CoChat
Sign Up
Cited by 81Healthcare Decision-Making and RestraintsPsychiatric care and mental health servicesWorkplace Violence and Bullying

Aggression and violence in psychiatric hospitals with and without open door policies: A 15-year naturalistic observational study

Schneeberger, Andres R., Kowalinski, Eva, Fröhlich, Daniela, Schröder, Katrin, von Felten, Stefanie, Zinkler, Martin, Beine, Karl H., Heinz, Andreas +4 more·2017·Journal of Psychiatric Research
DOI 10.1016/j.jpsychires.2017.08.017
Open this paper in CoChat — free account

Abstract

Aggressive behavior and violence in psychiatric patients have often been quoted to justify more restrictive settings in psychiatric facilities. However, the effects of open vs. locked door policies on aggressive incidents remain unclear. This study had a naturalistic observational design and analyzed the occurrence of aggressive behavior as well as the use of seclusion or restraint in 21 German hospitals. The analysis included data from 1998 to 2012 and contained a total of n = 314,330 cases, either treated in one of 17 hospitals with (n = 68,135) or in one of 4 hospitals without an open door policy (n = 246,195). We also analyzed the data according to participants' stay on open, partially open, or locked wards. To compare hospital and ward types, we used generalized linear mixed-effects models on a propensity score matched subset (n = 126,268) and on the total dataset. The effect of open vs. locked door policy was non-significant in all analyses of aggressive behavior during treatment. Restraint or seclusion during treatment was less likely in hospitals with an open door policy. On open wards, any aggressive behavior and restraint or seclusion were less likely, whereas bodily harm was more likely than on closed wards. Hospitals with open door policies did not differ from hospitals with locked wards regarding different forms of aggression. Other restrictive interventions used to control aggression were significantly reduced in open settings. Open wards seem to have a positive effect on reducing aggression. Future research should focus on mental health care policies targeted at empowering treatment approaches, respecting the patient's autonomy and promoting reductions of institutional coercion.

Integrity signals

Registry

Crossref · 10.1016/j.jpsychires.2017.08.017

Cites

31 of 31 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Once a person was admitted as an involuntary patient they were more likely to be subject to use of coercive treatment modalities such as restraint and seclusion than people admitted on a voluntary basis.

    “A similar cycle of coercive care provision may also be evident during admission, with the available literature indicating that once a person was admitted as an involuntary patient they were more likely to be subject to use of coercive treatment modalities such as restraint and seclusion than people admitted on a voluntary basis (34,76–88), and may be more likely to display aggressive behaviours (”

    From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [84]

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Schneeberger, A. R., Kowalinski, E., Fröhlich, D., Schröder, K., von Felten, S., Zinkler, M., Beine, K. H., Heinz, A., Borgwardt, S., Lang, U. E., Bux, D. A., & Huber, C. G.
Affiliations
  • Albert Einstein College of Medicine (US)
  • University of Basel (CH)
  • University Medical Center Hamburg-Eppendorf (DE)
  • Stiftung Charité (DE)
  • Montefiore Medical Center (US)
Corresponding author
Schneeberger, Andres R.
ORCID
Venue
Journal of Psychiatric Research
Publisher
Elsevier BV
Published
2017-12
Volume
95
Pages
189-195
ISSN
0022-3956 (ISSN-L)
DOI
10.1016/j.jpsychires.2017.08.017
OpenAlex
W2750125663
Cited by
81
References
31
Citations by year
2026: 6 · 2025: 11 · 2024: 10 · 2023: 11 · 2022: 9 · 2021: 8 · 2020: 8 · 2019: 14 · 2018: 4
FWCI
8.80
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of Psychiatric Research (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Social Sciences › Sociology and Political Science › Workplace Violence and Bullying
Keywords
aggression, violence, open door policy, locked wards, psychiatric hospitals, seclusion, physical restraint, restrictive practices, institutional coercion, personal injury, psychiatric inpatient care
MeSH terms
Adult, Aged, Aggression, Female, Germany, Hospitals, Psychiatric, Humans, Inpatients, Male, Middle Aged, Patient Isolation, Restraint, Physical, Violence, Organizational Policy, Safety Management, Persons with Psychiatric Disorders

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review