Thea Linkhorst , Søren Fryd Birkeland , Frederik Alkier Gildberg , Jan Mainz , Christian Torp-Pedersen , Henrik Bøggild
{"title":"在丹麦精神科病房使用侵入性最小的胁迫:一项基于登记的队列研究,在35,812例入院患者中,131,632例首次和随后的胁迫事件","authors":"Thea Linkhorst , Søren Fryd Birkeland , Frederik Alkier Gildberg , Jan Mainz , Christian Torp-Pedersen , Henrik Bøggild","doi":"10.1016/j.ijlp.2022.101838","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>Psychiatric legislation in Denmark implies a principle of using the least intrusive types of coercion first. The intrusiveness is not universally agreed upon. We examined the order in which coercive measures during admission were used, implying that the first used should be less intrusive than the following types.</p></div><div><h3>Methods</h3><p>For coercive episodes reported to the national administrative register for the period 2011–16, the order of 12 legal coercive interventions during each admission was examined. Comparing with mechanical restraint, the odds ratio (OR) and confidence interval (95%CI) of being first or subsequent used types were estimated using conditioned (96,611 episodes) and unconditioned (131,632 episodes) logistic regression models, stratified on sex.</p></div><div><h3>Results</h3><p>Totally 17,796 patients aged 18+ were subjected to at least one coercive episode. The median time between admission and the first episode was 4 days in men and 6 for women. For females, involuntary detention, forced feeding, coercive treatment of somatic disorder, locking of doors and close observations in females were used before mechanical restraint, and forced follow-up, involuntary electro convulsive therapy (ECT), forced treatment, use of gloves and straps, physical restraint and forced intramuscular medication was used later. In men, only involuntary detention was used before mechanical restraint, while involuntary ECT, close observations, administration of drugs, use of gloves and straps, physical restraint and forced intramuscular medication was used after mechanical restraint.</p></div><div><h3>Conclusion</h3><p>The order of used coercive measures is not consistent with the international ranking of the least intrusive types, especially in men and in younger adults.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0160252722000644/pdfft?md5=eccb5dd93988abdf7338fb352da947ea&pid=1-s2.0-S0160252722000644-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Use of the least intrusive coercion at Danish psychiatric wards: A register-based cohort study of 131,632 first and subsequent coercive episodes within 35,812 admissions\",\"authors\":\"Thea Linkhorst , Søren Fryd Birkeland , Frederik Alkier Gildberg , Jan Mainz , Christian Torp-Pedersen , Henrik Bøggild\",\"doi\":\"10.1016/j.ijlp.2022.101838\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>Psychiatric legislation in Denmark implies a principle of using the least intrusive types of coercion first. The intrusiveness is not universally agreed upon. We examined the order in which coercive measures during admission were used, implying that the first used should be less intrusive than the following types.</p></div><div><h3>Methods</h3><p>For coercive episodes reported to the national administrative register for the period 2011–16, the order of 12 legal coercive interventions during each admission was examined. Comparing with mechanical restraint, the odds ratio (OR) and confidence interval (95%CI) of being first or subsequent used types were estimated using conditioned (96,611 episodes) and unconditioned (131,632 episodes) logistic regression models, stratified on sex.</p></div><div><h3>Results</h3><p>Totally 17,796 patients aged 18+ were subjected to at least one coercive episode. The median time between admission and the first episode was 4 days in men and 6 for women. For females, involuntary detention, forced feeding, coercive treatment of somatic disorder, locking of doors and close observations in females were used before mechanical restraint, and forced follow-up, involuntary electro convulsive therapy (ECT), forced treatment, use of gloves and straps, physical restraint and forced intramuscular medication was used later. In men, only involuntary detention was used before mechanical restraint, while involuntary ECT, close observations, administration of drugs, use of gloves and straps, physical restraint and forced intramuscular medication was used after mechanical restraint.</p></div><div><h3>Conclusion</h3><p>The order of used coercive measures is not consistent with the international ranking of the least intrusive types, especially in men and in younger adults.</p></div>\",\"PeriodicalId\":47930,\"journal\":{\"name\":\"International Journal of Law and Psychiatry\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2022-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S0160252722000644/pdfft?md5=eccb5dd93988abdf7338fb352da947ea&pid=1-s2.0-S0160252722000644-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Law and Psychiatry\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0160252722000644\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"LAW\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Law and Psychiatry","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0160252722000644","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"LAW","Score":null,"Total":0}
Use of the least intrusive coercion at Danish psychiatric wards: A register-based cohort study of 131,632 first and subsequent coercive episodes within 35,812 admissions
Objective
Psychiatric legislation in Denmark implies a principle of using the least intrusive types of coercion first. The intrusiveness is not universally agreed upon. We examined the order in which coercive measures during admission were used, implying that the first used should be less intrusive than the following types.
Methods
For coercive episodes reported to the national administrative register for the period 2011–16, the order of 12 legal coercive interventions during each admission was examined. Comparing with mechanical restraint, the odds ratio (OR) and confidence interval (95%CI) of being first or subsequent used types were estimated using conditioned (96,611 episodes) and unconditioned (131,632 episodes) logistic regression models, stratified on sex.
Results
Totally 17,796 patients aged 18+ were subjected to at least one coercive episode. The median time between admission and the first episode was 4 days in men and 6 for women. For females, involuntary detention, forced feeding, coercive treatment of somatic disorder, locking of doors and close observations in females were used before mechanical restraint, and forced follow-up, involuntary electro convulsive therapy (ECT), forced treatment, use of gloves and straps, physical restraint and forced intramuscular medication was used later. In men, only involuntary detention was used before mechanical restraint, while involuntary ECT, close observations, administration of drugs, use of gloves and straps, physical restraint and forced intramuscular medication was used after mechanical restraint.
Conclusion
The order of used coercive measures is not consistent with the international ranking of the least intrusive types, especially in men and in younger adults.
期刊介绍:
The International Journal of Law and Psychiatry is intended to provide a multi-disciplinary forum for the exchange of ideas and information among professionals concerned with the interface of law and psychiatry. There is a growing awareness of the need for exploring the fundamental goals of both the legal and psychiatric systems and the social implications of their interaction. The journal seeks to enhance understanding and cooperation in the field through the varied approaches represented, not only by law and psychiatry, but also by the social sciences and related disciplines.