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At least 19 recordsLinked to original sources
PubMed2004

Men's sexual coercion in intimate relationships: development and initial validation of the Sexual Coercion in Intimate Relationships scale.

We report the development and initial validation of the Sexual Coercion in Intimate Relationships Scale (SCIRS), a measure designed to assess the prevalence and severity of sexual coercion in committed intimate relationships. We review existing measures of sexual coercion and discuss their limitations, describe the identification of the SCIRS items, perform a principal components analysis and describe the resulting three components, and present evidence for the convergent and discriminative validity of the SCIRS. Because sexual coercion in intimate relationships often takes the form of subtle tactics, the SCIRS items assess communicative tactics such as hinting and subtle manipulations in addition to tactics such as the use of physical force. The SCIRS provides researchers and clinicians with a valid, reliable, and comprehensive measure with which to study the dynamics of sexual coercion in intimate relationships.

Adult↗
PubMed1999

Sexual coercion history, calloused sexual beliefs and judgments of sexual coercion in a date rape analogue.

This study compared men with and without a history of coercive sexual behavior on their judgments of how far a man should go in using coercion in an audiotaped date rape simulation. Calloused sexual beliefs (CSB) and a "token resistance" manipulation were expected to differentially interact with coercion history. Results showed no effect for "token resistance." Calloused sexual beliefs interacted with coercion group, such that sexually coercive men high in CSB took significantly longer to stop the date rape interaction than coercive men low in CSB, who did not differ from noncoercive men. These findings support a model of sexual coercion in which a cognitive set consisting of rape-supportive beliefs may serve as a disinhibitor of behavior.

Adolescent↗
PubMed2006

Outpatient commitment and coercion in New Zealand: a matched comparison study.

BACKGROUND: It has been hypothesized that a degree of coercion is a necessary component in using outpatient commitment to attain therapeutic outcome for those people subject to mental health law. However, what degree of coercion is required and how it is sustained is poorly understood. There is speculation that patients' recognition of beneficial as well as unwanted aspects of outpatient commitment (ambivalence) maybe an indicator that the necessary level of coercion has been achieved to facilitate a therapeutic outcome. AIM: The aim of this study was to determine the level of coercion perceived by those under outpatient commitment in New Zealand. Emphasis was given to consideration of the presence of ambivalence and the role of interactive processes, including procedural justice, in influencing patients' perceptions of coercion. METHOD: A cross-sectional comparative study was undertaken to compare the perceptions of coercion of patients on outpatient commitment (n = 69) to a matched sample of voluntary outpatients (n = 69), using the Perceived Coercion Scale. The influence of a range of variables, including patients' knowledge of and beliefs concerning outpatient commitment, were considered. RESULTS: Although the level of coercion for involuntary outpatients was relatively low, it was significantly higher than that experienced by voluntary outpatients. Yet involuntary outpatients were more likely to espouse benefits of outpatient commitment. Although there was an inverse correlation between perceptions of procedural justice and perceived coercion, procedural justice did not feature in the linear regression analysis. DISCUSSION: In the New Zealand context, involuntary outpatients hold contrasting views to outpatient commitment. We suggest that this ambivalence is an indicator that the degree of coercion is suffice to achieve therapeutic outcome. Furthermore, this study suggests the impact of procedural justice on patients' perceptions of coercion may be more crucial during admission to hospital than in the context of on-going community care.

Adult↗
PubMed2003

Coercion in mental healthcare: the principle of least coercive care.

Coercive practices are relatively common in mental healthcare, but coercion is ethically problematic because it involves acting against an individual's autonomy. However, coercion is often poorly defined in mental health literature, resulting in problems in considering coercion from an ethical perspective. This paper challenges the traditional paternalistic justification for coercive practices in mental healthcare, and argues that the failure to make a conceptual distinction between what counts as coercive practice and what justifies coercive practice results in instances of unjustified use of coercion. It also results in the failure to recognize other justifications for coercive practice. We propose a broad definition of coercion that recognizes the prevalence of coercion in mental healthcare. In particular, we wish to recognize the potential for persuasion and manipulation of clients' wishes to be coercive. We argue that there should be a prima facie ban on coercion in mental healthcare, and that the use of coercive practices needs to be justified in the specific circumstances of each case. The presupposition that mental illness involves limited autonomy cannot be taken to justify use of coercion. We outline a principle of least coercive intervention that we think has the potential to lessen the prevalence and extent of coercion in mental healthcare.

Coercion↗
PubMed2002

Perceived coercion among patients admitted to acute wards in Norway.

Several studies suggest that the patient's experience of being coerced, during the admission process to mental hospitals, does not necessarily correspond with their legal status. Rather, perceived coercion appears to be associated with having experienced force and/or threats (negative pressures), as well as feeling that their views were not taken into consideration in the admission process (process exclusion). We investigated perceived coercion, among patients admitted both voluntarily and involuntarily, to acute wards in Norway. We used a visual analogue scale (the Coercion Ladder, CL) and the MacArthur Perceived Coercion Scale (MPCS), a five-item questionnaire, to measure perceived coercion. Two hundred and twenty-three consecutively admitted patients to four acute wards were included and interviewed within 5 days of admission. Many patients reported high levels of perceived coercion in the admission process, with the involuntary group experiencing significantly higher levels than the voluntary group. However, 32% of voluntarily admitted patients perceived high levels, and 41% of involuntarily admitted patients perceived low levels of coercion. Legal status did not significantly predict perceived coercion on either the MPCS or the CL after taking negative pressures and process exclusion into account. Applying a visual analogue scale (CL) seems to provide a useful measure of patients' perception of coercion and one that largely parallels the MPCS.

