Effect of coercive measures on mental health status in adult psychiatric populations: a nationwide trial emulation

被引:1
|
作者
Baggio, S. [1 ,2 ]
Kaiser, S. [3 ]
Huber, C. G. [4 ]
Wullschleger, A. [3 ]
机构
[1] Univ Bern, Inst Primary Hlth Care BIHAM, Bern, Switzerland
[2] Univ Fribourg, Lab Populat Hlth PopHealthLab, Fribourg, Switzerland
[3] Geneva Univ Hosp, Dept Psychiat, Adult Psychiat Div, Geneva, Switzerland
[4] Univ Basel, Univ Psychiat Clin UPK, Basel, Switzerland
关键词
causal inference; coercive measures; psychiatric hospitalizations; MECHANICAL RESTRAINT; FOLLOW-UP; SECLUSION;
D O I
10.1017/S2045796024000416
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Aims. Healthcare staff use coercive measures to manage patients at acute risk of harm to self or others, but their effect on patients' mental health is underexplored. This nationwide Swiss study emulated a trial to investigate the effects of coercive measures on the mental health of psychiatric inpatients at discharge. Methods. We analysed retrospective longitudinal data from all Swiss adult psychiatric hospitals that provided acute care (2019-2021). The primary exposure was any coercive measure during hospitalization; secondary exposures were seclusion, restraint and forced medication. Our primary outcome was Health of the Nations Outcome Scale (HoNOS) score at discharge. We used inverse probability of treatment weighting to emulate random assignment to the exposure. Results. Of 178,369 hospitalizations, 9.2% (n = 18,800) included at least one coercive measure. In patients exposed to coercive measures, mental health worsened a small but statistically significant amount more than in non-exposed patients. Those who experienced at least one coercive measure during hospitalization had a significantly higher HoNOS score (1.91-point, p < .001, 95% confidence interval [CI]: 1.73; 2.09) than those who did not experience any coercive measure. Results were similar for seclusion (1.60-point higher score, p < .001, 95% CI: 1.40; 1.79) and forced medication (1.97-point higher score, p < .001, 95% CI: 1.65; 2.30). Restraint had the strongest effect (2.83-point higher score, p < .001, 95% CI: 2.38; 3.28). Conclusions. Our study presents robust empirical evidence highlighting the detrimental impact of coercive measures on the mental health of psychiatric inpatients. It underscores the importance of avoiding these measures in psychiatric hospitals and emphasized the urgent need for implementing alternatives in clinical practice.
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页数:7
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