AUTHOR=Flammer Erich , Hirsch Sophie , Thilo Nancy , Steinert Tilman 

TITLE=“Our Patients Are Different”: Predictors of Seclusion and Restraint in 31 Psychiatric Hospitals

JOURNAL=Frontiers in Psychiatry

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.791333

DOI=10.3389/fpsyt.2022.791333

ISSN=1664-0640

ABSTRACT=<sec><title>Background</title><p>Research in recent years has demonstrated that the use of coercive measures such as seclusion and restraint differs very much between hospitals within a country. In 2015, a central register for all coercive measures in the German federal state of Baden-Wuerttemberg has been established for 32 hospitals treating involuntary patients. The objective of the present study was to identify factors that determine the differences between these hospitals.</p></sec><sec><title>Methods</title><p>Data on coercive measures and diagnoses from the central register in 2015–2017 were linked with structural data of the 32 hospitals and their supply areas.</p></sec><sec><title>Results</title><p>On average, coercive measures were applied in 6.7% of cases (<italic>SD</italic> = 2.8%; Min–Max = 0.35–12.0%). The proportion of affected cases was significantly correlated with the proportion of involuntary patients (<italic>r</italic> = 0.56), the proportion of cases with affective or neurotic, stress-related and somatoform disorders (<italic>r</italic> = −0.42), number of hospital beds (<italic>r</italic> = 0.44), a sheltered home associated with the hospital (<italic>r</italic> = 0.43) and number of addiction counseling centers per 100,000 inhabitants in the service area (<italic>r</italic> = −0.39). The final regression model only included the proportion of involuntary cases as a significant predictor (standardized beta = 0.55, adjusted <italic>R</italic><sup>2</sup> = 0.27).</p></sec><sec><title>Conclusions</title><p>The predominating part of the considerable variance observed between hospitals could not be explained by structural variables. The proportion of involuntary patients had a significant impact, but a considerable amount of unexplained variance due to different practices within psychiatric hospitals remains.</p></sec>