{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T14:10:31Z","timestamp":1790086231470,"version":"4.0.1"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Defensive medicine (DM) refers to practices adopted to avoid potentially distressing medico-legal situations. Although DM has been widely studied across various medical specialties, evidence in psychiatry remains limited, and no studies have specifically examined this issue in child and adolescent psychiatry. This study aimed to examine the prevalence of DM among child and adolescent psychiatrists in T\u00fcrkiye and to identify associated factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study was conducted using an anonymous online survey distributed between November 2024 and February 2025. The survey included a sociodemographic and professional data form and a questionnaire assessing DM-related practices. Participants who reported engaging in defensive practices in at least half of their patients were classified as practicing DM. Group comparisons were conducted using appropriate statistical methods, and logistic regression analysis was performed to identify independent predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 203 child and adolescent psychiatrists participated, of whom 41.4% were classified as practicing DM. No significant differences were observed between groups in terms of sociodemographic or professional characteristics. DM-related practices were commonly reported across multiple domains, including patient assessment, pharmacological decision-making, suicide risk management, and report-related practices. Psychiatrists who reported practicing DM demonstrated significantly higher frequencies of several behaviors such as not initiating assessment or pharmacotherapy in the absence of a parent or legal guardian, increased documentation and detailed disclosure of rare adverse effects, and cardiology referrals before initiating stimulant or atomoxetine treatment without clear indication. In regression analysis, a higher number of health committee patients (OR = 2.198, p = 0.017), detailed disclosure of rare but severe adverse effects (OR = 1.580, p = 0.002), and cardiology referral without clinical indication (OR = 1.419, p = 0.010) were identified as significant predictors of DM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>DM-related practices appear to be common among child and adolescent psychiatrists in T\u00fcrkiye and may reflect both medico-legal concerns and context-specific features of clinical practice. Such practices are more closely associated with specific clinical situations than with sociodemographic or professional characteristics. These findings underscore the need for further research and for context-sensitive strategies to reduce defensive practices while maintaining high-quality patient care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1860742","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T13:58:26Z","timestamp":1790085506000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Defensive medicine\u2013related practices among child and adolescent psychiatrists in T\u00fcrkiye: prevalence, behavioral patterns, and associated factors"],"prefix":"10.3389","volume":"17","author":[{"given":"Esra","family":"Ho\u015fo\u011flu","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Karadeniz Technical University","place":["Trabzon, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bedia Sultan","family":"\u00d6nal","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Giresun Universitesi Tip Fakultesi","place":["Giresun, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bahadir","family":"Turan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Karadeniz Technical University","place":["Trabzon, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.26745\/ahbvuibfd.994079","article-title":"Defansif t\u0131p ve defansif t\u0131p konusunda yap\u0131lan akademik \u00e7al\u0131\u015fmalar \u00fczerine bir derleme","volume":"23","author":"Mansur","year":"2021","journal-title":"Ankara Hac\u0131 Bayram Veli \u00dcniversitesi \u0130ktisadi ve \u0130dari Bilimler Fak\u00fcltesi Dergisi"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-014153","article-title":"Cross-sectional survey on defensive practices and defensive behaviours among Israeli psychiatrists","volume":"7","author":"Reuveni","year":"2017","journal-title":"BMJ Open"},{"key":"B3","first-page":"1","article-title":"Why do doctors practice defensive medicine? The side-effects of medical litigation","volume":"15","author":"Catino","year":"2011","journal-title":"Saf Sci Monitor"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000040619","article-title":"Factors associated with defensive medicine practice in United Arab Emirates: A cross-sectional study with multivariate analysis","volume":"103","author":"Al Awar","year":"2024","journal-title":"Medicine"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1177\/1355819617707224","article-title":"Prevalence and costs of defensive medicine: a national survey of Italian physicians","volume":"22","author":"Panella","year":"2017","journal-title":"J Health