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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV0239

Did stricter legislation reduce coercive measures in child and adolescent psychiatry? A controlled interrupted time series analysis

DID STRICTER LEGISLATION REDUCE COERCIVE MEASURES IN CHILD AND ADOLESCENT PSYCHIATRY? A CONTROLLED TIME-SERIES ANALYSIS

Stricter legislation introduced in Sweden in 2020 did not reduce coercive measures among child and adolescent inpatients and had unintended consequences, including an immediate increase in involuntary medication.

The aim was to evaluate whether the Swedish legislative reform introduced on July 1, 2020, which imposed stricter conditions and shorter authorization periods for coercive measures involving minors, reduced coercive measures in inpatient child and adolescent mental health services (CAMHS). The study used a controlled interrupted time series design covering 2017 to 2021; the exposed group comprised patients under 18 in Stockholm CAMHS (7,075 admissions), while the control groups comprised psychiatric patients aged 18 to 24 in Stockholm (18,493 admissions) and national CAMHS data from Finland (39,062 admissions). The outcome measures were seclusion, mechanical restraint, involuntary medication, and a composite measure, analyzed using segmented Poisson/negative binomial regression with Newey–West standard errors. No clear change was detected in seclusion, mechanical restraint, or the composite measure. Involuntary medication increased immediately after the reform (incidence rate ratio, IRR 2.49; 95% confidence interval 1.63 to 3.81). In the post-reform trend, the duration of seclusion increased by 12% and the duration of mechanical restraint by 6% relative to the young adult control group. According to the authors, this pattern suggests that legal restrictions changed only the form of coercion used, without reducing overall exposure to coercion; the immediate increase in involuntary medication may reflect uncertainty regarding implementation and compensatory use alongside other coercive measures. Shorter reassessment intervals did not translate into shorter episodes of coercion.

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