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

Abstract

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.