Cited by 343Healthcare Decision-Making and RestraintsPsychiatric care and mental health servicesEthics and bioethics in healthcare

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Two scales for measuring patients’ perceptions for coercion during mental hospital admission

Gardner, William, Hoge, Steven K., Bennett, Nancy, Roth, Loren H., Lidz, Charles W., Monahan, John, Mulvey, Edward P.·1993·Behavioral Sciences & the Law

DOI 10.1002/bsl.2370110308

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Abstract

Legal and extra-legal coercion are pervasive in mental hospital admission and there are sharp disputes about its appropriate role. This article presents two scales for measuring psychiatric patients' perceptions of coercion during hospital admission and reports data on these scales' internal consistency. We measure patients' perceptions of coercion by asking questions, in either an interview or questionnaire format, about their experience of lack of control, choice, influence, and freedom in hospital admission. Patients' responses to questions about their perceptions of coercion were highly internally consistent. The internal consistency of the scale was robust with respect to variation in site, instrument format, patient population, and interview procedure. Correspondence analysis was used to construct two numerical scales of perceived coercion.

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Method
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Influential
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BackgroundMethodInfluential
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Method
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Background
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“Appelbaum et al. (2009) suggest that the MacArthur Perceived Coercion Scale (PCS; Gardner et al., 1993), developed to measure coercion in the context of inpatient psychiatric hospitalization, can be modified to measure voluntariness for research.”
Background
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BackgroundMethod
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MethodInfluential
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Background
Involuntary Interventions in Dual Disorders Programs
Noordsy, D. L., Mercer, C. C., & Drake, R. E. (2005) · Kluwer Academic Publishers eBooks · doi:10.1007/0-306-47558-8_7 · Cited by 4
Ideals and Realities in the Development and Practice of Informed Consent
Follette, W. C., Davis, D., & Kemmelmeier, M. (2003) · Sage eBooks · doi:10.4135/9781412990004.n13 · Cited by 4
Cultural Diversity and Mental Health Treatment
Woo, B., Walton, E. C., & Takeuchi, D. T. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.029 · Cited by 4
Ethical Issues of Participating in Psychiatric Research on Coercion
Kjellin, L. (2011) · Wiley eBooks · doi:10.1002/9780470978573.ch16 · Cited by 4
Coercion in Psychiatry: Exploring the Subjective Experience of Coercion Among Patients in Five Portuguese Psychiatric Departments
Aluh, D. O., Diaz-Milanes, D., Azeredo-Lopes, S., Barbosa, S., Santos-Dias, M., Silva, M., Grigaitė, U., Pedrosa, B., Velosa, A., Cardoso, G., et al. (2025) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-024-09890-7 · Cited by 3
Sociological Approaches to Mental Illness
Thoits, P. A. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.010 · Cited by 3
Communication in Psychiatric Coercive Treatment and Patients’ Decisional Capacity to Consent
Mandarelli, G., & Parmigiani, G. (2021) · Springer eBooks · doi:10.1007/978-3-030-65106-0_7 · Cited by 3
What Outcomes Should the Study of Mental Health Try to Explain?
Schnittker, J. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.008 · Cited by 3
Marital Status and Mental Health
Williams, K., Frech, A., & Carlson, D. L. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.020 · Cited by 3
Omsorg under tvang - En narrativ studie av pasienters fortellinger om tvang og psykisk helsevern
Lorem, G. F., Steffensen, M., Frafjord, J. S., & Wang, C. E. (2014) · Tidsskrift for psykisk helsearbeid · doi:10.18261/issn1504-3010-2014-02-03 · Cited by 3
Solicited kidney donors: Are they coerced?
Serur, D. S., Bretzlaff, G., Christos, P. J., Desrosiers, F., & Charlton, M. (2015) · Nephrology · doi:10.1111/nep.12551 · Cited by 3
Efficacy of mental health crisis houses compared with acute mental health wards: a literature review
Smithson, J. S. (2019) · Mental Health Practice · doi:10.7748/mhp.2019.e1404 · Cited by 3
“…findings. services, London Service Satisfaction Scale – Residential Form (Attkisson and Greenfield 1994), the WAS and the Admission Experience Scale (Gardner et al 1993) having more ‘voice’, greater autonomy, more support and less anger and aggression than in the ward environment Siskind et al…”
BackgroundInfluential
Mental Illness and the Criminal Justice System
Hiday, V. A., & Ray, B. R. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.028 · Cited by 3
Mental Health in Cross-Cultural Context
Lefley, H. P. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.011 · Cited by 3
Perceived coercion in psychiatric inpatients: a validation study of the Romanian-language version of the Admission Experience Survey
Păun, R.-M., Pavel, N. A., Matei, V.-P., & Tudose, C. (2026) · Psychiatry, Psychology and Law · doi:10.1080/13218719.2024.2372767 · Cited by 2
“Factor 1, corresponding to ‘ Perceived coercion ’ , encompassed items 1, 4, 7, 9, 14, 15, the only difference from the original being the inclusion of Item 9.”
