"Coercion Experience Scale" (CES) - validation of a questionnaire on coercive measures

Center for Psychiatry Suedwuerttemberg, Ulm University, Ravensburg-Weissenau, Germany.
BMC Psychiatry (Impact Factor: 2.21). 01/2010; 10(1):5. DOI: 10.1186/1471-244X-10-5
Source: PubMed


Although the authors of a Cochrane Review on seclusion and mechanical restraint concluded that "there is a surprising and shocking lack of published trials" on coercive interventions in psychiatry, there are only few instruments that can be applied in trials. Furthermore, as main outcome variable safety, psychopathological symptoms, and duration of an intervention cannot meet the demand to indicate subjective suffering and impact relevant to posttraumatic stress syndromes. An instrument used in controlled trials should assess the patients' subjective experiences, needs to be applicable to more than one intervention in order to compare different coercive measures and has to account for the specific psychiatric context.
The primary version of the questionnaire comprised 44 items, nine items on restrictions to human rights, developed on a clinical basis, and 35 items on stressors, derived from patients' comments during the pilot phase of the study. An exploratory factor analysis (EFA) using principal axis factoring (PAF) was carried out. The resulting factors were orthogonally rotated via VARIMAX procedure. Items with factor loadings less than .50 were eliminated. The reliability of the subscales was assessed by calculating Cronbach.
Data of 102 patients was analysed. The analysis yielded six factors which were entitled "Humiliation", "Physical adverse effects", "Separation", "Negative environment", "Fear" and "Coercion". These six factors explained 54.5% of the total variance. Cronbach alpha ranged from .67 to .93, which can be interpreted as a high internal consistency. Convergent and discriminant validity yielded both highly significant results (r = .79, p < .001, resp. r = .38, p < .001).
The "Coercion Experience Scale" is an instrument to measure the psychological impact during psychiatric coercive interventions. Its psychometric properties showed satisfying reliability and validity. For purposes of research it can be used to compare different coercive interventions. In clinical practice it can be used as a screening instrument for patients who need support after coercive interventions to prevent consequences from traumatic experiences. Further research is needed to identify possible diagnostic, therapeutic or prognostic implications of the total score and the different subscales.
Current Controlled Trials ISRCTN70589121.

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    • "In a study by Georgieva et al., women reported that they had experienced coercive interventions as more burdensome than men [69], which may reflect their greater emotional responsiveness and lower average tolerance thresholds for painful stimuli [70]. In the future, instruments which measure the psychological impact of psychiatric coercive interventions, such as the “Coercion Experience Scale” [71] should be used to how compare different coercive interventions are experienced by patients. No significant difference was observed in the reasons given for the use of coercive measures. "
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    ABSTRACT: Despite the recent increase of research interest in involuntary treatment and the use of coercive measures, gender differences among coerced schizophrenia patients still remain understudied. It is well recognized that there are gender differences both in biological correlates and clinical presentations in schizophrenia, which is one of the most common diagnoses among patients who are treated against their will. The extent to which these differences may result in a difference in the use of coercive measures for men and women during the acute phase of the disease has not been studied. 291 male and 231 female coerced patients with schizophrenia were included in this study, which utilized data gathered by the EUNOMIA project (European Evaluation of Coercion in Psychiatry and Harmonization of Best Clinical Practice) and was carried out as a multi-centre prospective cohort study at 13 centers in 12 European countries. Sociodemographic and clinical characteristics, social functioning and aggressive behavior in patients who received any form of coercive measure (seclusion and/or forced medication and/or physical restraint) during their hospital stay were assessed. When compared to the non-coerced inpatient population, there was no difference in sociodemographic or clinical characteristics across either gender. However coerced female patients did show a worse social functioning than their coerced male counterparts, a finding which contrasts with the non-coerced inpatient population. Moreover, patterns of aggressive behavior were different between men and women, such that women exhibited aggressive behavior more frequently, but men committed severe aggressive acts more frequently. Staff used forced medication in women more frequently and physical restraint and seclusion more frequently with men. Results of this study point towards a higher threshold of aggressive behavior the treatment of women with coercive measures. This may be because less serious aggressive actions trigger the application of coercive measures in men. Moreover coerced women showed diminished social functioning, and more importantly more severe symptoms from the "excitement/hostile" cluster in contrast to coerced men. National and international recommendation on coercive treatment practices should include appropriate consideration of the evidence of gender differences in clinical presentation and aggressive behaviors found in inpatient populations.
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    • "user involvement [20] [21] and crowding [22]). This progress was accompanied by mental health research that provided the basis for data assessment, benchmarking [7] [8], and evaluation of instruments (for overview, see [23] [24]). *Address correspondence to this author at the ZfP Suedwuerttemberg, "
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    ABSTRACT: For a reduction in the use of coercive interventions it will be necessary to identify patients at risk. The aim of this study was to explore the impact of basic patient characteristics at admission, history within 24 hours before admission, and living conditions on the risk of experiencing coercive measures, controlling for ward characteristics in a multi-level approach. Patient characteristics of 3389 patients (1920 women) who had received inpatient treatment in 2007, data relating to coercive measures, and ward characteristics were extracted from the clinical basic documentation. Patients with aggressive behaviour in the 24 hours prior to admission had a three times higher risk of coercive measures compared to non-aggressive patients. Severity of illness increased the risk of coercion markedly. With each level of severity, the risk of coercion was doubled. Voluntariness of stay appeared to be the best protective factor against coercive measures. If a patient stayed voluntarily, this reduced the risk of coercion by more than two thirds. No impact was found for living conditions. To identify patients at risk, it is most important to intensively monitor patients with aggressive behaviour prior to admission and patients with a greater severity of psychopathological symptoms.
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    • "A avaliação psicológica contemporânea tem apresentado grandes avanços na mensuração de diferentes estados emocionais (Bergk, Flammer e Steinert, 2010; Garseen e Van Der Lee, 2010; Oh, Seo e Kozub, 2010). As formas de apresentação dos instrumentos são das mais diversas, desde computadorizadas (Conde, Filgueiras e Lameira, 2009; Filgueiras, 2010; Stahl, 2006), passando por métodos de coleta de dados fisiológicos (Buske-Kirschbaum, 2009; Törnhage, 2009) e chegando aos instrumentos mais comuns: os questionários de autopreenchimento (Bergk et al., 2010; Chapman, Williams, Mast e Woodruff-Borden, 2009). Contudo, esses instrumentos têm como característica primordial a experiência visuomotora na forma de leitura, interpretação e escrita durante o preenchimento dos itens. "
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