Article

Ratings of Coercive Interventions by Inpatients and Staff in Germany

Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 10/2009; 60(10):1401; author reply 1401-2. DOI: 10.1176/appi.ps.60.10.1401
Source: PubMed
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    ABSTRACT: No evidence is available on the relative restrictiveness of seclusion and mechanical restraint, although guidelines recommend use of the least restrictive intervention. This study compared the restrictiveness of these interventions from patients' point of view. Data were collected from three general psychiatric admission units in South Germany. A total of 102 patients with schizophrenia, an affective disorder, or a personality disorder were included in a comprehensive cohort study with optional randomization. Restrictions of human rights as measured by the Coercion Experience Scale (CES) were the primary outcome variable. Possible total scores range from 1 to 5, with higher scores indicating a higher level of restriction. Twenty-six patients were randomly assigned to seclusion (N=12) or mechanical restraint (N=14). A total of 76 were excluded from randomization and included in the cohort arms (48 experienced seclusion, and 28 experienced mechanical restraint). No difference in mean CES total scores was found between the randomly assigned patients after they experienced seclusion or mechanical restraint (seclusion median score=1.88 [range 1.24-4.24]; restraint median score=2.14 [range 1.28-4.00]). When randomly assigned patients and patients in the cohort arms were considered as a group, no significant difference in CES scores was found (seclusion median score=.40, [range 1.1-4.2]; restraint median score=2.59 [range 1.1-4.0]). The results do not provide evidence for using one intervention rather than the other. Clinical decisions should take into account patients' preferences. Randomized controlled trials of coercive interventions are feasible. Such studies contribute to the development of ethical and evidence-based guidelines.
    Preview · Article · Nov 2011 · Psychiatric services (Washington, D.C.)
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    ABSTRACT: Aims and method: To assess how common the subjective experience of coercion is in psychiatric care and what affects its prevalence. A review of published data was undertaken to assess prevalence of coercion and potential confounding variables. The heterogeneity of results was studied using meta-regression to quantify the relative impact of four potential explanatory variables. Results: The raw prevalence of perceived coercion ranged from 16 to 90%. A quarter of legally detained patients did not feel coerced into psychiatric care, whereas a quarter of voluntary in-patients reported coercion in care. Coercion was more common in studies outside the USA, among patient populations subject to legal detention and populations studied using the MacArthur Perceived Coercion Scale as opposed to other measures. Timing of the interview was not associated with coercion. Clinical implications: Coercion in psychiatric care remains highly prevalent but varies widely by study. Consistency in measurement is necessary to allow better comparison between studies.
    Full-text · Article · Sep 2012
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    ABSTRACT: Objective: Patients who participated in a randomized controlled trial comparing subjective distress and traumatic impact after seclusion or mechanical restraint were interviewed about the coercive measure about one year later. Methods: Between May and December 2006, patients were interviewed about one year after experiencing seclusion or mechanical restraint as an inpatient. Items from the Coercion Experience Scale (CES) were used in the original and the follow-up studies to assess distress on a 5-point scale, with higher scores indicating greater distress. Patients were also asked about subjective feelings about the coercive measure and completed the Impact of Event Scale-Revised (IES-R) to assess symptoms of posttraumatic stress disorder (PTSD). Results: Sixty (59%) of the 102 patients in the original sample were included for follow-up. Although the original study found no differences between patients who experienced seclusion or mechanical restraint, the follow-up study found significantly higher mean scores for CES items among patients who had experienced mechanical restraint (2.5 and 3.7, respectively, p<.001). IES-R scores did not differ significantly. IES-R scores for two patients who experienced mechanical restraint and one who experienced seclusion indicated probable PTSD. Patients reported experiencing a wide range of negative feelings during the measure, most frequently helplessness, tension, fear, and rage. However, 58% reported some positive effects. Contact with staff was most helpful in alleviating distress during the coercive measure. Conclusions: Contrary to the original study, the follow-up study suggested that seclusion might be a less restrictive alternative for most patients. The incidence of PTSD seemed lower than expected.
    Preview · Article · Jun 2013 · Psychiatric services (Washington, D.C.)

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