title: A comparison of two hospital districts with low and high figures in the compulsory care of minors: an ecological study.
abstract: BACKGROUND
  The last decade in Finland has seen a vast increase both in involuntary psychiatric treatment of adolescents and in the numbers of adolescents taken into care under the Child Welfare Act. Moreover, the variation in figures between different hospital districts is remarkable. The reasons for this are not known, but it cannot be due to variation in the epidemiology of mental disorders in minors.
  
  
  OBJECTIVE
  The aim of the study was to explore features associated with compulsory care of adolescents at regional level by comparing two hospital districts clearly differing in this regard. The characteristics of involuntarily treated adolescents and adolescents taken into care, the resources and structures of adolescent psychiatric services and child welfare services, and the environmental factors associated with adolescent well-being and adaptation, such as indicators of social deprivation of families were all considered.
  
  
  METHODS
  For the present study, 2 out of the 22 hospital districts in Finland were selected, one using compulsory psychiatric care and taking into care of 13-17-year olds above and the other below the average in Finland. Register data on patient characteristics, services, and social deprivation were used. Absolute and population adjusted figures (95% confidence intervals) from the variables are given. The differences in incidences between health care districts were compared using Poisson regression analysis.
  
  
  RESULTS
  Proportions of divorces, single parent families, social exclusion and outpatient mental health service use, and detoxification treatment use of adults were higher in the health care district with above average coercion figures than in the area with below average coercion figures. The numbers of adolescent psychiatric outpatient visits were higher in the health care district with coercion figures below average despite the fact that the number of positions in adolescent outpatient services was lower than in the health care district with above average coercion figures.
  
  
  CONCLUSIONS
  Factors other than the characteristics of the adolescents themselves are associated with use of compulsory care on them, although an ecological study design cannot establish causality.
authors.affiliation: Department of Nursing Science, University of Turku, 20014, Turku, Finland. ulla.siponen@turkuai.fi
authors.forename: Ulla
authors.initials: U
authors.lastname: Siponen
authors.forename: Maritta
authors.initials: M
authors.lastname: Välimäki
authors.forename: Matti
authors.initials: M
authors.lastname: Kaivosoja
authors.forename: Mauri
authors.initials: M
authors.lastname: Marttunen
authors.forename: Riittakerttu
authors.initials: R
authors.lastname: Kaltiala-Heino
mesh_terms: D000293:Adolescent; D000296:Adolescent Psychiatry / Q000458:organization & administration / Q000706:statistics & numerical data*; D003068:Coercion; D003134:Commitment of Persons with Psychiatric Disorders / Q000706:statistics & numerical data; D005195:Family Relations; D005260:Female; D005387:Finland; D006767:Hospitals, District / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000145:classification; D008605:Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D033242:Minors; D016012:Poisson Distribution; D011610:Psychosocial Deprivation; D012042:Registries / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012043:Regression, Psychology; D012959:Socioeconomic Factors