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Coercion in Psychiatry: Exploring the Subjective Experience of Coercion Among Patients in Five Portuguese Psychiatric Departments

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Abstract

The subjective experience of coercion may have a more significant impact on clinical outcomes than formal coercive measures. This study aimed to investigate the subjective experience of coercion among patients on admission in Portuguese psychiatric departments by assessing their perceived coercion, procedural justice, and negative pressures during admission. The study also investigated whether this subjective experience of coercion changed with time during admission, and the predictors of this change. Validated instruments, including the McArthur Admission Experience Survey (AES) and the Client Assessment of Treatment Scale, were used to collect information from 208 adults admitted to five public psychiatric inpatient departments in rural and urban regions of Portugal. About a third (32.24%, n = 49) of the sample had a legal involuntary admission status, while more than a third of them perceived their admission to be involuntary (40.13%, n = 61). The subjective experience of coercion was significantly higher among people who perceived their admission to be involuntary compared to people who perceived their admission to be voluntary (Median = 10, IQR = 5.5 vs. Median = 3, IQR = 6; p < 0.001). Satisfaction with their care was significantly inversely correlated with the subjective experience of coercion (p < 0.01). The changes in the subjective experience of coercion at the second assessment were predicted by the perceived admission status rather than the legal admission status, and the initial procedural justice (p < 0.05). The study findings highlight the importance of improving procedural justice in psychiatric admissions, regardless of the legal status of admission.

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Data Availability

The data analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors gratefully acknowledge the study participants who generously shared their time for this study. We also acknowledge Miguel Cardoso Caldas-de-Almeida and Ana Rita Dias for their help with the translation process.

Funding

The study did not receive any specific funding. Deborah Oyine Aluh is a PhD student receiving the support of a PhD fellowship from “la Caixa” Foundation (LCF/BQ/DI20/11780013). Barbara Pedrosa and Ugnė Grigaitė are PhD students receiving financial support from the FCT—Fundação para a Ciência e a Tecnologia (UI/BD/151073/2021 and UI/BD/151072/2021).

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Authors and Affiliations

  1. Lisbon Institute of Global Mental Health, Lisbon, Portugal

    Deborah Oyine Aluh PhD, Margarida Santos-Dias BSc, Manuela Silva PhD, Ugnė Grigaitė MSc, Barbara Pedrosa MPH, Graça Cardoso PhD & José Miguel Caldas-de-Almeida PhD

  2. Comprehensive Health Research Centre (Chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal

    Deborah Oyine Aluh PhD, Margarida Santos-Dias BSc, Manuela Silva PhD, Ugnė Grigaitė MSc, Barbara Pedrosa MPH, Graça Cardoso PhD & José Miguel Caldas-de-Almeida PhD

  3. Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nsukka, Nigeria

    Deborah Oyine Aluh PhD

  4. Department of Quantitative Methods, Universidad Loyola Andalusia, Seville, Spain

    Diego Diaz-Milanes PhD

  5. Health Research Institute, University of Canberra, Canberra, ACT, Australia

    Diego Diaz-Milanes PhD

  6. NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal

    Sofia Azeredo-Lopes PhD

  7. Department of Statistics and Operational Research, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal

    Sofia Azeredo-Lopes PhD

  8. Unidade de Internamento Do Serviço de Psiquiatria E Saúde Mental de Adultos - Departamento de Saúde Mental Do Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal

    Sofia Barbosa MD

  9. Serviço de Psiquiatria E Saúde Mental de Adultos, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal

    Ana Velosa MD

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  1. Deborah Oyine Aluh PhD
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Contributions

Deborah Oyine Aluh conceptualized and designed the study, interpreted the statistical analysis, and wrote the first manuscript draft; Diego Diaz-Milanes and Sofia Azeredo-Lopes conducted the statistical analysis and made a critical review of the manuscript; Barbara Pedrosa contributed in the translation process of the instrument and made a critical review of the manuscript; Sofia Barbosa, Margarida Dias, Manuela Silva, and Ana Velosa contributed in the data collection and critical review of the manuscript; Ugnė Grigaitė made a critical review of the manuscript, Graça Cardoso and José Miguel Caldas-de-Almeida contributed to the supervision of the project and made a critical review of the manuscript. All authors read and approved the final version of the manuscript.

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Correspondence to Deborah Oyine Aluh PhD.

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Aluh, D.O., Diaz-Milanes, D., Azeredo-Lopes, S. et al. Coercion in Psychiatry: Exploring the Subjective Experience of Coercion Among Patients in Five Portuguese Psychiatric Departments. J Behav Health Serv Res (2024). https://doi.org/10.1007/s11414-024-09890-7

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