Aggression and violence in psychiatric hospitals with and without open door policies: A 15-year naturalistic observational study.

Autor: Schneeberger AR; Universitäre Psychiatrische Kliniken Basel, Universität Basel, Wilhelm-Klein-Str. 27, CH-4012 Basel, Switzerland; Psychiatrische Dienste Graubünden, Loëstrasse 220, CH-7000 Chur, Switzerland; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, 3331 Bainbridge Avenue, Bronx, NY 10467, USA. Electronic address: andres.schneeberger@pdgr.ch., Kowalinski E; Universitäre Psychiatrische Kliniken Basel, Universität Basel, Wilhelm-Klein-Str. 27, CH-4012 Basel, Switzerland., Fröhlich D; Universitäre Psychiatrische Kliniken Basel, Universität Basel, Wilhelm-Klein-Str. 27, CH-4012 Basel, Switzerland., Schröder K; Klinik für Psychiatrie und Psychotherapie, UKE Hamburg, Martinistr. 52, D-20246 Hamburg, Germany., von Felten S; Clinical Trial Unit, Universitätsspital Basel, Spitalstrasse 12, CH-4031 Basel, Switzerland., Zinkler M; Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Schloßhaustrasse 100, D-89522 Heidenheim/Brenz, Germany., Beine KH; St. Marien-Hospital Hamm, Nassauerstraße 13-19, D-59065 Hamm, Germany., Heinz A; Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charitéplatz 1, D-10117 Berlin, Germany., Borgwardt S; Universitäre Psychiatrische Kliniken Basel, Universität Basel, Wilhelm-Klein-Str. 27, CH-4012 Basel, Switzerland., Lang UE; Universitäre Psychiatrische Kliniken Basel, Universität Basel, Wilhelm-Klein-Str. 27, CH-4012 Basel, Switzerland., Bux DA; Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA., Huber CG; Universitäre Psychiatrische Kliniken Basel, Universität Basel, Wilhelm-Klein-Str. 27, CH-4012 Basel, Switzerland.
Jazyk: angličtina
Zdroj: Journal of psychiatric research [J Psychiatr Res] 2017 Dec; Vol. 95, pp. 189-195. Date of Electronic Publication: 2017 Aug 26.
DOI: 10.1016/j.jpsychires.2017.08.017
Abstrakt: Aggressive behavior and violence in psychiatric patients have often been quoted to justify more restrictive settings in psychiatric facilities. However, the effects of open vs. locked door policies on aggressive incidents remain unclear. This study had a naturalistic observational design and analyzed the occurrence of aggressive behavior as well as the use of seclusion or restraint in 21 German hospitals. The analysis included data from 1998 to 2012 and contained a total of n = 314,330 cases, either treated in one of 17 hospitals with (n = 68,135) or in one of 4 hospitals without an open door policy (n = 246,195). We also analyzed the data according to participants' stay on open, partially open, or locked wards. To compare hospital and ward types, we used generalized linear mixed-effects models on a propensity score matched subset (n = 126,268) and on the total dataset. The effect of open vs. locked door policy was non-significant in all analyses of aggressive behavior during treatment. Restraint or seclusion during treatment was less likely in hospitals with an open door policy. On open wards, any aggressive behavior and restraint or seclusion were less likely, whereas bodily harm was more likely than on closed wards. Hospitals with open door policies did not differ from hospitals with locked wards regarding different forms of aggression. Other restrictive interventions used to control aggression were significantly reduced in open settings. Open wards seem to have a positive effect on reducing aggression. Future research should focus on mental health care policies targeted at empowering treatment approaches, respecting the patient's autonomy and promoting reductions of institutional coercion.
(Copyright © 2017 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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