Research
Attitude of young psychiatrists toward coercive measures in psychiatry: a case vignette study in Japan
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* Corresponding author: Masaru Tateno tatema@sapmed.ac.jp
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
International Journal of Mental Health Systems 2009, 3:20 doi:10.1186/1752-4458-3-20
Published: 22 September 2009Abstract
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.