Adolescent↗
PubMed2005

Invocation of coercion context in compliance communication -- power dynamics in psychiatric care.

This article draws on observations from ethnographic fieldwork to develop a theoretical understanding of the power dynamics in psychiatric care. The aim is to analyze how psychiatric clinicians solve compliance problems by invoking "coercion context". It is suggested that clinicians take a rather instrumental approach to laws regulating coercive intervention. Clinicians may invoke a coercion context even with voluntary patients. For example, they may use wordings that connote coercion, or they may make use of how treatment wards are set up to accommodate involuntary patients, thus stalling voluntary patients who cannot exit through locked doors. A coercion context can also be invoked to solve mundane practical problems, e.g. when clinicians talk about "coerced showers". The management of information and maintaining a suitable "awareness context" with regards to coercion is an essential feature in clinical attempts to achieve compliance from patients. In conclusion, the notion of coercion context helps explain the confusing findings from previous research about patients' apparent misconceptions of their formal legal status. Furthermore, it is argued that research that rely on decontextualised, objectifications of "coercion" risk to miss the meaning coercion is assigned in everyday clinical practice.

Attitude↗
PubMedDate not supplied

Sexual coercion and abuse among women with a severe mental illness in India: an exploratory investigation.

Research from the west indicates that women living with a psychiatric disorder are particularly vulnerable to sexual coercion and abuse. However, there have been no published reports of sexual abuse among female psychiatric patients in India. This exploratory study sought (1) to determine the prevalence of sexual coercion in a representative sample of female psychiatric patients in India; (2) to identify clinical and sociodemographic correlates of sexual coercion; (3) to clarify the association between sexual coercion and human immunodeficiency virus (HIV)-related risk behavior; and (4) to determine whether self-report of sexual coercion from these patients was recorded in their medical charts. Consecutive female inpatient admissions (N = 146) to a large psychiatric hospital in southern India were assessed using a structured interview and standardized measures. During these structured clinical interviews, sexual coercion was reported by 30% of the 146 women. The most commonly reported experience was sexual intercourse involving threatened or actual physical force (reported by 14% of women), and the most commonly identified perpetrator was the woman's husband or intimate partner (15%), or a person in a position of authority in their community (10%). Women with a history of abuse were more likely to report HIV-related sexual behavior (P <.001). In contrast to the 30% of women who reported sexual coercion during interviews, only 3.5% of the medical records contained this information. Thus, sexual coercion is a serious and prevalent concern among female Indian psychiatric patients, but is rarely reported in medical charts. Increased screening and reporting are indicated, as are sexual abuse prevention and treatment programs.

Adolescent↗
PubMed2004

Patients' perception of coercion in acute psychiatric wards. An intervention study.

A project based on the "Breakthrough series" for reducing the patients' perception of coercion in psychiatric acute wards is presented. Three different measures were chosen: 1) engagement of the patients in the formulation of the treatment plan, 2) frequent and regular joint patient and staff evaluations, and 3) renegotiation of treatment plans if necessary. A 5-week baseline was followed by a 12-week intervention period. Anonymously administered self-rating scales were used: the Coercion Ladder and the SPRI questionnaire. Two questions addressing aversive events (verbal and physical) were added. Participation rates were 86% (patients). Data from 190 admissions were analysed. The interventions resulted in only marginal changes in two of eight parameters (the staff's respect and understanding and on total satisfaction with the received help) and no change in experienced coercion. Seclusion accounted for 46% of the explained variance (62%) and participation in the formulation of the treatment plan for only 8% in regression analyses where perceived coercion was the dependent variable; a third of the patients had experienced insulting communication from the staff, and 10% physical harassment during their stay. It was concluded that: 1) the average value of experienced coercion was low, 2) taking part in the planning and evaluation of the treatment had marginal effect on experienced coercion, and 3) the main predictor of felt coercion was seclusion. Actions taken primarily to control behaviour were more strongly related to perceived coercion than aspects of compulsory treatment. More thorough analysis of seclusion and improved routines for its implementation are needed.

Acute Disease↗
PubMed2003

Sex in Australia: experiences of sexual coercion among a representative sample of adults.

