Department of Psychiatry, Trinity Centre for Health Sciences, Tallaght University Hospital, Tallaght, Dublin 24 D24 NR0A, Ireland.
Adult Mental Health Service, University College Hospital Galway, Newcastle Road, Galway H91 YR71, Ireland.
Int J Law Psychiatry. 2021 Mar-Apr;75:101680. doi: 10.1016/j.ijlp.2021.101680. Epub 2021 Feb 17.
Involuntary care is a feature of mental health services around the world. In addition to involuntary admission and treatment, specific coercive practices include seclusion and physical restraint. Our study aimed to determine the relationships, if any, between these practices and perceived coercion on admission among psychiatry inpatients in Ireland, as well as any relationships between perceived coercion on admission and variables such as age, gender and diagnosis. We included 107 psychiatry inpatients aged 18 years or over who were admitted to the acute psychiatry admission units in Tallaght University Hospital and Connolly Hospital, Dublin, Ireland over a 30-month period between September 2017 and February 2020. Over a quarter (27.1%) of participating patients had involuntary status; nine (8.4%) had experienced at least one episode of seclusion, and ten (9.3%) had experienced at least one episode of restraint. Perceived coercion on admission was significantly associated with involuntary status and female gender; perceived negative pressures on admission were significantly associated with involuntary status and positive symptoms of schizophrenia; perceived procedural injustice on admission was significantly associated with fewer negative symptoms, involuntary status, cognitive impairment and female gender; and negative affective reactions to hospitalisation on admission were significantly associated with birth in Ireland and being employed. Total score across these four subscales was significantly associated with involuntary status and positive symptoms, and had borderline significant associations with birth in Ireland, being employed and female gender. Overall, perceived coercion on admission, assessed in retrospect by the patient, is more closely associated with involuntary status and symptoms than it is with subsequent formal coercive practices, such as seclusion and restraint. The role of gender merits particular attention in future research, especially in relation to procedural injustice on admission and perceived coercion on admission.
非自愿护理是世界各地精神卫生服务的一个特征。除了非自愿入院和治疗外，特定的强制性措施还包括隔离和身体约束。我们的研究旨在确定这些做法与爱尔兰精神病住院患者入院时的感知强制之间是否存在任何关系，以及入院时的感知强制与年龄、性别和诊断等变量之间的任何关系。我们纳入了 107 名年龄在 18 岁及以上的精神病住院患者，他们在 2017 年 9 月至 2020 年 2 月的 30 个月期间在爱尔兰都柏林塔拉赫特大学医院和康诺利医院的急性精神病入院病房入院。超过四分之一（27.1%）的参与患者有非自愿状态；九名（8.4%）经历过至少一次隔离，十名（9.3%）经历过至少一次约束。入院时的感知强制与非自愿状态和女性性别显著相关；入院时的负面压力与非自愿状态和精神分裂症的阳性症状显著相关；入院时的程序不公正与较少的负面症状、非自愿状态、认知障碍和女性性别显著相关；入院时对住院的负面情感反应与在爱尔兰出生和就业显著相关。这四个分量表的总分与非自愿状态和阳性症状显著相关，与在爱尔兰出生、就业和女性性别有边缘显著关系。总的来说，由患者回顾性评估的入院时的感知强制与非自愿状态和症状的关系比与随后的正式强制措施（如隔离和约束）更密切。性别问题值得未来研究特别关注，尤其是在入院时的程序不公正和入院时的感知强制方面。
