Long-term effects of involuntary hospitalization on medication adherence, treatment engagement and perception of coercion
Abstract
Purpose The purpose of the study was to examine the long-term influence of involuntary hospitalization on medication adherence, engagement in out-patient treatment and perceived coercion to treatment participation.Methods In a naturalistic observational multi-centre study, 290 voluntarily and 84 involuntarily hospitalized patients with schizophrenia or schizoaffective disorder had been followed up over a period of 2 years with half-yearly assessments. Assessments included self-rated medication adherence, externally judged medication adherence by blood levels, engagement in treatment and perceived coercion. The statistical analyses were based on multilevel hierarchical modelling of longitudinal data. Level and development of the outcome was controlled for involuntariness, for sociodemographic characteristics and clinical history.Results Involuntariness of the index-hospitalization did not have an effect on the development of treatment engagement or medication adherence judged by blood levels in the course of the follow-up period when the models were controlled for sociodemographic variables and clinical history. It was associated, though, with a continuously lower self-rated medication adherence. Moreover, former involuntarily hospitalized patients more often felt coerced in several treatment aspects at the follow-up assessments. Yet, there was no difference between the voluntary and involuntary group with regard to the development of the levels of adherence or coercion experiences over time.Conclusions Involuntary hospitalization does not seem to impair future treatment engagement in patients with schizophrenia, but formerly involuntarily hospitalized patients continue to be more sensitive to subjective or real coercion in their treatment and more vulnerable to medication non-adherence. Hereby, their risk of future involuntary hospitalization might be increased.
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Involuntary treatment was associated with an increased risk of the admission being perceived as coercive or procedurally unfair when compared to those receiving voluntary care.
“Involuntary treatment is by definition associated with objective coercion, but it was also associated with an increased risk of the admission being perceived as coercive (for example experiencing a lack of control or agency) or procedurally unfair when compared to those receiving voluntary care (10,11,15,18–31).”
From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [22]
Self-rated medication adherence was lower and self-reported coercion greater.
“However, self-rated medication adherence was lower and self-reported coercion greater (22).”
From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [22]
There was no association between legal status or perceived coercion and medication as measured by blood levels over two years.
“By contrast, two studies found no association between legal status or perceived coercion and adherence to treatment plans (38,39), or medication as measured by blood levels over two years (22).”
From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [22]
People with lower education levels experienced a greater increase in perceived coercion over time in one study.
“However, one study found that people with lower education levels experienced a greater increase in perceived coercion over time [98].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [98]
Patients with a history of involuntary admission reported higher perceived coercion.
“Additionally, patients with a history of involuntary admission reported higher perceived coercion [14,74,75,81,89,98,131]”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [98]
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Examining Perceived Coercion in Drug Treatment Courts
Bruzios, K. E., Shaffer, P. M., Byrne, T. H., Pinals, D. A., Trojano, M. L., Pressman, K., & Smelson, D. A. (2022) · International Journal of Offender Therapy and Comparative Criminology · doi:10.1177/0306624x221102838 · Cited by 4 · see citing works
“For example, studies examining perceptions of choice among individuals involuntarily committed to psychiatric hospitals and among those in voluntary outpatient care settings have demonstrated that high perceived coercion is associated with poorer treatment engagement and adherence, social functioning, and substance us…”
BackgroundYoungmann, R., Goldberger, N., Haklai, Z., Pugachova, I., & Neter, E. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.113958 · Cited by 4 · see citing works
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 · see citing works
“20 In the study conducted in Amsterdam on acute psychiatry, it was found that patients who had been involuntarily admitted in the past were more likely to express overall dissatisfaction with mental health services.”
Korkmaz, U., & Şimşek, M. H. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1624706 · Cited by 3 · see citing works
Treatment engagement: A concept analysis
Kudo, A., Deguchi, N. K., Omiya, T., & Sankai, T. (2023) · Journal of International Nursing Research · doi:10.53044/jinr.2022-0012 · Cited by 3 · see citing works
Chai, S., & Kim, G. (2024) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.13090 · Cited by 3 · see citing works
“Elevated stress in these patients adversely affects their coping strategies (Park & Sung, 2016), treat-ment adherence (Jaeger et al., 2013 ), and neurocognitive function (Krkovic et al., 2017).”
The Challenge of Nonadherence in Schizophrenia
Lawrence, R. E., & Dixon, L. B. (2019) · Springer eBooks · doi:10.1007/978-3-030-12665-0_4 · Cited by 3 · see citing works
Morandi, S., Silva, B., Pauli, G., Martinez, D., Bachelard, M., Bonsack, C., & Golay, P. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.03.017 · Cited by 2 · see citing works
“(Bindman et al., 2005; Jaeger et al., 2013).”
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 · see citing works
“High perceived coercion is, in turn, detrimental to patient – clinician rapport (12) and may lead to poorer treatment adherence and worse long-term outcomes (13).”
Mankiewicz, P. D., Reid, J., & Hughes, E. A. (2021) · ATHENS JOURNAL OF HEALTH & MEDICAL SCIENCES · doi:10.30958/ajhms.8-3-1 · Cited by 2 · see citing works
“Jaeger et al. (2013) found that patients who had been involuntarily admitted to mental health wards reported lower intervention adherence and were more likely to feel coerced into treatment upon discharge.”
BackgroundTochkov, K., & Williams, N. (2018) · Ethical Human Psychology and Psychiatry · doi:10.1891/1559-4343.20.1.56 · Cited by 1 · see citing works
“Additionally, Jaeger et al. (2013) found that participants in the same study from above were significantly more likely to perceive treatment as coercive if they had initially been hospitalized involuntarily.”