Serv Res Policy"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.4649","article-title":"The cost of defensive medicine on 3 hospital medicine services","volume":"174","author":"Rothberg","year":"2014","journal-title":"JAMA Intern Med"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dky098","article-title":"Defensive medicine among antibiotic stewards: the international ESCMID AntibioLegalMap survey","volume":"73","author":"Tebano","year":"2018","journal-title":"J Antimicrob Chemother"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jflm.2020.101970","article-title":"Defensive medicine among different surgical disciplines: a descriptive cross-sectional study","volume":"73","author":"Calikoglu","year":"2020","journal-title":"J Forensic Legal Med"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzad096","article-title":"Prevalence and determinants of defensive medicine among physicians: a systematic review and meta-analysis","volume":"35","author":"Zheng","year":"2023","journal-title":"Int J For Qual Health Care"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.18863\/pgy.562489","article-title":"Psikiyatride malpraktis","volume":"12","author":"Bulut","year":"2020","journal-title":"Psikiyatride G\u00fcncel Yakla\u015f\u0131mlar"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3390\/medicina59111928","article-title":"Predictors of defensive practices among Italian psychiatrists: additional findings from a national survey","volume":"59","author":"Morena","year":"2023","journal-title":"Medicina"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1080\/14789949.2015.1062995","article-title":"Ethical issues in child and adolescent forensic psychiatry: a review","volume":"26","author":"Kaltiala-Heino","year":"2015","journal-title":"J Forensic Psychiatry Psychol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1136\/pmj.78.925.671","article-title":"Defensive practice among psychiatrists: a questionnaire survey","volume":"78","author":"Passmore","year":"2002","journal-title":"Postgrad Med J"},{"key":"B14","doi-asserted-by":"publisher","first-page":"887","DOI":"10.1016\/s1056-4993(02)00023-8","article-title":"Ethics in child and adolescent forensic psychiatry","volume":"11","author":"Ratner","year":"2002","journal-title":"Child Adolesc Psychiatr Clinics"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.chc.2009.08.002","article-title":"Ethics and risk management in administrative child and adolescent psychiatry","volume":"19","author":"Sondheimer","year":"2010","journal-title":"Child Adolesc Psychiatr Clinics"},{"key":"B16","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1186\/s12910-025-01323-0","article-title":"Artificial intelligence guidance in ethically challenging clinical scenarios in child and adolescent psychiatry: a qualitative study in the context of Turkiye","volume":"26","author":"\u0130\u00e7en","year":"2025","journal-title":"BMC Med Ethics"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.37989\/gumussagbil.728648","article-title":"The challenges of child and adolescent psychiatrists in the process of the disability report evaluation","volume":"9","author":"Esin","year":"2020","journal-title":"G\u00fcm\u00fc\u015fhane \u00dcniversitesi Sa\u011fl\u0131k Bilimleri Dergisi"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.17986\/blm.2017332862","article-title":"Adli olgu bildirimiyle ilgili ikilemlerde hekimlerin tutumlar\u0131","volume":"23","author":"Can","year":"2018","journal-title":"Bull Legal Med"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.4274\/tjcamh.galenos.2021.43434","article-title":"\u00c7ocuklar i\u00e7in \u00f6zel gereksinim de\u011ferlendirmesine ili\u015fkin y\u00f6netmelik (\u00c7\u00d6ZGER) sonras\u0131 \u00e7ocuk ve ergen psikiyatrisi alan\u0131nda uygulamada kar\u015f\u0131la\u015f\u0131lan zorluklar","volume":"28","author":"Uygun","year":"2021","journal-title":"Turkish J Child Adolesc Ment Health"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1176\/appi.focus.20150032","article-title":"Ethical issues in child and adolescent psychiatry","volume":"14","author":"Goldsmith","year":"2016","journal-title":"Focus (Madison)"},{"key":"B21","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1186\/s12991-023-00482-x","article-title":"Effect of perceived stigma on work and social roles among individuals with mental health disorders in Saudi Arabia: findings from a national survey","volume":"22","author":"AlFattani","year":"2023","journal-title":"Ann Gen Psychiatry"},{"key":"B22","doi-asserted-by":"publisher","first-page":"395","DOI":"10.5505\/kpd.2022.33716","article-title":"Psikiyatri bran\u015f\u0131yla ilgili t\u0131bbi uygulama hatas\u0131 (malpraktis) iddias\u0131 nedeniyle de\u011ferlendirilen vakalar\u0131n klinik \u00f6zellikleri ve adli psikiyatrik a\u00e7\u0131dan incelenmesi","volume":"25","author":"Cesur","year":"2022","journal-title":"Klinik Psikiyatri Dergisi"},{"key":"B23","unstructured":"Regulation on Health Eligibility for the Turkish Armed Forces, Gendarmerie, and Coast Guard\n          \n          \n          \n          2016"},{"key":"B24","unstructured":"Regulation on Health