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Risk factors of coercion among psychiatric inpatients: a nationwide register-based cohort study

Social Psychiatry and Psychiatric Epidemiology volume 52, pages 979–987 (2017)Cite this article

Abstract

Purpose

Reducing the use of coercion among patients with mental disorders has long been a political priority. However, risk factors for coercive measures have primarily been investigated in smaller studies. To reduce the use of coercion, it is crucial to identify people at risk which we aim to do in this first large-scale study.

Methods

A cohort study was conducted among all psychiatric inpatients in Denmark, following 112,233 individuals during 1999–2014. Data from Danish registers were analysed using logistic regression for repeated measures.

Results

24,594 inpatients were exposed to a coercive measure (21.9%). Clinical characteristics were the foremost predictors of coercion and patients with organic mental disorder had the highest increased risk of being subjected to a coercive measure (OR = 5.56; 95% CI = 5.04, 6.14). The risk of coercion was the highest in the first admission and decreased with the number of admissions (all p < 0.001). The following socioeconomic variables were associated with an increased risk of coercion: male sex, unemployment, lower social class and immigrants from low and middle income countries (all p < 0.001). Early retirement and social relations, such as being married and having children, reduced the risk of being subjected to coercive measure (all p < 0.05).

Conclusion

From our nationwide data, we identified a broad range of risk factors associated with coercive measures. Our findings can assist researchers in identifying patients at risk of coercion and thereby help targeting new coercion reduction programs.

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Acknowledgements

This work was supported by a grant from the Mental Health Centre, Frederiksberg. Thomsen received funding from the Danish Health Authority as a part of PhD training. The authors are grateful to the head of the Mental Health Centre, Frederiksberg, Dr. Kristen Kistrup for making the research possible. In addition, we thank Dr. Holger Jelling Sørensen at the Mental Health Centre, Copenhagen, for his valuable advice.

Author information

Affiliations

  1. Mental Health Centre Frederiksberg, Copenhagen University Hospital, Ndr. Fasanvej 57, Frederiksberg, 2000, Copenhagen, Denmark

    Christoffer Thomsen

  2. Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark

    Christoffer Thomsen, Merete Nordentoft & Michael Eriksen Benros

  3. Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark

    Liis Starkopf & Per Kragh Andersen

  4. Psychiatric Research Unit, Region Zealand, Denmark

    Lene Halling Hastrup

Authors
  1. Christoffer Thomsen
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  2. Liis Starkopf
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  3. Lene Halling Hastrup
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  4. Per Kragh Andersen
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  5. Merete Nordentoft
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  6. Michael Eriksen Benros
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Corresponding author

Correspondence to Christoffer Thomsen.

Ethics declarations

Ethical standards

All personal information from the registers is anonymized when used for research purposes and the project was approved by the Danish Data Protection Agency, hence, according to Danish legislation, informed consent from participants was not required.

Conflict of interest

The authors declare that they have no conflict of interest.

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Thomsen, C., Starkopf, L., Hastrup, L.H. et al. Risk factors of coercion among psychiatric inpatients: a nationwide register-based cohort study. Soc Psychiatry Psychiatr Epidemiol 52, 979–987 (2017). https://doi.org/10.1007/s00127-017-1363-3

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  • DOI: https://doi.org/10.1007/s00127-017-1363-3

Keywords

  • Psychiatry
  • Coercion
  • Risk factors
  • Inpatient
  • Epidemiology