Epilogue: The Three Solitudes of the Sociology of Mental Health
Avison, W. R. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.034 · Cited by 2
Perceived coercion and need for hospital admission among psychiatric in-patients: figures from a Pakistani tertiary care hospital
Zuberi, S. I., Sajid, A., Yousafzai, A. W., Bhutto, N., & Khan, M. M. (2011) · International Psychiatry · doi:10.1192/s1749367600006184 · Cited by 2
“The AES has good internal reliability (Gardner et al, 1993).”
Result
The HIV-Mental Health Challenge
Walkup, J. T., & Crystal, S. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.032 · Cited by 2
Profiles of Psychological Strengths on Symptom Distress, Recovery, and Quality of Life Among Young Adults with a History of Adolescent Psychiatric Hospitalization
Layman, D. M., & Fisher, C. B. (2022) · Community Mental Health Journal · doi:10.1007/s10597-022-00936-8 · Cited by 2
“One item was adapted from the MacArthur Admission Experience Scale (Gardner et al., 1993) to identify the degree to which participants perceived their adolescent hospitalization was their decision (on a 5-point Likert scale from “strongly disagree” to “strongly agree”).”
Method
Revisiting the psychometric properties of the McArthur admission experience survey: Validating the Portuguese version using a bifactor approach
Aluh, D. O., Lopes, S. A., Pedrosa, B., Silva, M., Grigaitė, U., Martins, A., Mousinho, M. F. D. A., Cardoso, G., & Caldas‐de‐Almeida, J. M. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e24114 · Cited by 2
“Validity was estimated based on the first assessment, by testing the three-factor model (perceived coercion, negative pressure, and voice sub-domains) as reported in previous studies [18,33,34], a one-factor model [33], and a new bifactor model.”
Method
Perception of coercion
Lidz, C. W., Hoge, S. K., & Monahan, J. T. (1997) · Nordic Journal of Psychiatry · doi:10.3109/08039489709109098 · Cited by 2
Pandemic lockdowns: who feels coerced and why? - a study on perceived coercion, perceived pressures and procedural justice during the UK COVID-19 lockdowns
Ranieri, V. F., Gordon, C., Kamboj, S. K., & Edwards, S. (2024) · BMC Public Health · doi:10.1186/s12889-024-17985-1 · Cited by 1
“…possible) and divided into two categories according to whether their responses, as per the amended MacArthur Admission Experience survey (AES) included within the parent survey, indicated that they perceived the lock-down as coercive to a high (scores of 4–5) or low degree (scores of 0–1) [1].”
Background
Voices of Students in Crisis: Qualitative Interviews with College Students Hospitalized for Psychiatric Distress
Morpeth, E., Brownson, C. B., Weppner, C. H., & Pitasky, S. N. (2025) · Psychiatric Quarterly · doi:10.1007/s11126-025-10199-7 · Cited by 1
“Voluntary” but Pressured: Informal Coercion Mechanisms in Inpatient Psychiatry and a Nursing-Led Safeguard Package
Grant, E. (2026) · Policy Politics & Nursing Practice · doi:10.1177/15271544261444727 · Cited by 1
“…what researchers ’ term informal coercion, perceived coercion, or treatment pressures — forms of in ﬂ uence, leverage, or threat that operate outside formal legal orders but nonetheless constrain patient choice and autonomy (Gardner et al., 1993; Hoge et al., 1997; Katsakou & Priebe, 2006).”
Influential
Do the Psychopathic Personality Traits of Fearless Dominance and Self‐Centered Impulsivity Predict Attitudes about and Influences on Research Participation?
Smith, S. T., Edens, J. F., Epstein, M. K., Stiles, P. G., & Poythress, N. G. (2012) · Behavioral Sciences & the Law · doi:10.1002/bsl.1992 · Cited by 1
“Although there is an increased prevalence of psychopathic traits in forensic and correctional contexts (Hare, 2003; Lilienfeld & Widows, 2005), there is also considerable individual variability within this personality domain. Conceivably, those offenders who are very low and very high in these traits might differ cons…”
BackgroundMethod
Sociological Perspectives of Coercion in Psychiatry
Middleton, H. C. (2016) · Springer eBooks · doi:10.1007/978-3-319-26748-7_4 · Cited by 1
The Context and Dynamic Social Processes Underlying Mental Health Treatment: Classic and Contemporary Approaches to Understanding Individuals' Responses to Illness in Light of the Affordable Care Act
Pescosolido, B. A., & Boyer, C. A. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.025 · Cited by 1
La satisfaction d’une clientèle psychiatrique dangereuse à l’égard des soins et services qu’ils reçoivent : l’expérience de l’Institut Philippe Pinel de Montréal
Garceau, L., & Lusignan, R. (2000) · Psychiatrie et violence · doi:10.7202/1074957ar · Cited by 1
From Good Soldier to Bad Apple: The Dark Side of Corporation Social Responsibility
Song, X. (2023) · Journal of Leadership Accountability and Ethics · doi:10.33423/jlae.v2023i20.6516 · Cited by 1
Prevalence of Current Clinical Leverage and Association with Perceived Coercion in Outpatient and Community Psychiatric Settings: A First in Canada Study
Nakhost, A., Sirotich, F., Simpson, A. I. F., & Law, S. (2025) · Community Mental Health Journal · doi:10.1007/s10597-024-01444-7 · Cited by 1
“Perceived coercion was also measured using a scale developed by the research team (Nakhost et al., 2018), adapted from the Perceived Coercion Scale of the MacAr‑ thur Admission Experience Survey (MAES) (Gardner et al., 1993).”

