Correlates of Perceived Coercion During Psychiatric Hospital Admission

Department of Mental Health Law & Policy, University of South Florida, Tampa, Florida, United States
International Journal of Law and Psychiatry (Impact Factor: 1.19). 02/1997; 20(4):445-58. DOI: 10.1016/S0160-2527(97)00014-9
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Available from: Michele Cascardi, Jul 29, 2015
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    • "To our knowledge, a direct association between the therapeutic relationship and the level of procedural justice experienced on admission has not previously been reported in the literature. Procedural justice is generally inversely related to perceived coercion, and it has been suggested that clinicians might help minimize service users' experience of coercion during an involuntary admission by attending more closely to procedural justice issues (Cascardi and Poythress, 1997; Lidz et al., 1995). Mental Health Tribunals (in a forensic population ) have been found not to have any direct effect on the therapeutic relationship; although we cannot comment on causality, we found that those individuals admitted involuntarily who had Tribunals reported significantly worse therapeutic relationship than those who did not have Tribunals (Donnelly et al., 2011). "
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    ABSTRACT: The therapeutic relationship is one of the most central and important factors in the treatment of mental health disorders. A better therapeutic relationship is associated with service engagement, medication adherence, and satisfaction with services. This study aimed to compare the demographic and clinical factors associated with the therapeutic relationship in voluntarily and involuntarily admitted psychiatric service users. We found that individuals who had been admitted involuntarily, who had a diagnosis of a psychotic disorder, and who reported higher levels of perceived pressures on admission were more likely to have a poorer therapeutic relationship with their consultant psychiatrist. Greater levels of insight and treatment satisfaction, together with higher levels of procedural justice experienced on admission, were associated with a better therapeutic relationship. We found that the level of perceived coercion on admission was not related to the therapeutic relationship. Targeted interventions to improve the therapeutic relationship, particularly for involuntarily admitted service users, are discussed.
    Full-text · Article · Mar 2014 · The Journal of nervous and mental disease
    • "Furthermore, it was hypothesized that psychiatric symptom severity would predict perceived coercion (Hypothesis 3) because more severe symptomatology is typically related to poorer insight. Consistent with previous research (Cascardi & Poythress, 1997; Doyle & Dolan, 2006; Gardner et al., 1999; O'Donoghue et al., 2010; Poulsen & Engberg, 2001) an association between involuntary admission status and perceived coercion was hypothesized (Hypothesis 4). Gender was hypothesized (hypothesis 5) to be unrelated to perceived coercion. "
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    ABSTRACT: The origins of patients’ perceptions of coercion during short-term psychiatric hospitalization are varied. The purpose of this study was to elucidate the characteristics of patients that are associated with higher levels of perceived coercion and to determine whether these perceptions remain stable one year after admission. One hundred and twenty-five patients were recruited within three days of admission to the acute units at the Alfred Hospital Inpatient Psychiatry Department, Melbourne, Australia. In the initial recruitment phase, patients’ perceptions of coercion, psychiatric symptoms and interpersonal style were assessed using the Macarthur Admission Experience Scale, the Brief Psychiatric Rating Scale-18 and the Impact Message Inventory–Circumplex. Admission status (voluntary versus involuntary) and demographic characteristics were also assessed. Follow-up assessments were conducted approximately one year later. Results suggest that a significant but small positive correlation existed between perceived coercion and a Hostile–Dominant interpersonal style at initial recruitment. Females reported significantly higher perceptions of coercion than males, but admission status and severity of psychiatric symptoms were unrelated to perceived coercion. Despite perceptions of coercion appearing to lessen over time, there is a need for specific interventions for these patients during their admission to hospital. There was a statistically significant decrease in perceived coercion over time.
    No preview · Article · Jan 2012 · Psychiatry Psychology and Law
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    • "There was no correlation between C-AES and psychotic symptom severity measured by BPRS. Similar results have been reported in other studies [4,13,30,31]. It is possible that psychotic symptoms or distorted reality testing may not have any direct bearing on the subjective experience of admission or the perceived justification for hospitalization. "
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    ABSTRACT: The paper reports on a study to evaluate the psychometric properties and cultural appropriateness of the Chinese translation of the Admission Experience Survey (AES). The AES was translated into Chinese and back-translated. Content validity was established by focus groups and expert panel review. The Chinese version of the Admission Experience Survey (C-AES) was administered to 135 consecutively recruited adult psychiatric patients in the Castle Peak Hospital (Hong Kong SAR, China) within 48 hours of admission. Construct validity was assessed by comparing the scores from patients admitted voluntarily versus patients committed involuntarily, and those received physical or chemical restraint versus those who did not. The relationship between admission experience and psychopathology was examined by correlating C-AES scores with the Brief Psychiatric Rating Scale (BPRS) scores. Spearman's item-to-total correlations of the C-AES ranged from 0.50 to 0.74. Three factors from the C-AES were extracted using factor analysis. Item 12 was omitted because of poor internal consistency and factor loading. The factor structure of the Process Exclusion Scale (C-PES) corresponded to the English version, while some discrepancies were noted in the Perceived Coercion Scale (C-PCS) and the Negative Pressure Scale (C-NPS). All subscales had good internal consistencies. Scores were significantly higher for patients either committed involuntarily or subjected to chemical or physical restrain, independent on severity of psychotic symptoms. The Chinese AES is a psychometrically sound instrument assessing the three different aspects of the experience of admission, namely "negative pressure, "process exclusion" and "perceived coercion". The potential of C-AES in exploring subjective experience of psychiatric admission and effects on treatment adherence should be further explored.
    Full-text · Article · Nov 2008 · BMC Psychiatry
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