guidelines was conducted, adopting a descriptive-configurative approach to map the distribution of available research and gaps in the literature about restraints in inpatient pediatric psychiatry. Six databases were searched for literature reviews and empirical studies of all study designs published between each database's inception and March 24, 2021, manually updated on November 25, 2022.

Results

The search yielded 114 English-language publications, with a majority (76%) comprising quantitative studies that relied primarily on institutional records. Contextual information about the research setting was provided in less than half of the studies, and there was an unequal representation of the three main stakeholder groups: patients, family, and professionals. The studies also exhibited inconsistencies in the terms, definitions, and measurements used to examine restraints, with a general lack of attention given to human rights considerations. Additionally, all studies were conducted in high-income countries and mainly focused on intrinsic factors such as age and psychiatric diagnosis of the children, while contextual factors and the impact of restraints were not adequately explored. Legal and ethical aspects were largely absent, with only one study (0.9%) explicitly referencing human rights values.

Conclusions

Research on restraints of children in psychiatric units is increasing; however, inconsistent reporting practices hinder the understanding of the meaning and frequency of restraints. The exclusion of crucial features, such as the physical and social environment, facility type, and family involvement, indicates inadequate incorporation of the CRPD. Additionally, the lack of references to parents suggests insufficient consideration of the CRC. The shortage of quantitative studies focusing on factors beyond patient-related aspects, and the general absence of qualitative studies exploring the perspectives of children and adolescents regarding restraints, suggest that the social model of disability proposed by the CRPD has not yet fully penetrated the scientific research on this topic.

中文翻译：

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确定住院儿科精神病学约束研究关键特征的系统映射审查：人权视角

介绍

约束是儿科精神病学中一种受到高度监管和有争议的措施，对儿童有重大的负面影响。《儿童权利公约》(CRC) 和《残疾人权利公约》(CRPD) 等国际人权标准的应用促使全球努力减少或消除约束的使用。然而，在该领域的定义和术语以及质量指标方面缺乏共识，阻碍了比较研究和评估干预措施的一致性。

目的

从人权的角度系统地映射关于在住院儿科精神病学中对儿童施加限制的现有文献。具体而言，确定并澄清文献在出版趋势、研究方法、研究背景、研究参与者、使用的定义和概念以及法律方面方面的差距。这些方面对于评估已发表的研究是否在人际关系、背景、操作和法律限制要求方面有助于实现 CRPD 和 CRC 至关重要。

方法

基于 PRISMA 指南进行了系统的映射审查，采用描述性配置方法来映射可用研究的分布和文献中关于住院儿科精神病学限制的空白。搜索了六个数据库，以查找每个数据库成立至 2021 年 3 月 24 日之间发布的所有研究设计的文献综述和实证研究，并于 2022 年 11 月 25 日手动更新。

结果

搜索产生了 114 种英文出版物，其中大部分 (76%) 包括主要依赖机构记录的定量研究。不到一半的研究提供了有关研究环境的背景信息，并且三个主要利益相关者群体的代表性不平等：患者、家庭和专业人员。这些研究还表明，用于检查约束的术语、定义和衡量标准存在不一致，普遍缺乏对人权考虑的关注。此外，所有研究都是在高收入国家进行的，主要关注儿童的年龄和精神病诊断等内在因素，而没有充分探讨背景因素和约束的影响。法律和道德方面基本上不存在，

结论

关于精神病院儿童约束的研究正在增加；然而，不一致的报告做法阻碍了对限制的含义和频率的理解。排除关键特征，例如物理和社会环境、设施类型和家庭参与，表明 CRPD 的纳入不充分。此外，没有提及父母表明对 CRC 的考虑不够。缺乏关注患者相关方面以外因素的定量研究，以及普遍缺乏探索儿童和青少年关于约束的观点的定性研究，表明 CRPD 提出的残疾社会模型尚未完全渗透到科学研究中关于这个话题。