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Risk Factors Associated with use of Coercive Practices in Adult Inpatient Mental Health Patients: A Systematic Review

Research output: Contribution to journalReview articlepeer-review

Lewys Beames, Juliana Onwumere

Original languageEnglish
JournalJournal of Psychiatric and Mental Health Nursing
Accepted/In press24 Mar 2021

King's Authors


Introduction: Coercive practices, such as physical restraint and seclusion, are a common feature of all mental healthcare systems. However, there is considerable variation in their use, concern about their iatrogenic potential and agreement internationally on the need to monitor and reduce their use.
Aims: To examine the evidence concerning risk factors associated with use of coercive practices in adults admitted to inpatient psychiatric services.
Method: A systematic review, consistent with PRIMSA guidelines, of four databases (PsychINFO, Medline, CINHAL and Embase). Peer-reviewed, English language articles from database inception to February 2020, were included. Methodological quality was assessed using the Quality Assessment Tool for Quantitative Studies.
Results: Twenty studies met inclusion criteria. Risk factors examined in the studies organised around four categories: patient socio-demographic; patient clinical; staff; and organisational factors. Overall, methodological quality of papers was deemed weak and there was insufficient evidence to support any singular risk factor.
Discussion: The reviewed evidence suggests risk of coercive practice in inpatient mental health settings is multifactorial. Further research to standardise concept definitions and elucidate the mechanisms behind variance in use is required.

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