Abstract：
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.
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.
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.
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.
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.
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.
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.
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.
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.
摘要：
背景：限制，儿科精神病学中的一项高度规范和有争议的措施，对儿童有很大的负面影响。国际人权标准的适用，如《儿童权利公约》（CRC）和《残疾人权利公约》（CRPD），刺激了全球努力减少或消除限制的使用。然而,对定义和术语缺乏共识，以及该领域的质量指标，阻碍了一致地比较研究和评估干预措施的能力。
目的：从人权角度系统地绘制现有文献中关于住院儿科精神病学中对儿童施加的限制。具体来说,为了确定和澄清文献在出版趋势方面的差距，研究方法，研究背景，研究参与者，使用的定义和概念，和法律方面。这些方面对于评估已发表的研究是否有助于在人际关系方面实现CRPD和CRC至关重要，上下文,操作,和法律要求的限制。
方法：进行了基于PRISMA指南的系统绘图审查，采用描述性配置方法来绘制有关住院儿科精神病学约束的可用研究分布和文献空白。搜索了六个数据库，以获取每个数据库成立至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，大多数(76%)包括主要依赖机构记录的定量研究。在不到一半的研究中提供了有关研究环境的上下文信息，三个主要利益相关者群体的代表性不平等：患者，家庭,和专业人士。这些研究还表现出术语不一致，定义,和用于检查约束的测量，普遍缺乏对人权考虑的关注。此外,所有研究均在高收入国家进行，主要关注儿童的年龄和精神病诊断等内在因素，而环境因素和限制的影响没有得到充分的探讨。法律和道德方面基本上没有，只有一项研究(0.9%)明确提到了人权价值观。
结论：关于精神科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，比如物质和社会环境，设施类型,和家庭参与，表明CRPD的纳入不足。此外,缺乏对父母的提及表明对《儿童权利公约》的考虑不足。缺乏关注患者相关因素以外的定量研究，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，这表明CRPD提出的残疾社会模型尚未完全渗透到这一主题的科学研究中。
目的：从人权角度系统地绘制现有文献中关于住院儿科精神病学中对儿童施加的限制。具体来说,为了确定和澄清文献在出版趋势方面的差距，研究方法，研究背景，研究参与者，使用的定义和概念，和法律方面。这些方面对于评估已发表的研究是否有助于在人际关系方面实现CRPD和CRC至关重要，上下文,操作,和法律要求的限制。
方法：进行了基于PRISMA指南的系统绘图审查，采用描述性配置方法来绘制有关住院儿科精神病学约束的可用研究分布和文献空白。搜索了六个数据库，以获取每个数据库成立至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，大多数(76%)包括主要依赖机构记录的定量研究。在不到一半的研究中提供了有关研究环境的上下文信息，三个主要利益相关者群体的代表性不平等：患者，家庭,和专业人士。这些研究还表现出术语不一致，定义,和用于检查约束的测量，普遍缺乏对人权考虑的关注。此外,所有研究均在高收入国家进行，主要关注儿童的年龄和精神病诊断等内在因素，而环境因素和限制的影响没有得到充分的探讨。法律和道德方面基本上没有，只有一项研究(0.9%)明确提到了人权价值观。
结论：关于精神科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，比如物质和社会环境，设施类型,和家庭参与，表明CRPD的纳入不足。此外,缺乏对父母的提及表明对《儿童权利公约》的考虑不足。缺乏关注患者相关因素以外的定量研究，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，这表明CRPD提出的残疾社会模型尚未完全渗透到这一主题的科学研究中。
