Determinants of Seclusion After Aggression in Psychiatric Inpatients Fleur J. Vruwink, Eric O. Noorthoorn, Henk L.I. Nijman, Joanneke E.L. VanDerNagel, Joop J. Hox, and Cornelis L. Mulder Some aggressive incidents in psychiatric wards result in seclusion, whereas others do not. We used the Staff Observation Aggression Scale^Revised and the mental health trust’s database to identify determinants that predicted seclusion after aggression. These consisted of demographic, diagnostic, contextual, and aggression characteristics and were analyzed in a multilevel logistic regression. This showed associations between seclusion and aggres- sion for the following: younger age, involuntary status, history of previous aggression, physical or dangerous violence, aggression being directed against objects, and a more severe incident. Thus, seclusion after aggres- sion appears to be mainly predicted by aggression itself. © 2012 Elsevier Inc. All rights reserved. B ECAUSE SECLUSION SEEMS to be harm- ful not only to psychiatric patients but also to mental health nurses (Hoekstra, Lendemeijer, & Jansen, 2004; VanDerNagel, Tuts, Hoekstra, & Noorthoorn, 2009), Dutch mental health trusts and psychiatric hospitals have increasingly started to focus on reducing seclusion (Abma, Widdershoven, & Lendemeijer, 2005; Landeweer et al., 2007). For mental health nurses, seclusion could very well compose a risk factor for work-related mental burden and ultimately burnout symptoms (VanDerNagel et al., 2009). By requiring consider- able time to be devoted to the care of a single patient, it also seems to disrupt ward routine and patient care. Several international studies have shown that seclusion is often preceded by aggressive incidents (12%–100%, the trend being around 50%; Demeestere, Abraham, & Moens, 1995; El-Badri & Mellsop, 2002; Kaltiala-Heino, Tuohimaki, Korkeila, & Lehtinen, 2003). However, not all such incidents are followed by seclusion: two European studies found that about half of the aggressive incidents were followed by the use of a coercive measure, usually seclusion (Abderhalden et al., 2007; Nijman, Allertz, Merckelbach, a Campo, & Ravelli, 1997). It is barely known which characteristics determine whether aggression is followed by seclusion. Staff's decision to seclude a patient may be associated with the nature and severity of the aggressive incident, but also a Available online at www.sciencedirect.com Former affiliation where most work was done: Mediant GGZ, Enschede, the Netherlands. From the GGNet, Kenniscentrum, Warnsveld, the Netherlands; Forensic psychology, Behavioural Science Institute (BSI), Radboud University, Nijmegen, the Netherlands; Altrecht Aventurijn, Den Dolder, the Netherlands; Mediant GGZ Twente, Enschede, the Netherlands; Social Science Methodology at the Faculty of Social Sciences, University of Utrecht, Utrecht, the Netherlands; Public Mental Health Research Center O3, Erasmus MC Bavo Europoort, Mental Health Center Rotterdam, Rotterdam, the Netherlands. Corresponding Author: Fleur J. Vruwink, MD, GGNet, Kenniscentrum, PO Box 2003, 7230 GC Warnsveld, the Netherlands. E–mail addresses: fleurvruwink@gmail.com (F.J. Vruwink), e.noorthoorn@ggnet.nl (E.O. Noorthoorn), h.nijman@altrecht.nl (H.L.I. Nijman), je.vandernagel@mediant.nl (J.E.L. VanDerNagel), j.hox@uu.nl (J.J. Hox), niels.clmulder@wxs.nl (C.L. Mulder) © 2012 Elsevier Inc. All rights reserved. 0883-9417/1801-0005$34.00/0 doi:10.1016/j.apnu.2011.10.004 Archives of Psychiatric Nursing, Vol. 26, No. 4 (August), 2012: pp 307–315 307