Clinical factors associated with coercive behavioral interventions in psychiatric inpatients: A prospective cohort...

Coercive behavioral interventions (CBIs), including injections, seclusion, and restraint, are sometimes required in psychiatric care but can strain therapeutic relationships and raise ethical concerns. Identifying factors associated with CBIs may support early intervention and prevention.

This prospective multicenter study included 278 psychiatric inpatients with mood disorders or schizophrenia spectrum disorders admitted to three hospitals during 2023-2024. CBIs comprised seclusion, restraint, and injections for acute behavioral control. The Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMRS), Montgomery-Åsberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAMA), and Columbia-Suicide Severity Rating Scale were administered at baseline and weekly thereafter. Logistic regression assessed baseline factors, whereas generalized estimating equations assessed time-varying factors among patients who experienced CBIs.

Seventy-seven CBIs were recorded among 37 patients (13.3%), predominantly within 2 weeks of enrollment. These patients had more severe baseline psychopathology across symptom scales. In multivariable analysis, BPRS Negative and Affective subscale scores and self-harm frequency remained associated with CBI occurrence. Among patients who experienced CBIs, symptom scores were higher during the week preceding an event; only BPRS Resistance remained independently associated after mutual adjustment. Seclusion and/or restraint events were associated with higher BPRS Negative and Resistance scores than injection-only events.

Baseline assessment and ongoing monitoring may help identify patients at greater likelihood of subsequent CBIs. Attention to negative symptoms and resistance, with structured, empathic engagement, may support safer, patient-centered care.