Research

Attitude of young psychiatrists toward coercive measures in psychiatry: a case vignette study in Japan

Masaru Tateno¹ , Kanna Sugiura² , Kumi Uehara³ , Daisuke Fujisawa⁴ , Yueren Zhao⁵ , Naoki Hashimoto⁶ , Hidehiko Takahashi⁷ , Naofumi Yoshida⁸ , Takahiro Kato⁹ , Wakako Nakano¹⁰ , Yosuke Wake¹¹ , Tomohiro Shirasaka¹ , Seiju Kobayashi¹ and Soichiro Sato¹²

¹  Department of Neuropsychiatry, School of Medicine, Sapporo Medical University, South-1, West-16, Chuo-ku, Sapporo, Japan 0608543

²  Department of Psychiatry, Yokohama City University, Yokohama, Japan

³  Department of Psychiatry, Kanagawa Psychiatric Center Serigaya Hospital, Yokohama, Japan

⁴  Department of Psychiatry, School of Medicine, Keio University, Tokyo, Japan

⁵  Department of Psychiatry, Meisei Hospital, Kumamoto, Japan

⁶  Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan

⁷  Department of Molecular Neuroimaging, Clinical Neuroimaging Section, National Institute of Radiological Sciences, Chiba, Japan

⁸  Department of Neuropsychiatry, Toho University, School of Medicine, Tokyo, Japan

⁹  Department of Neuropsychiatry, Graduate school of Medical Sciences, Kyushu University, Fukuoka, Japan

¹⁰  Department of Psychiatry, University of Occupational and Environmental Health, Kitakyushu, Japan

¹¹  Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

¹²  Department of Psychiatry, Zikei Hospital, Okayama, Japan

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International Journal of Mental Health Systems 2009, 3:20doi:10.1186/1752-4458-3-20

Published:	22 September 2009

Abstract

Background

Every psychiatrist must pay careful attention to avoid violating human rights when initiating coercive treatments such as seclusion and restraint. However, these interventions are indispensable in clinical psychiatry, and they are often used as strategies to treat agitated patients. In this study, we investigated young psychiatrists' attitudes toward psychiatric coercive measures.

Methods

A total of 183 young psychiatrists participated as subjects in our study. A questionnaire with a case vignette describing a patient with acute psychosis was sent to the study subjects via the Internet or by mail. This questionnaire included scoring the necessity for hospitalization, and the likelihood of prescribing seclusion and/or restraint, on a 9-point Likert scale (with 9 indicating strong agreement).

Results

There was general agreement among the study subjects that the case should be admitted to a hospital (8.91 ± 0.3) and secluded (8.43 ± 1.0). The estimated length of hospitalization was 13.53 ± 6.4 weeks. Regarding the likelihood of prescribing restraint, results showed great diversity (5.14 ± 2.5 on 9-point scale); psychiatrists working at general hospitals scored significantly higher (6.25 ± 2.5) than those working at university hospitals (5.02 ± 2.3) or psychiatric hospitals (4.15 ± 2.6). A two-group comparison of the length of inpatient care revealed a significant difference between those psychiatrists who scored 1-3 (n = 55, 14.22 ± 7.4 wks) and those who scored 7-9 (n = 62, 12.22 ± 4.0) regarding the need to use restraint.

Conclusion

Our results may reflect the current dilemma in Japanese psychiatry wherein psychiatrists must initiate coercive measures to shorten hospitalization stays. This study prompted its subject psychiatrists to consider coercive psychiatric treatments.