How patients' characteristics influence the use of coercive measures

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.

The aim of the study was to identify sociodemographic and clinical characteristics of patients that were associated with coercion during hospital treatment.

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.

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.

Assessments of patients' sociodemographic and clinical characteristics can help clinicians recognize patients who are particularly at risk of being subjected to coercive measures.