隔离和约束的患病率和危险因素:回顾性分析的结果。

IF 3.4 2区 医学 Q2 PSYCHIATRY
Alexandre Wullschleger, Marie Chieze, Delphine Courvoisier, Samia Hurst, Othman Sentissi, Stefan Kaiser
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引用次数: 0

摘要

背景:减少胁迫是住院精神卫生服务的核心挑战。人们对在敞开大门的环境中使用隔离和约束知之甚少。这项工作的目的是分析瑞士大学精神病院开放住院病房强制措施的流行程度和风险因素。方法:回顾性分析2017 - 2019年住院患者隔离约束的使用情况。使用多变量泊松回归计算发病率比,以确定患者和住院相关的强迫风险因素。结果:在1764例患者中,293例(16.6%)在住院期间至少接受过一次强制措施(主要是隔离)。强迫措施的经历与以下因素相关:男性(IRR为1.34 [1.26,1.38],p)。结论:年轻、单身或离婚、男性、诊断为器质性、双相情感障碍或精神障碍、领取残疾福利和既往精神病住院治疗被确定为强迫措施的危险因素。在急诊科转诊中,胁迫的发生率较低。项目1入学时的HoNOS分数可能足以对胁迫风险进行有意义的评估。我们的研究结果表明,攻击性行为和强制措施的使用之间存在着密切的联系。对处于危险中的患者的识别应与减少强迫的方案结合起来。应进一步调查影响使用胁迫的体制和文化因素的作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prevalence and risk factors for seclusion and restraint: results of a retrospective analysis.

Background: The reduction of coercion is a central challenge of inpatient mental health services. Little is known about the use of seclusion and restraint in open-door settings. This work aims to analyse the prevalence and risk factors of coercive measures in open inpatient wards of a Swiss university psychiatric hospital.

Methods: The use of seclusion and restraint was retrospectively analysed between 2017 and 2019. Incidence rate ratios using multivariable Poisson regressions were calculated to determine patient- and hospital stay-related risk factors for coercion.

Results: Of 1764 patients, 293 (16.6%) underwent at least one coercive measure (mostly seclusion) during their stay. The experience of coercive measures was associated with the following factors: male gender (IRR 1.34 [1.26, 1.38], p < 0.001), younger age (IRR 0.97 [0.97, 0.97], p < 0.001), being single or divorced (IRR 1.49 [1.43, 1.60], p < 0.001), diagnoses of organic (IRR 13.43 [13.38, 13.48], p < 0.001), psychotic (IRR 1.79 [1.79, 1.79], p < 0.001), or bipolar (IRR 2.17 [2.16, 2.17], p < 0.001) disorders, receiving disability benefits (IRR 1.92 [1.90, 2.07], p < 0.001), higher number of previous psychiatric hospitalizations (IRR 1.03 [1.03, 1.03], p < 0.001), and higher Health of the Nation Outcome Scales (HoNOS) item 1-scores (overactive, aggressive, or agitated behaviour) at admission 1.27 [1.27, 1.27], p < 0.001). Referrals from the emergency department (ED) (IRR 0.78 [0.77, 0.86], p < 0.001) were associated with a lower risk of coercion.

Conclusions: Young age, being single or divorced, male gender, diagnoses of organic, bipolar, or psychotic disorders, being on disability benefits, and previous psychiatric hospitalizations were identified as risk factors of coercion. The incidence of coercion was lower in ED referrals. Item 1 HoNOS scores at admission might be sufficient for a meaningful assessment of coercion risk. Our results suggest a strong link between aggressive behaviour and the use of coercive measures. Identification of patients at risk should be integrated to coercion reduction programs. The role of institutional and cultural factors influencing the use of coercion should be further investigated.

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来源期刊
BMC Psychiatry
BMC Psychiatry 医学-精神病学
CiteScore
5.90
自引率
4.50%
发文量
716
审稿时长
3-6 weeks
期刊介绍: BMC Psychiatry is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of psychiatric disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
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