Who is Subjected to Coercive Measures as a Psychiatric Inpatient? A Multi-Level Analysis

Flammer, Erich; Steinert, Tilman; Eisele, Frank; Bergk, Jan; Uhlmann, Carmen

doi:10.2174/1745017901309010110

Cited by 42 publications

(42 citation statements)

References 21 publications

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“…Because data on the previous practice are only scarcely available, it is difficult to say whether the percentage of exposed patients has decreased after the introduction of the legislation. Estimations of percentage of affected patients vary between 0.4 and 5.6% ( 10 – 12 ). According to these data, there is some uncertain evidence that the use of involuntary medication has considerably decreased after the introduction of the legislation, which had been intended.…”

Section: Discussionmentioning

confidence: 99%

Involuntary Medication, Seclusion, and Restraint in German Psychiatric Hospitals after the Adoption of Legislation in 2013

Flammer

Steinert

2015

Front. Psychiatry

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BackgroundInvoluntary medication in psychiatric treatment of inpatients is highly controversial. While laws regulating involuntary medication have been changed in Germany, no data have been available to date on how often involuntary medication is actually applied. Recently, our hospital group introduced specific routine documentation of legal status and application of involuntary medication in the patients’ electronic records, which allows the assessment of the frequency of involuntary medication.MethodFor the year 2014, we extracted aggregated data from the electronic database on age, sex, psychiatric diagnosis, legal status during admission, kind of coercive measure (mechanical restraint, seclusion, and involuntary medication) applied, and the number and duration of seclusion and restraint episodes for seven study sites.ResultsA total of 1,514 (9.6%) of 15,832 admissions were involuntary. At least one coercive measure was applied in 976 (6.2%) admissions. Seclusion was applied in 579 (3.7%) admissions, mechanical restraint was applied in 529 (3.3%) admissions, and involuntary medication was applied in 78 (0.5%) admissions. Two-thirds of involuntary medications were applied in cases of emergency; the remainder was applied after a formal decision by a judge. In 55 (70.5%) of the admissions with involuntary medication, at least one other coercive measure (seclusion, restraint, or both) was applied as well.ConclusionInvoluntary medication is rarely applied and less frequent than seclusion or mechanical restraint, possibly as a consequence of recent legal restrictions.

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Section: Discussionmentioning

confidence: 99%

Involuntary Medication, Seclusion, and Restraint in German Psychiatric Hospitals after the Adoption of Legislation in 2013

Flammer

Steinert

2015

Front. Psychiatry

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“…Also personality disorders ( 25 , 26 ), substance-use-related disorders ( 19 ) and mental retardation ( 25 ) were found to be associated with coercion. A history of aggression ( 16 – 18 , 22 , 23 , 25 , 27 – 29 ) was frequently found to be associated with coercion and violence/threats were described to be the second most frequent reasons after agitation/disorientation for the usage of coercion ( 30 ). Patients with a history of former voluntary and/or involuntary commitments (IC) and frequent hospitalizations ( 16 – 20 , 24 ) and those with longer duration of hospitalizations ( 31 ) were also described to experience coercion more often.…”

Section: Introductionmentioning

confidence: 99%

Machine Learning: An Approach in Identifying Risk Factors for Coercion Compared to Binary Logistic Regression

et al. 2018

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Introduction: Although knowledge about negative effects of coercive measures in psychiatry exists, its prevalence is still high in clinical routine. This study aimed at define risk factors and test machine learning algorithms for their accuracy in the prediction of the risk to being subjected to coercive measures.Methods: In a sample of involuntarily hospitalized patients (n = 393) at the University Hospital of Psychiatry Zurich, we analyzed risk factors for the experience of coercion (n = 170 patients) using chi-square tests and Mann Whitney U tests. We trained machine learning algorithms [logistic regression, Supported Vector Machine (SVM), and decision trees] with these risk factors and tested obtained models for their accuracy via five-fold cross validation. To verify the results we compared them to binary logistic regression.Results: In a model with 8 risk-factors which were available at admission, the SVM algorithm identified 102 out of 170 patients, which had experienced coercion and 174 out of 223 patients without coercion (69% accuracy with 60% sensitivity and 78% specificity, AUC 0.74). In a model with 18 risk-factors, available after discharge, the logistic regression algorithm identified 121 out of 170 with and 176 out of 223 without coercion (75% accuracy, 71% sensitivity, and 79% specificity, AUC 0.82).Discussion: Incorporating both clinical and demographic variables can help to estimate the risk of experiencing coercion for psychiatric patients. This study could show that trained machine learning algorithms are comparable to binary logistic regression and can reach a good or even excellent area under the curve (AUC) in the prediction of the outcome coercion/no coercion when cross validation is used. Due to the better generalizability machine learning is a promising approach for further studies, especially when more variables are analyzed. More detailed knowledge about individual risk factors may help to prevent the occurrence of situations involving coercion.

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“…Enforced medication is defined as the application of intramuscular medication by force against the patient's will. In addition, medication administered under psychological pressure is registered, allowing comparisons with international data [18,[22][23][24].…”

mentioning

confidence: 99%

Seclusion and enforced medication in dealing with aggression: A prospective dynamic cohort study

et al. 2017

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Who is Subjected to Coercive Measures as a Psychiatric Inpatient? A Multi-Level Analysis

Cited by 42 publications

References 21 publications

Involuntary Medication, Seclusion, and Restraint in German Psychiatric Hospitals after the Adoption of Legislation in 2013

Involuntary Medication, Seclusion, and Restraint in German Psychiatric Hospitals after the Adoption of Legislation in 2013

Machine Learning: An Approach in Identifying Risk Factors for Coercion Compared to Binary Logistic Regression

Seclusion and enforced medication in dealing with aggression: A prospective dynamic cohort study

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