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

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

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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Authors and Affiliations

  1. Department of Psychiatry, 1st Medical School, Charles University, Prague, Czech Republic

    Lucie Kalisova, Jiri Raboch, Alexander Nawka & Libor Cihal

  2. Department of Psychiatry and Psychotherapy, University of Technology, Fetscherstraße 74, Dresden, Germany

    Thomas W. Kallert

  3. Department of Psychiatry, Medical University of Sofia, Sofia, Bulgaria

    Georgi Onchev

  4. Psychiatric Hospital, Thessaloniki, Greece

    Anastasia Karastergiou

  5. Department of Psychiatry, University of Naples, Naples, Italy

    Gaia Sampogna, Valeria del Vecchio & Andrea Fiorillo

  6. Department of Psychiatry, Medical University, Wroclaw, Poland

    Andrzej Kiejna & Tomasz Adamowski

  7. Centro de Investigacion Biomedica en Red de Salud Mental (CIBERSAM), University of Granada, Granada, Spain

    Francisco Torres-Gonzales & Jorge A. Cervilla

  8. Unit for Social and Community Psychiatry, Queen Mary, University of London, London, UK

    Stephan Priebe & Domenico Giacco

  9. Psychiatric Research Centre, Örebro, Sweden

    Lars Kjellin

  10. Psychiatric Clinic, Vilnius Mental Health Centre, University of Vilnius, Vilnius, Lithuania

    Algirdas Dembinskas

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  1. Lucie Kalisova
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Kalisova, L., Raboch, J., Nawka, A. et al. Do patient and ward-related characteristics influence the use of coercive measures? Results from the EUNOMIA international study. Soc Psychiatry Psychiatr Epidemiol 49, 1619–1629 (2014). https://doi.org/10.1007/s00127-014-0872-6

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