Use of coercion at Danish psychiatric wards by day of week and time of day.

INTRODUCTION Mechanical restraint and other forms of coercion may be used under certain circumstances at psych-iatric wards. The use of coercion receives considerable focus, yet little is known about its diurnal distribution. We examined the initiation of mechanical restraint, sedative drug administration, physical retention, door locking and personal shielding by time of day and week. METHODS Group 3 protocols in the national Register of Coercion for patients aged ≥ 18 years in the years 2010-2012 were analysed. The first coercive episode was internally compared with respect to type, shift and whether it had been initiated on weekdays or weekend days. The odds ratio for experiencing coercive episodes outside day shifts on weekdays was calculated and adjusted for sex, age and hospital. Episodes initiated after 24 hours of admission were also analysed. RESULTS The dataset consisted of 68,619 records from 7,338 persons. The first coercive episode was mostly initiated during a day shift on a weekday (44.9%), but this differed markedly between types of coercion. Compared with locking of doors, the adjusted odds ratio of being subjected to coercion outside the day shift on weekdays was 3.32 (95% confidence interval (CI): 2.91-3.79) for mechanical restraint and 2.70 (95% CI: 2.32-3.16) for physical retention. This pattern persisted if the first episode was initiated at least 24 hours after admission. CONCLUSIONS The initiation of coercion was lower during evenings, nights and weekends, but different coercive types and hospitals followed different diurnal patterns, which indicates unexplained variations. FUNDING The establishment of the data set was funded by the Public Health Officers North. TRIAL REGISTRATION not relevant.