Authors: Gardner, W., Hoge, S. K., Bennett, N., Roth, L. H., Lidz, C. W., Monahan, J., & Mulvey, E. P.
Affiliations: University of Pittsburgh (US)
Corresponding author: Gardner, William
ORCID: Gardner, William
Monahan, John
Mulvey, Edward P.
Venue: Behavioral Sciences & the Law
Publisher: Wiley
Published: 1993-06
Volume: 11
Issue: 3
Pages: 307-321
ISSN: 0735-3936 (ISSN-L)
1099-0798
DOI: 10.1002/bsl.2370110308
OpenAlex: W2155774656
Cited by: 342
References: 10
Citations by year: 2026: 3 · 2025: 5 · 2024: 9 · 2023: 6 · 2022: 5 · 2021: 10 · 2020: 6 · 2019: 3 · 2018: 10 · 2017: 40 · 2016: 11 · 2015: 13 · 2014: 11 · 2013: 13 · 2012: 14
FWCI: 7.53
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor, 6919 d)
Locations: Behavioral Sciences & the Law (publishedVersion)
PubMed (publishedVersion)
The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Keywords: coercion, psychiatric hospital admissions, patient perspectives, internal consistency, involuntary psychiatric admission, patient autonomy, freedom of choice
MeSH terms: Adolescent, Adult, Aged, Aged, 80 and over, Mental Disorders, Coercion, Female, Hospitalization, Humans, Male, Middle Aged, Psychometrics, Surveys and Questionnaires, Observer Variation, Multivariate Analysis, Linear Models

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Two scales for measuring patients’ perceptions for coercion during mental hospital admission

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