Enhancement of outpatient treatment adherence: Patients’ perceptions of coercion, fairness and effectiveness
Open accessAbstract
Interventions aimed at enhancing psychiatric patients' outpatient treatment adherence frequently include informal coercion such as inducements, and threats of negative sanctions. Little is known about patients' subjective perspective concerning these practices. This study examined the perceived coercion, and also the appraisal of the fairness and effectiveness of the treatment. A total of 187 psychiatric patients with different diagnoses were interviewed using a structured questionnaire that included socio-demographic and clinical data, insight into illness (ITAQ), psychopathology (BPRS), functioning (GAF) and a modified version of the MacArthur Admission Experience Survey (AES) as a measure of perceived coercion, fairness and effectiveness. Bivariate correlations and logistic regression analyses were used to identify the influencing factors on the outcome variables. Perceived coercion was associated with experience with informal coercive treatment pressures (OR 2.5-2.9; P<0.05), and a main diagnosis of a schizophrenic disorder (OR 3.8; P<0.001). Experience with informal coercion was inversely associated with fairness (OR 0.3-0.4; P<0.05), but not with effectiveness. Patients with more insight into their illness indicated higher fairness and effectiveness concerning the procedures for enhancing their treatment adherence (OR 3.1; P<0.01). Insight into illness was not associated with perceived coercion. This might indicate that enhancing insight using psycho-educational approaches and high transparency when applying informal coercive practices could improve patients' appreciation for these procedures. They could probably cope better with perceived coercion when understanding its purpose, and when they perceive they are being treated fairly.
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Eight studies found no significant association between marital status and perceived coercion.
“Eight studies found no significant association [15,82,85,117,123,130,139,154].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [85]
Many studies have found a positive association between perceived coercion and the use of threats, leverage, or displays of force.
“Many studies have found a positive association between perceived coercion and the use of threats, leverage, or displays of force [41,45,47,48,65,85,162].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [85]
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Enfermagem, E. D., & da Silveira, B. V. (2013)
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Clément, M., & Robichaud, F. (2020) · Soins Psychiatrie · doi:10.1016/s0241-6972(20)30020-7
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Coercion in community mental health care
Molodynski, A. (2022) · doi:10.1093/med/9780198861478.003.0067
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- Authors
- Jaeger, M., & Rossler, W.
- Affiliations
- University Hospital Zurich (CH)
- Corresponding author
- Jaeger, Matthias
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2010-11
- Volume
- 180
- Issue
- 1
- Pages
- 48-53
- ISSN
- 0165-1781 (ISSN-L)
- OpenAlex
- W2011241496
- Cited by
- 77
- References
- 41
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 4 · 2023: 6 · 2022: 3 · 2021: 2 · 2020: 3 · 2019: 7 · 2018: 4 · 2017: 7 · 2016: 8 · 2015: 4 · 2014: 5 · 2013: 8 · 2012: 4
- FWCI
- 5.63
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Psychiatry Research (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich)
- 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 › Family Practice › Medication Adherence and Compliance
- Keywords
- medication adherence, outpatient psychiatric care, perceived coercion, informal coercion, inducement, negative sanctions, insight into illness, schizophrenia, psychiatric patients, patient perspectives
- MeSH terms
- Adolescent, Adult, Aged, Mental Disorders, Coercion, Female, Humans, Male, Middle Aged, Outpatients, Patient Admission, Patient Compliance, Patient Participation, Perception, Psychiatric Status Rating Scales, Surveys and Questionnaires, Regression Analysis, Statistics, Nonparametric, Young Adult
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