Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Lenggstrasse 31, Postfach 1931, 8032, Zürich, Switzerland.
Département de Psychiatrie et Psychothérapie du Centre Hospitalier du Valais Romand, Route de Morgins 10, 1870, Monthey, Valais, Switzerland.
BMC Psychiatry. 2019 Apr 29;19(1):128. doi: 10.1186/s12888-019-2092-9.
In psychiatric treatment containment measures are used to de-escalate high-risk situations. These measures can be characterized by their immanent amount of coercion. Previous research could show that the attitudes towards different containment measures vary throughout countries. The aim of this study was to compare the attitudes towards containment measures between three study sites in Switzerland which differ in their clinic traditions and policies and their actual usage of these measures.
We used the Attitude to Containment Measures Questionnaire (ACMQ) in three psychiatric hospitals in Switzerland (Zurich, Muensingen and Monthey) in patients, their next of kin (NOK) and health care professionals (HCP). Furthermore, we assessed the cultural specifics and rates of coercive measures for these three hospitals.
We found substantial differences in the usage of and the attitudes towards some containment measures between the three study sites. The study site accounted for a variance of nearly zero in as needed medication to 15% in seclusion. The differences between study sites were bigger in the HCPs' attitudes (up to 50% of the variance), compared to NOK and patients. In the latter the study site accounted for up to 6% of the variance. The usage/personal experience of containment measures in general was associated with higher agreement.
Although being situated in the same country, there are substantial differences in the rates of containment measures between the three study sites. We showed that the HCP's attitudes are more associated with the clinic traditions and policies compared to patients' and their NOKs' attitudes. One can conclude that patients' preferences depend less on clinic traditions and policies. Therefore, it is important to adapt treatment to the individual patients' attitudes.
The study was reviewed and approved by the Cantonal Ethics Commission of Zurich, Switzerland (Ref.-No. EK: 2016-01526, decision on 28.09.2016) and the Cantonal Ethics Commission of Bern, Switzerland (Ref.-Nr.
KEK-BE: 2015-00074). This study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The permission for conduction of the study was granted by the medical directors at the three study sites. The authors informed the respondents (patients, NOK, HCP) of their rights in the study in an oral presentation and/or a cover letter. They assured the participants of the confidentiality and anonymity of the data, and the voluntariness of participation. Patients were given an information sheet with the possibility to consent in the conduction of the study. Return of the completed questionnaires from HCP and NOK was constituted as confirmation of their consent. No identifying factors were collected to ensure privacy. This article does not contain any studies with animals performed by any of the authors.
在精神科治疗中，会使用约束措施来缓解高危情况。这些措施的特点是内在的强制程度。先前的研究表明，不同国家对不同约束措施的态度存在差异。本研究的目的是比较瑞士三个研究地点（苏黎世、蒙泰尼和穆尔腾根）之间对约束措施的态度，这三个研究地点在其临床传统和政策以及实际使用这些措施方面存在差异。
我们在瑞士的三家精神病院（苏黎世、蒙泰尼和蒙特勒）使用了态度约束措施问卷（ACMQ），对患者、其近亲属（NOK）和医疗保健专业人员（HCP）进行了调查。此外，我们还评估了这三家医院的文化特殊性和强制性措施的使用情况。
我们发现，在这三个研究地点之间，对一些约束措施的使用和态度存在实质性差异。研究地点对按需用药的影响几乎为零，而对隔离的影响则达到 15%。研究地点之间的差异在 HCP 的态度中更大（高达 50%的方差），与 NOK 和患者相比。在后者中，研究地点占方差的比例高达 6%。一般来说，对约束措施的使用/个人经验与更高的一致性相关。
尽管位于同一个国家，但这三个研究地点的约束措施使用率存在实质性差异。我们表明，与患者及其近亲属的态度相比，HCP 的态度更多地与临床传统和政策相关。可以得出结论，患者的偏好较少取决于临床传统和政策。因此，适应治疗以满足个体患者的态度非常重要。
该研究经瑞士苏黎世州伦理委员会（瑞士，注册号：EK：2016-01526，2016 年 9 月 28 日决定）和瑞士伯尔尼州伦理委员会（瑞士，注册号：KEK-BE：2015-00074）审查和批准。本研究符合 1964 年《赫尔辛基宣言》及其后修正案规定的伦理标准。该研究的开展得到了三个研究地点的医学主任的许可。作者在口头报告和/或附函中向研究对象（患者、近亲属、HCP）告知了他们在研究中的权利。他们向参与者保证了数据的保密性和匿名性，以及参与的自愿性。患者收到了一份带有参与研究可能性的信息表。HCP 和 NOK 填写并返回完整的调查问卷，被视为同意参与研究。为了确保隐私，没有收集任何可识别的因素。本文不包含任何作者进行的动物研究。