Requirements for the Police Organization\n          \n          \n          \n          2018"},{"key":"B25","unstructured":"Statement on Requests for the Removal of Past Psychiatric Diagnoses\n          \n          \n          \n          2024"},{"key":"B26","volume-title":"Membership Statistics as of August 20, 2026. Unpublished Institutional Data","year":"2026"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.1244101","article-title":"Vox clamantis in deserto: a survey among Italian psychiatrists on defensive medicine and professional liability","volume":"14","author":"Scognamiglio","year":"2023","journal-title":"Front Psychiatry"},{"key":"B28","unstructured":"Suicide Data and Statistics\n          \n          \n          \n          2025"},{"key":"B29","unstructured":"Communiqu\u00e9 on the Procedures and Principles Regarding Institutional Contribution to Compulsory Financial Liability Insurance for Medical Malpractice\n          \n          \n          \n          2010"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1155\/2024\/8226403","article-title":"Medical malpractice stress syndrome and defensive medicine in obstetricians and gynecologists in Turkey","volume":"2024","author":"Gunenc","year":"2024","journal-title":"Int J Clin Pract"},{"key":"B31","doi-asserted-by":"publisher","first-page":"e995","DOI":"10.1097\/pts.0000000000000706","article-title":"The effect of clinical volume on annual and per-patient encounter medical malpractice claims risk","volume":"17","author":"Schaffer","year":"2021","journal-title":"J Patient Saf"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1997.03540310051034","article-title":"Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons","volume":"277","author":"Levinson","year":"1997","journal-title":"JAMA"},{"key":"B33","article-title":"Hekimlerin defansif t\u0131p tutumlar\u0131n\u0131n incelenmesi","volume":"25","author":"Banaz","year":"2022","journal-title":"Hacettepe Sa\u011fl\u0131k \u0130daresi Dergisi"},{"key":"B34","unstructured":"Regulation on Patient Rights\n          \n          \n          \n          1998"},{"key":"B35","unstructured":"Examination\/Treatment\/Planning of Medical Interventions for Patients Under 18 Years of Age\n          \n          \n          \n          2025"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2008.0129","article-title":"Parental attitudes toward children's use of antidepressants and psychotherapy","volume":"19","author":"Stevens","year":"2009","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.jad.2022.07.057","article-title":"Parent preferences for adolescent depression treatment: The role of past treatment experience and biological etiological beliefs","volume":"316","author":"Wallman","year":"2022","journal-title":"J Affect Disord"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014-1778","article-title":"Overdiagnosis: how our compulsion for diagnosis may be harming children","volume":"134","author":"Coon","year":"2014","journal-title":"Pediatrics"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.161.5.706","article-title":"How much information about adverse effects of medication do patients want from physicians","volume":"161","author":"Ziegler","year":"2001","journal-title":"Arch Internal Med"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1542\/9781610023658-part01-clinical","article-title":"Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit\/hyperactivity disorder in children and adolescents","volume":"144","author":"Wolraich","year":"2019","journal-title":"Pediatrics"},{"key":"B41","article-title":"Attention deficit hyperactivity disorder: Diagnosis and management","year":"2018"},{"key":"B42","article-title":"Management of the suicidal patient in the era of defensive medicine: focus on suicide risk assessment and boundaries of responsibility","volume":"13","author":"Bleich","year":"2011","journal-title":"Israel Med Assoc Journal: IMAJ"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1016\/s1056-4993(02)00020-2","article-title":"Malpractice in child and adolescent psychiatry","volume":"11","author":"Ash","year":"2002","journal-title":"Child Adolesc Psychiatr Clinics"},{"key":"B44","unstructured":"Grand National Assembly of T\u00fcrkiye\n          Minutes of the Parliamentary Research Commission on Strengthening the Participation of Persons With Disabilities in Social Life, Identifying the Problems They Face, and Developing Permanent Solutions to These Problems\n          \n          2025"},{"key":"B45","unstructured":"Frequently Asked Questions: Health Board Reports for Individuals With Disabilities\n          \n          \n          \n          2025"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1860742\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T13:58:32Z","timestamp":1790085512000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1860742\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,22]]},"references-count":45,"alternative-id":["10.3389\/fpsyt.2026.1860742"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2026.1860742","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,22]]},"article-number":"1860742"}}