Kalisova Lucie, Raboch Jiri, Nawka Alexander, Sampogna Gaia, Cihal Libor, Kallert Thomas W, Onchev Georgi, Karastergiou Anastasia, Del Vecchio Valeria, Kiejna Andrzej, Adamowski Tomasz, Torres-Gonzales Francisco, Cervilla Jorge A, Priebe Stephan, Giacco Domenico, Kjellin Lars, Dembinskas Algirdas, Fiorillo Andrea
Department of Psychiatry, 1st Medical School, Charles University, Prague, Czech Republic,
Soc Psychiatry Psychiatr Epidemiol. 2014 Oct;49(10):1619-29. doi: 10.1007/s00127-014-0872-6. Epub 2014 Apr 16.
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.
本研究旨在确定所选的患者及病房相关因素是否与强制手段的使用有关。这些数据是作为EUNOMIA国际合作研究的一部分收集的，该研究涉及十个欧洲国家强制手段的使用情况。
非自愿入院患者（N = 2027）被分为两组。第一组（N = 770）包括在住院期间至少受到以下一种强制手段的患者：约束、和/或隔离、和/或强制用药；另一组（N = 1257）包括在住院期间未接受任何强制手段的患者。为了确定强制手段使用的预测因素，在多变量逻辑回归模型中对患者的社会人口统计学和临床特征以及中心相关特征进行了测试，并对国家效应进行了控制。
强制手段的使用频率在各国之间存在显著差异，在波兰、意大利和希腊较高。接受强制手段的患者男性更为常见，且诊断为精神障碍（F20 - F29）。根据回归模型，精神病症状和敌意症状水平较高以及感知到强制程度较高的患者在入院时被强制的风险更高。在控制国家效应后，波兰被强制的风险更高。患者的社会人口统计学特征和病房相关因素未被确定为可能的预测因素，因为它们未进入模型。
在参与研究的国家中，强制手段的使用存在显著差异。在控制国家效应时，临床因素，如入院时精神病症状水平高和感知到的强制程度高，与强制手段的使用有关。旨在减少精神科病房强制手段使用的项目应考虑这些因素。
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