Restraint, seclusion and forced medication in compulsory psychiatric in-patient care: who are exposed and what follows?

Research problem and specific questionsRestraint, seclusion and forced medication are used to prevent patients in compulsory psychiatric care from harming themselves or others. Their use is controversial, but still the scientific knowledge on coercive interventions is scarce.

The projects’ overarching purpose is to increase the scientific understanding of risk factors and consequences related to coercive interventions, to enable safer care for patients.

Its three interim aims are to: 1) examine the reliability of data on coercive interventions in the Patient Register, 2) conduct a thorough examination of risk factors for coercive interventions and 3) determine associations between different coercive interventions and a range of long-term psychiatric outcomes (e.g. suicide, self-harm and psychiatric care consumption).Data and methodWe will establish a cohort of all individuals admitted to compulsory psychiatric care in Region Stockholm 2010-2022.

Participants will be followed retrospectively (aim 2) and prospectively (aim 3) through linked registries and medical records (aim 1). We focus on three types of coercive interventions: a) restraint, b) seclusion and c) forced medication. The reliability of data on these interventions in the Patient Register will be compared to medical records.

Clinical and sociodemographic risk factors as well as long-terms outcomes in the year following discharge will be examined.Societal relevance and utilisationSweden aims to increase the patient-safety and legal security of patients in compulsory psychiatric care, but this aim is hard to reach without knowing what patients are at risk.

Long-term effects of coercive interventions have been identified as an important knowledge gap in governmental reports, urging for more research in this area.

The data quality on coercive interventions in Swedish registries has received national and international critique and the project will contribute with a necessary evaluation of data quality,Plan for project realisationThis project will be conducted at the Rücklab research group, Center for Psychiatry Research, Karolinska Institutet, in collaboration with the EPiCSS research group at the Department of Global Public Health, KI.

The research groups have extensive experience of psychiatric epidemiology with Swedish register data.

Most work tasks will be performed by the applicant and PI Fredrik Johansson, the costs for the project consists mainly of his salary.