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Cited by 9Healthcare Decision-Making and RestraintsPsychiatric care and mental health servicesElectroconvulsive Therapy Studies

Relationship between perceived coercion and perceived justification of coercive measures – secondary analysis of a randomized-controlled trial

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Wullschleger, Alexandre, Vandamme, Angelika, Mielau, Juliane, Heinz, Andreas, Bermpohl, Felix, Mahler, Lieselotte, Montag, Christiane·2023·BMC Psychiatry
DOI 10.1186/s12888-023-05192-yPMC PMC10546675
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Abstract

Background: Subjective perception of coercion has gained attention as an important outcome. However, little is known about its relation to patients’ appraisal of the justification of coercive measures. The present study aims to analyze the relationship between patients’ appraisal of the justification of coercive measures and their level of perceived coercion. Methods: This study presents a secondary analysis of the results of a multi-center RCT conducted to evaluate the effects of post-coercion review. Patients who experienced at least one coercive measure during their hospital stay were included in the trial. Participants’ appraisal of the justification of coercive measures was categorized into patient-related and staff-related justifications. Subjective coercion was assessed using the Coercion Experience Scale (CES) and used as dependent variable in a multivariate regression model. Results: 97 participants who completed the CES were included in the analysis. CES scores were significantly associated with the perception of the coercive measure as justified by staff-related factors (B = 0,540, p < 0,001), as well as with higher level of negative symptoms (B = 0,265, p = 0,011), and with mechanical restraint compared to seclusion (B=-0,343, p = 0,017). Conclusions: Patients’ perceptions of coercive measures as justified by staff-related factors such as arbitrariness or incompetence of staff are related to higher levels of perceived coercion. Multiprofessional efforts must be made to restrict the use of coercive measures and to ensure a transparent and sustainable decision-making process, particularly with patients showing high levels of negative symptoms. Such key elements should be part of all coercion reduction programs.

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  • Studies focusing on procedural justice and informal coercion emphasized key relational dimensions that either contribute to or alleviate feelings of coercion, including transparent and bidirectional communication and information sharing, trust in professionals' intentions and competence, and avoidance of interventions based on threats, manipulation, or other forms of informal coercion.

    “Studies focusing on procedural justice and informal coercion further emphasized key relational dimensions that either contribute to or alleviate feelings of coercion. These include transparent and bidirectional communication and information sharing, trust in the professionals’ intentions and competence, and the avoidance of interventions and approaches based on threats, manipulation, or other form”

    From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [150]

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  • Patients who experienced coercive measures such as physical restraint, mechanical restraint, chemical restraint, and seclusion were more likely to perceive coercion.

    “Patients who experienced coercive measures such as physical restraint [111,124,127], mechanical restraint [150], chemical restraint [124], and seclusion [58,124] were more likely to perceive coercion.”

    From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [150]

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Authors
Wullschleger, A., Vandamme, A., Mielau, J., Heinz, A., Bermpohl, F., Mahler, L., & Montag, C.
Affiliations
Humboldt-Universität zu Berlin (DE)
Corresponding author
Wullschleger, Alexandre
ORCID
Venue
BMC Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2023-10-02
Volume
23
Issue
1
Pages
712-712
ISSN
1471-244X (ISSN-L)
DOI
10.1186/s12888-023-05192-y
PMC
PMC10546675
OpenAlex
W4387256212
Cited by
9
References
32
Citations by year
2026: 3 · 2025: 3 · 2024: 3
FWCI
2.61
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
University of Geneva
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, coercive measures, mechanical restraint, seclusion, negative symptoms, psychiatric inpatients
MeSH terms
Mental Disorders, Coercion, Hospitals, Psychiatric, Humans, Inpatients, Restraint, Physical

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