Social Psychiatry and Psychiatric Epidemiology

, Volume 49, Issue 10, pp 1619–1629 | Cite as

Do patient and ward-related characteristics influence the use of coercive measures? Results from the EUNOMIA international study

  • Lucie KalisovaEmail author
  • Jiri Raboch
  • Alexander Nawka
  • Gaia Sampogna
  • Libor Cihal
  • Thomas W. Kallert
  • Georgi Onchev
  • Anastasia Karastergiou
  • Valeria del Vecchio
  • Andrzej Kiejna
  • Tomasz Adamowski
  • Francisco Torres-Gonzales
  • Jorge A. Cervilla
  • Stephan Priebe
  • Domenico Giacco
  • Lars Kjellin
  • Algirdas Dembinskas
  • Andrea Fiorillo
Original Paper



This study aims to identify whether selected patient and ward-related factors are associated with the use of coercive measures. Data were collected as part of the EUNOMIA international collaborative study on the use of coercive measures in ten European countries.


Involuntarily admitted patients (N = 2,027) were divided into two groups. The first group (N = 770) included patients that had been subject to at least one of these coercive measures during hospitalization: restraint, and/or seclusion, and/or forced medication; the other group (N = 1,257) included patients who had not received any coercive measure during hospitalization. To identify predictors of use of coercive measures, both patients’ sociodemographic and clinical characteristics and centre-related characteristics were tested in a multivariate logistic regression model, controlled for countries’ effect.


The frequency of the use of coercive measures varied significantly across countries, being higher in Poland, Italy and Greece. Patients who received coercive measures were more frequently male and with a diagnosis of psychotic disorder (F20–F29). According to the regression model, patients with higher levels of psychotic and hostility symptoms, and of perceived coercion had a higher risk to be coerced at admission. Controlling for countries’ effect, the risk of being coerced was higher in Poland. Patients’ sociodemographic characteristics and ward-related factors were not identifying as possible predictors because they did not enter the model.


The use of coercive measures varied significantly in the participating countries. Clinical factors, such as high levels of psychotic symptoms and high levels of perceived coercion at admission were associated with the use of coercive measures, when controlling for countries’ effect. These factors should be taken into consideration by programs aimed at reducing the use of coercive measures in psychiatric wards.


Coercion Physical restraint Involuntary commitment International aspects 



This study was funded by a grant from the European Commission (Quality of Life and Management of Living Resources Programme, contract number QLG4-CT-2002-01036).

Conflict of interest

The authors report no competing interests.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Lucie Kalisova
    • 1
    Email author
  • Jiri Raboch
    • 1
  • Alexander Nawka
    • 1
  • Gaia Sampogna
    • 5
  • Libor Cihal
    • 1
  • Thomas W. Kallert
    • 2
  • Georgi Onchev
    • 3
  • Anastasia Karastergiou
    • 4
  • Valeria del Vecchio
    • 5
  • Andrzej Kiejna
    • 6
  • Tomasz Adamowski
    • 6
  • Francisco Torres-Gonzales
    • 7
  • Jorge A. Cervilla
    • 7
  • Stephan Priebe
    • 8
  • Domenico Giacco
    • 8
  • Lars Kjellin
    • 9
  • Algirdas Dembinskas
    • 10
  • Andrea Fiorillo
    • 5
  1. 1.Department of Psychiatry, 1st Medical SchoolCharles UniversityPragueCzech Republic
  2. 2.Department of Psychiatry and PsychotherapyUniversity of TechnologyDresdenGermany
  3. 3.Department of PsychiatryMedical University of SofiaSofiaBulgaria
  4. 4.Psychiatric HospitalThessalonikiGreece
  5. 5.Department of PsychiatryUniversity of NaplesNaplesItaly
  6. 6.Department of PsychiatryMedical UniversityWroclawPoland
  7. 7.Centro de Investigacion Biomedica en Red de Salud Mental (CIBERSAM)University of GranadaGranadaSpain
  8. 8.Unit for Social and Community Psychiatry, Queen MaryUniversity of LondonLondonUK
  9. 9.Psychiatric Research CentreÖrebroSweden
  10. 10.Psychiatric Clinic, Vilnius Mental Health CentreUniversity of VilniusVilniusLithuania

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