Temporal association between physical restraint and venous thromboembolism risk among psychiatric inpatients: A matched case-control study

doi:10.5498/wjp.123512

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Case Control Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Oct 19, 2026; 16(10): 123512
Published online Oct 19, 2026. doi: 10.5498/wjp.123512

Temporal association between physical restraint and venous thromboembolism risk among psychiatric inpatients: A matched case-control study

Shu-Chao Wu, Sheng-Ming Zhang, Li-Juan Qiao, He-Zeng Yang

Shu-Chao Wu, Sheng-Ming Zhang, Department of Nursing, Shenzhen Mental Health Center/Shenzhen Kangning Hospital, Shenzhen 518020, Guangdong Province, China

Li-Juan Qiao, Department of Nursing, Shenzhen Pingshan Hospital of Southern Medical University/Shenzhen Pingshan People’s Hospital, Shenzhen 518118, Guangdong Province, China

He-Zeng Yang, Department of Psychiatry, Shenzhen Mental Health Center/Shenzhen Kangning Hospital, Shenzhen 518118, Guangdong Province, China

Co-corresponding authors: Li-Juan Qiao and He-Zeng Yang.

Author contributions: Wu SC conceived the study, conducted data collection, performed the statistical analyses, and drafted the manuscript; Zhang SM contributed to data acquisition, data verification, and interpretation of the results; Qiao LJ contributed to the study design, provided professional support in nursing-related data interpretation, and critically revised the manuscript; Yang HZ was responsible for overall study conception, funding acquisition, and supervision of the research process; Qiao LJ and Yang HZ contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors contributed to the study and approved the final manuscript.

AI contribution statement: Portions of this manuscript were edited using AI tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.

Supported by the Shenzhen Fund for Guangdong Provincial High-level Clinical Key Specialties, No. SZGSP013.

Institutional review board statement: This study was approved by the Medical Ethics Committee of Shenzhen Kangning Hospital/Shenzhen Mental Health Center, approval No. 2023-K030-01.

Informed consent statement: The requirement for informed consent was waived by the Ethics Committee of Shenzhen Kangning Hospital/Shenzhen Mental Health Center because this study used retrospective and de-identified data generated during routine clinical care.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Corresponding author: Li-Juan Qiao, MSc, Chief Nurse, Department of Nursing, Shenzhen Pingshan Hospital of Southern Medical University/Shenzhen Pingshan People’s Hospital, No. 51 Julongshan Road, Pingshan District, Shenzhen 518118, Guangdong Province, China. dajiangzhizi@163.com

Received: May 21, 2026
Revised: July 27, 2026
Accepted: August 31, 2026
Published online: October 19, 2026
Processing time: 143 Days and 2.7 Hours

Abstract

BACKGROUND

Physical restraint (PR) is commonly used in psychiatric inpatient care to manage acute behavioral risks. However, restraint-related immobility may increase the risk of venous thromboembolism (VTE). Evidence regarding the temporal characteristics of restraint exposure and subsequent VTE risk remains limited.

AIM

To examine the association between PR and VTE risk among psychiatric inpatients, with a particular focus on restraint duration, cumulative restraint hours, and the interval between restraint discontinuation and VTE diagnosis.

METHODS

This single-center matched case-control study was conducted at a tertiary psychiatric hospital in China. Adult psychiatric inpatients who developed first-onset VTE during hospitalization between January 2019 and October 2021 were defined as cases. For each case, up to four controls were matched by ward, sex, age, and hospitalization duration. Exposure to PR was assessed using four indicators: Restraint use, restraint duration in days, cumulative restraint hours, and the interval from the final restraint episode to VTE diagnosis. Multivariable conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for demographic characteristics, psychotropic medication use, and VTE-related risk factors.

RESULTS

A total of 127 patients with VTE and their matched controls were included. Multivariable analysis showed that PR was an independent risk factor for VTE (OR = 1.82, 95%CI: 1.16-2.85). Temporal subgroup analyses showed that restraint duration ≤ 3 days (adjusted OR = 1.67, 95%CI: 1.04-2.70) and cumulative restraint exposure exceeding 12 hours (12-24 hours: Adjusted OR = 6.27; > 24 hours: Adjusted OR = 6.81) were associated with higher odds of VTE. In addition, the first 7 days after release from the last restraint episode represented a high-risk time window for VTE occurrence (OR = 5.29, 95%CI: 2.84-9.85).

CONCLUSION

PR was independently associated with higher VTE odds in psychiatric inpatients, particularly after cumulative exposure exceeding 12 hours and during the first 7 days after restraint discontinuation.

Keywords: Physical restraint; Venous thromboembolism; Psychiatric inpatients; Case-control study; Temporal association; Risk factors

Core Tip: This matched case-control study evaluated the temporal association between physical restraint and venous thromboembolism (VTE) among psychiatric inpatients. Physical restraint was independently associated with increased VTE risk, which was particularly elevated among patients with cumulative restraint exposure exceeding 12 hours and within 7 days after restraint discontinuation. These findings highlight the importance of incorporating restraint-related temporal indicators into VTE monitoring and prevention strategies in psychiatric wards.