BackgroundLuckhaus, C., Lay, B., Frommann, N., Janssen, B., & Nitschke, J. (2015) · Aggression and Violent Behavior · doi:10.1016/j.avb.2015.02.007 · Cited by 2 · see citing works
Zwangsmaßnahmen aus der Perspektive der klinischen Psychiatrie: Evidenz und Good Clinical Practice
Steinert, T. (2015) · Springer eBooks · doi:10.1007/978-3-662-47042-8_1 · Cited by 2 · see citing works
Self-citationGolay, P., Martinez, D. C. T., Bachelard, M., Silva, B., Brodard, A., Perrin, J., Fernando, N. P., Renaud, L.-A., Bonsack, C., & Morandi, S. (2024) · Annals of General Psychiatry · doi:10.1186/s12991-024-00501-5 · Cited by 2 · see citing works
Zwangsmassnahmen in der Psychiatrie: klinische Perspektive
Klein, G., & König, D. (2016) · Swiss Medical Forum ‒ Schweizerisches Medizin-Forum · doi:10.4414/smf.2016.02567 · Cited by 3 · see citing works
Agudelo‐Hernández, F., & Murillo-Alzate, L. F. (2026) · International Journal of Social Psychiatry · doi:10.1177/00207640261426477 · Cited by 1 · see citing works
“In Germany, a longitudinal study found that after involuntary hospitalization, self-reported adherence is lower and perceived coercion higher, suggesting lasting relational harm (Jaeger et al., 2013).”
Compulsory Hospitalization, Severity of Disorders and Territorial Landscape: A French Study
Roelandt, J.-L., Crétin, A., Askevis-Leherpeux, F., Baucheron, J.-P., Brun-Rousseau, H., Coldefy, M., Daoud, V., Defromont, L., Giordana, J., Maillard, I., et al. (2017) · Global Journal of Health Science · doi:10.5539/gjhs.v9n12p64 · Cited by 1 · see citing works
“The decision to resort to hospitalizations without consent concerns the whole range of psychological disorders, but is more frequent in the case of schizophrenia, and personality and behavioural disorders (Jaeger et al., 2013; Rusch et al., 2014; Van der Post et al., 2008; Wheeler, Robinson, & Robinson, 2005).”
BackgroundCorreia, T. (2018) · Revista Portuguesa de Enfermagem de Saúde Mental · doi:10.19131/rpesm.0230 · Cited by 1 · see citing works
Eisenberg, M. M., Hennessy, M. H., Coviello, D., Hanrahan, N. P., & Blank, M. B. (2016) · AIDS and Behavior · doi:10.1007/s10461-016-1517-4
“Consistent with prior findings regarding the valence of treatment outcomes versus procedures that could be considered coercive [65], we found no differences”
ResultDiCondina, J. (2016) · Digital Commons - PCOM (Philadelphia College of Osteopathic Medicine)
NECESSITY AND FREQUENCY OF INVOLUNTARY HOSPITALIZATION IN PSYCHIATRIC INSTITUTION
Nenadović, M. (2013) · Praxis medica · doi:10.5937/pramed1401067n
“Detaining the patients in the institution by force, should be legalized through adequate legislative regulation [15, 16, 17].”
BackgroundAdesão à terapêutica nos doentes com esquizofrenia: uma revisão da literatura
Descalço, N., & Afonso, P. (2018) · Revista Portuguesa de Psiquiatria e Saúde Mental · doi:10.51338/rppsm.2018.v1.i3.83
Durmaz, O., & Kumsar, N. A. (2020) · doi:10.35365/ctjpp.20.02.12
Durns, T. A., O'Connell, P., Shvartsur, A., Grey, J. S., & Kious, B. M. (2021) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2021.101695
Coercion in Mental Health Treatment
Gomila, A. (2023) · Collaborative bioethics · doi:10.1007/978-3-031-29455-6_28
Methods for Remediation of Theory of Mind (ToM) Deficits in Schizophrenia
Olfson, R. H. (2014) · doi:10.14418/wes01.1.1086
“program may pose a risk in terms of treatment attrition (Jaeger et al., 2013).”
Background
- Authors
- Jaeger, S., Pfiffner, C., Weiser, P., Längle, G., Croissant, D., Schepp, W., Kilian, R., Becker, T., Eschweiler, G., & Steinert, T.
- Affiliations
- Universität Ulm (DE)
- Zentrum für Psychiatrie Südwürttemberg (DE)
- University of Tübingen (DE)
- Corresponding author
- Jaeger, Susanne
- ORCID
- Venue
- Social Psychiatry and Psychiatric Epidemiology
- Published
- 2013-04-19
- Volume
- 48
- Issue
- 11
- Pages
- 1787-1796
- ISSN
- 0933-7954 (ISSN-L)
- 1433-9285
- OpenAlex
- W2072195984
- Cited by
- 63
- References
- 46
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 6 · 2023: 2 · 2022: 6 · 2021: 11 · 2020: 3 · 2019: 6 · 2018: 7 · 2017: 5 · 2016: 5 · 2015: 3 · 2014: 5 · 2013: 1
- FWCI
- 5.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Social Psychiatry and Psychiatric Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- University of Regensburg Publication Server (University of Regensburg) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- involuntary admission, medication adherence, treatment engagement, perceived coercion, schizophrenia, schizoaffective disorder, voluntary hospitalization, long-term outcomes, relapse risk
- MeSH terms
- Adult, Coercion, Commitment of Persons with Psychiatric Disorders, Female, Hospitalization, Hospitals, Psychiatric, Humans, Longitudinal Studies, Male, Middle Aged, Perception, Psychotic Disorders, Surveys and Questionnaires, Schizophrenia, Schizophrenic Psychology, Socioeconomic Factors, Time, Antipsychotic Agents, Treatment Outcome, Medication Adherence, Multilevel Analysis, Young Adult
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