Gender differences in coerced patients with schizophrenia

Abstract

BackgroundDespite the recent increase of research interest in involuntary treatment and the use of coercive measures, gender differences among coerced schizophrenia patients still remain understudied. It is well recognized that there are gender differences both in biological correlates and clinical presentations in schizophrenia, which is one of the most common diagnoses among patients who are treated against their will. The extent to which these differences may result in a difference in the use of coercive measures for men and women during the acute phase of the disease has not been studied.Methods291 male and 231 female coerced patients with schizophrenia were included in this study, which utilized data gathered by the EUNOMIA project (European Evaluation of Coercion in Psychiatry and Harmonization of Best Clinical Practice) and was carried out as a multi-centre prospective cohort study at 13 centers in 12 European countries. Sociodemographic and clinical characteristics, social functioning and aggressive behavior in patients who received any form of coercive measure (seclusion and/or forced medication and/or physical restraint) during their hospital stay were assessed.ResultsWhen compared to the non-coerced inpatient population, there was no difference in sociodemographic or clinical characteristics across either gender. However coerced female patients did show a worse social functioning than their coerced male counterparts, a finding which contrasts with the non-coerced inpatient population. Moreover, patterns of aggressive behavior were different between men and women, such that women exhibited aggressive behavior more frequently, but men committed severe aggressive acts more frequently. Staff used forced medication in women more frequently and physical restraint and seclusion more frequently with men.ConclusionsResults of this study point towards a higher threshold of aggressive behavior the treatment of women with coercive measures. This may be because less serious aggressive actions trigger the application of coercive measures in men. Moreover coerced women showed diminished social functioning, and more importantly more severe symptoms from the “excitement/hostile” cluster in contrast to coerced men. National and international recommendation on coercive treatment practices should include appropriate consideration of the evidence of gender differences in clinical presentation and aggressive behaviors found in inpatient populations.

Prevalence of aggression in hospitalized patients with schizophrenia in China: A meta‐analysis

“…Many factors have been reported to be associated with the rate of aggression in the psychiatry wards, such as age (Cho et al ., ), gender (Nawka et al ., ), ethnicity (Bruce et al ., ), and substance use (Lejoyeux et al ., ). In this study, only the sample size was significantly associated with aggression by inpatients with schizophrenia.…”

Patient Experience of Coercive Measures

“…Men were more often secluded or restrained, while women were more likely to receive forced medication. The authors suggest that gender issues should be taken into account when making national or international recommendations (Nawka et al 2013).…”

“…Nawka et al (2013) studied gender differences among coerced patients with schizophrenia in 12 European countries. They found that coerced women were more likely to show aggressive behaviours but with a lesser intensity than their male counterparts, while aggression in men was more severe.…”

An examination of the incidence and nature of chemical restraint on adult acute psychiatric inpatient units in Adelaide, South Australia

“…Chemical restraint is reported to be the most common type of coercive measure used in several countries, for example, the UK, Bulgaria, Poland, and Sweden (Nawka et al . ; Raboch et al . ) and is often used with seclusion and physical/mechanical restraint (Flammer & Steinert ; Georgieva et al .…”

“…Nawka et al . () studied gender differences in consumers with schizophrenia who experienced coercive measures across 12 European countries, finding women to be more frequently chemically restrained than men. Husum et al .…”