Defensive medicine-related practices among child and adolescent psychiatrists in Türkiye: prevalence, behavioral patterns, and associated factors.

Introduction: 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 Türkiye and to identify associated factors. Methods: 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. Results: 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. Conclusion: DM-related practices appear to be common among child and adolescent psychiatrists in Türkiye 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.