Psychiatric University Hospital Zurich, Research Unit for Clinical and Social Psychiatry, Militärstrasse 8, PO Box 1930, 8021 Zurich, Switzerland.
Eur Psychiatry. 2011 May;26(4):244-51. doi: 10.1016/j.eurpsy.2010.11.007. Epub 2011 Feb 5.
The use of coercive measures in psychiatry is still poorly understood. Most empirical research has been limited to compulsory admission and to risk factors on an individual patient level. This study addresses three coercive measures and the role of predictive factors at both patient and institutional levels.
Using the central psychiatric register that covers all psychiatric hospitals in Canton Zurich (1.3 million people), Switzerland, we traced all inpatients in 2007 aged 18-70 (n = 9698). We used GEE models to analyse variation in rates between psychiatric hospitals.
Overall, we found quotas of 24.8% involuntary admissions, 6.4% seclusion/restraint and 4.2% coerced medication. Results suggest that the kind and severity of mental illness are the most important risk factors for being subjected to any form of coercion. Variation across the six psychiatric hospitals was high, even after accounting for risk factors on the patient level suggesting that centre effects are an important source of variability. However, effects of the hospital characteristics 'size of the hospital', 'length of inpatient stay', and 'work load of the nursing staff' were only weak ('bed occupancy rate' was not statistically significant).
The significant variation in use of coercive measures across psychiatric hospitals needs further study.
精神科使用强制性措施的情况仍未得到充分理解。大多数实证研究仅限于强制性入院和针对个体患者的风险因素。本研究探讨了三种强制性措施以及患者和机构两个层面的预测因素的作用。
利用覆盖瑞士苏黎世州所有精神病院（130 万人口）的中央精神科登记处，我们追踪了 2007 年所有 18-70 岁的住院患者（n=9698）。我们使用广义估计方程模型分析了不同精神病院之间的比率差异。
总体而言，我们发现非自愿入院的比例为 24.8%，隔离/约束的比例为 6.4%，强制用药的比例为 4.2%。结果表明，精神疾病的类型和严重程度是最容易被施以任何形式强制手段的重要风险因素。即使考虑了患者层面的风险因素，六家精神病院中仍存在很大的差异，这表明中心效应是变异性的一个重要来源。然而，医院特征（“医院规模”、“住院时间”和“护理人员工作量”）的影响较弱（“床位占有率”在统计学上无显著意义）。
精神病院中强制性措施使用情况的显著差异需要进一步研究。
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