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The following is a summary of “Prevalence and risk factors for seclusion and restraint: results of a retrospective analysis,” published in the June 2025 issue of BMC Psychiatry by Wullschleger et al. 

The reduction of coercion was a major challenge in inpatient mental health services, with limited knowledge about seclusion and restraint use in open-door settings.  

Researchers conducted a retrospective study to examine the prevalence and risk factors of coercive measures in open inpatient wards of a Swiss university psychiatric hospital.  

They analyzed the use of seclusion and restraint from 2017 to 2019. Incidence rate ratios (IRR) were estimated by multivariable Poisson regression models to identify patient- and hospital stay-related risk factors associated with coercion.  

The results showed that out of 1,764 patients, 293 (16.6%) experienced at least 1 coercive measure, primarily seclusion. Coercion was linked to male gender IRR 1.34 [1.26, 1.38], P< 0.001), younger age (IRR 0.97 [0.97, 0.97], P< 0.001), and being single or divorced (IRR 1.49 [1.43, 1.60], P< 0.001). Diagnoses of organic (IRR 13.43 [13.38, 13.48], P< 0.001), psychotic (IRR 1.79 [1.79, 1.79], P< 0.001), or bipolar disorders (IRR 2.17 [2.16, 2.17], P< 0.001) were also associated with higher coercion risk. Additional factors included receiving disability benefits (IRR 1.92 [1.90, 2.07], P< 0.001), more prior psychiatric hospitalizations (IRR 1.03 [1.03, 1.03], P< 0.001), and elevated Health of the Nations Outcome Scale (HoNOS) item 1 scores (IRR 1.27 [1.27, 1.27], P< 0.001). Referral from the emergency department (ED) was linked to a lower risk (IRR 0.78 [0.77, 0.86], P< 0.001).  

Investigators concluded that multiple demographic and clinical factors increased coercion risk, highlighting the need for targeted assessment and further study of institutional influences. 

Source: bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-025-07025-6