Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
Eval Health Prof. 2024 Mar;47(1):3-10. doi: 10.1177/01632787231164489. Epub 2023 Mar 10.
The use of coercive practices, i.e., interventions against a person's will, is controversial. Recent observational studies highlighted their potential detrimental effects on patients' mental health, but this topic remains understudied. This study investigated the effect of a common coercive practice, seclusion (i.e., being locked in a closed room), on mental health using a trial emulation of observational data to allow causal inference. We used data from 1200 psychiatric inpatients, classified as being either secluded or non-secluded during their hospital stay. Inverse probability of treatment weighting was used to emulate the random assignment to the intervention. The primary outcome was the Health of the Nations Outcome Scales (HoNOS). The secondary outcome was the first item of the HoNOS, which focuses on overactive, aggressive, disruptive, or agitated behavior. Both outcomes were assessed at hospital discharge. There was a significant effect of seclusion with increases in both total HoNOS score ( = .002) and item 1 of the HoNOS ( = .01). Seclusion may have a negative causal effect of patients' mental health status and should therefore be avoided in mental health care settings. Training efforts should raise the awareness of the medical staff about potential adverse effects instead of therapeutic benefits.
使用强制性手段，即违背个人意愿的干预措施，存在争议。最近的观察性研究强调了这些手段对患者心理健康可能产生的不利影响，但这一主题仍研究不足。本研究通过对观察性数据进行试验模拟，以进行因果推断，调查了一种常见的强制性手段——隔离（即被关在一个封闭的房间里）对心理健康的影响。我们使用了来自 1200 名精神科住院患者的数据，根据他们在住院期间是否被隔离进行分类。使用逆概率治疗加权来模拟对干预措施的随机分配。主要结局指标是国家健康结果量表（HoNOS）。次要结局指标是 HoNOS 的第一项，主要关注过度活跃、攻击性行为、破坏性行为或激动行为。这两个结局指标都是在出院时评估的。隔离有显著影响，HoNOS 总分增加（ =.002），HoNOS 第一项增加（ =.01）。因此，隔离可能对患者的心理健康状况产生负面影响，因此应在精神卫生保健环境中避免使用。培训工作应提高医务人员对潜在不良影响而非治疗益处的认识。
