How patients’ characteristics influence the use of coercive measures

BACKGROUND: Coercive measures are applied in psychiatry as a last resort to control self- and hetero-aggressive behaviors in situations where all other possible strategies have failed. For ethical and clinical reasons, the number of instances of coercion should be reduced as far as possible. AIM: The aim of the study was to identify sociodemographic and clinical characteristics of patients that were associated with coercion during hospital treatment. MATERIALS AND METHODS: The study has a descriptive, longitudinal design, based on a 1 year prospective observation of patients admitted to a psychiatric hospital consisting of six inpatient psychiatric wards with a total of 236 beds. RESULTS: In the 12-month period covered by the study, 1476 people (778 men and 698 women) were treated in the hospital; 226 of them (15%) were subjected to coercion on a total of 405 occasions. The most frequently implemented form of direct coercion was mechanical restraint. The following factors involved in the use of direct coercion were identified: Male gender, young age, mental disorders resulting from the abuse of psychoactive drugs, involuntary admission to the hospital and the use of direct coercion in the past. CONCLUSION: Assessments of patients’ sociodemographic and clinical characteristics can help clinicians recognize patients who are particularly at risk of being subjected to coercive measures.