Factual sources of psychiatric patients’ perceptions of coercion in the hospital admission process

Lidz, Charles W.; Mulvey, Edward P.; Hoge, Steven K.; Kirsch, Brenda L.; Monahan, John; Eisenberg, Marlene; Gardner, William; Roth, Loren H.

doi:10.1176/ajp.155.9.1254

Cited by 106Healthcare Decision-Making and RestraintsPsychiatric care and mental health servicesElectroconvulsive Therapy Studies

Factual sources of psychiatric patients’ perceptions of coercion in the hospital admission process

Lidz, Charles W., Mulvey, Edward P., Hoge, Steven K., Kirsch, Brenda L., Monahan, John, Eisenberg, Marlene, Gardner, William, Roth, Loren H.·1998·American Journal of Psychiatry

DOI 10.1176/ajp.155.9.1254

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Abstract

OBJECTIVE: The purpose of this study was to determine what predicts patients' perceptions of coercion surrounding admission to a psychiatric hospital. METHOD: For 171 cases, the authors integrated data from interviews with patients, admitting clinicians, and other individuals involved in the patients' psychiatric admissions with data from the medical records. Using a structured set of procedures, coders determined whether or not nine coercion-related behaviors occurred around the time of admission. Correlation and regression analyses were used to describe the predictors of patients' scores on the MacArthur Perceived Coercion Scale. RESULTS: The use of legal force, being given orders, threats, and "a show of force" were all strongly correlated with perceived coercion. A least squares regression accounted for 43.3% of the variance in perceived coercion. The evidence also suggested that force is typically only used in conjunction with less coercive pressures. CONCLUSIONS: Force and negative symbolic pressures, such as threats and giving orders about admission decisions, induce perceptions of coercion in persons with mental illness. Positive symbolic pressures, such as persuasion, do not induce perceptions of coercion. Such positive pressures should be tried in order to encourage admission before force or negative pressures are used.

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Most studies found no significant association between sex/gender and perceived coercion.
“Most studies found no significant association [15,38,41,42,44,54,65,67,82,85,117,123,130,139,154,160]”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [41]
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 [41]
Several studies found no correlation between perceived coercion and socioeconomic status.
“Several studies found no correlation between perceived coercion and socioeconomic status [41,65]”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [41]

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Authors: Lidz, C. W., Mulvey, E. P., Hoge, S. K., Kirsch, B. L., Monahan, J., Eisenberg, M., Gardner, W., & Roth, L. H.
Affiliations: University of Massachusetts Chan Medical School (US)
ORCID: Mulvey, Edward P.
Monahan, John
Eisenberg, Marlene
Gardner, William
Venue: American Journal of Psychiatry
Publisher: American Psychiatric Association Publishing
Published: 1998-09-01
Volume: 155
Issue: 9
Pages: 1254-1260
ISSN: 0002-953X (ISSN-L)
1535-7228
DOI: 10.1176/ajp.155.9.1254
OpenAlex: W2111165658
Cited by: 106
References: 22
Citations by year: 2026: 1 · 2025: 2 · 2024: 7 · 2023: 6 · 2022: 3 · 2021: 4 · 2020: 2 · 2019: 7 · 2018: 5 · 2017: 5 · 2016: 3 · 2015: 3 · 2014: 4 · 2013: 5 · 2012: 4
FWCI: 2.50
Type: journal article
Language: en
Open access: closed
Locations: American Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
eScholarship@UMassChan (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 › Psychiatry and Mental health › Electroconvulsive Therapy Studies
Keywords: perceived coercion, psychiatric hospital admissions, legal force, threats, persuasion, admission decisions, mental illness
MeSH terms: Adult, Aged, Aged, 80 and over, Attitude to Health, Mental Disorders, Coercion, Commitment of Persons with Psychiatric Disorders, Female, Hospital Records, Hospitals, Psychiatric, Humans, Interviews as Topic, Male, Middle Aged, Patient Admission, Patient Participation, Persuasive Communication, Surveys and Questionnaires, Research Design

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Factual sources of psychiatric patients’ perceptions of coercion in the hospital admission process

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