Who is Subjected to Coercive Measures as a Psychiatric Inpatient? A Multi-Level Analysis

E Flammer1, *, T Steinert1, F Eisele1, J Bergk1, 2, C Uhlmann1
1 ZfP Suedwuerttemberg, Weingartshofer Straße 2, 88214 Ravensburg, Germany
2 Werner-Schwidder-Klinik, Herbert-Hellmann-Allee 38, 79189 Bad Krozingen, Germany

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© Flammer et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the ZfP Suedwuerttemberg, Weingartshofer Straße 2, 88214 Ravensburg, Germany; Tel: +49 751 7601 2371; Fax: +49 751 7601 2987; E-mail:



For a reduction in the use of coercive interventions it will be necessary to identify patients at risk. The aim of this study was to explore the impact of basic patient characteristics at admission, history within 24 hours before admission, and living conditions on the risk of experiencing coercive measures, controlling for ward characteristics in a multi-level approach.


Patient characteristics of 3389 patients (1920 women) who had received inpatient treatment in 2007, data relating to coercive measures, and ward characteristics were extracted from the clinical basic documentation.


Patients with aggressive behaviour in the 24 hours prior to admission had a three times higher risk of coercive measures compared to non-aggressive patients. Severity of illness increased the risk of coercion markedly. With each level of severity, the risk of coercion was doubled. Voluntariness of stay appeared to be the best protective factor against coercive measures. If a patient stayed voluntarily, this reduced the risk of coercion by more than two thirds. No impact was found for living conditions.


To identify patients at risk, it is most important to intensively monitor patients with aggressive behaviour prior to admission and patients with a greater severity of psychopathological symptoms.

Keywords: : Coercion, multi-level-analysis, patient characteristics, patients at risk, prediction, psychiatric inpatients, ward characteristics.