OBJECTIVE: To provide reliable estimates of the prevalence, correlates and consequences of sexual coercion among a representative sample of Australian adults. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years. The response rate was 73.1% (69.4% men, 77.6% women). RESULTS: Overall, 4.8% of men and 21.1% of women had experienced sexual coercion, i.e. being forced or frightened into unwanted sexual activity, and 2.8% of men and 10.3% of women had been coerced when aged 16 or younger. Although women were significantly more likely than men to have been sexually coerced, correlates of sexual coercion were similar for men and women and were not limited to effects on sexual behaviour. People who had been coerced reported greater psychosocial distress, were more likely to smoke, were more anxious about sex, and more likely to have acquired a sexually transmitted infection. Few people had talked to others about their experiences of sexual coercion and fewer had talked to a professional. CONCLUSION: Sexual coercion is an unacceptably common experience. Sexual coercion has detrimental effects on various aspects of people's lives. It most commonly occurs at the ages at which people become sexually active and women are more likely than men to be sexually coerced. IMPLICATIONS: There may be need for more readily accessible services that are better able to minimise the detrimental effects of sexual coercion. This is in addition to a more general need to reduce the incidence of sexual coercion.

Adolescent↗
PubMed2005

Perceived coercion at admission to psychiatric hospital and engagement with follow-up--a cohort study.

BACKGROUND: Measures of perceived coercion at psychiatric hospital admission have been developed. We aimed to investigate predictors of perceived coercion in subjects admitted to psychiatric hospital in the UK, and to test the hypothesis that high perceived coercion at admission predicts poor engagement with community follow-up. METHOD: A cohort of consecutively admitted subjects were interviewed at admission and before discharge, and were followed prospectively for 10 months. Service use and compliance with care were rated from case notes and by clinicians. RESULTS: One hundred interviews were obtained from 118 consecutive admissions (85%). Compulsory admission was strongly associated with perceived coercion, but one-third of voluntary patients felt highly coerced, and two-thirds were not certain they were free to leave hospital. Greater age, less insight, and non-white ethnicity were associated with high perceived coercion. Perceived coercion did not predict engagement with follow-up. CONCLUSIONS: Services recognise provision of care in the least restrictive setting as a key objective. Perceived coercion should be regarded as an important outcome measure in service evaluation.

Adult↗
PubMedDate not supplied

Perceived coercion among clients entering substance abuse treatment: structural and psychological determinants.

Little is known about the extent to which admission to alcohol and other drug treatment programs is perceived as a coercive imposition. This is because coercion is typically inferred from referral source rather than measured. In this study, clients (N = 300) entering substance abuse treatment were assessed on structural variables (sociodemographic background, criminal history, current legal status, referral source), psychological variables (personal beliefs about substance abuse, perceived interpersonal pressures), alcohol/drug use, and perceived coercion. Mandated treatment status predicted perceived coercion; however, many mandated clients did not, and many self-referrals did, report being coerced into treatment. Psychological factors accounted for additional variance in perceived coercion, controlling for referral source. Substance dependence did not add to the predictability of perceived coercion beyond structural and psychological variables. These findings are inconsistent with the notion that coercion can be inferred from referral source. Instead, results support self-determination theory (Deci & Ryan, 1985), which proposes that multiple social and psychological events promote perceived coercion by undermining personal autonomy.

Adult↗
PubMed1998

Factual sources of psychiatric patients' perceptions of coercion in the hospital admission process.

OBJECTIVE: The purpose of this study was to determine what predicts patients' perceptions of coercion surrounding admission to a psychiatric hospital. METHOD: For 171 cases, the authors integrated data from interviews with patients, admitting clinicians, and other individuals involved in the patients' psychiatric admissions with data from the medical records. Using a structured set of procedures, coders determined whether or not nine coercion-related behaviors occurred around the time of admission. Correlation and regression analyses were used to describe the predictors of patients' scores on the MacArthur Perceived Coercion Scale. RESULTS: The use of legal force, being given orders, threats, and "a show of force" were all strongly correlated with perceived coercion. A least squares regression accounted for 43.3% of the variance in perceived coercion. The evidence also suggested that force is typically only used in conjunction with less coercive pressures. CONCLUSIONS: Force and negative symbolic pressures, such as threats and giving orders about admission decisions, induce perceptions of coercion in persons with mental illness. Positive symbolic pressures, such as persuasion, do not induce perceptions of coercion. Such positive pressures should be tried in order to encourage admission before force or negative pressures are used.

Adult↗
PubMed2006

Beyond frequency and severity: development and validation of the brief coercion and conflict scales.

Responding to calls for improved measurement in the field of domestic violence, this paper reports the development and initial validation of the Brief Coercion and Conflict Scales in a sample of incarcerated women. Confirmatory factor analyses tested the scales hypothesized structure and supported coercion and conflict as moderately and positively related but distinct constructs. Although women reported experiencing both conflict and coercion in their most recent relationship before incarceration, they reported that their experiences were more often marked by interpersonal conflict than by coercion. Further, the coercion and conflict scales differentially predicted women's behavioral and psychological responses to abuse. Only coercion consistently predicted strategic responses and posttraumatic stress symptoms. Overall, findings support the instrument as a viable option, but further psychometric evaluation of internal and external validity with additional samples is warranted.

Adult↗
PubMedDate not supplied

[Involuntary commitment as a source of perceived coercion].

Involuntary commitment is a topic that provokes a lot of controversy. Authors, supported by a review of literature, explain the need for conducting research on the use of coercion in psychiatry. They also attempt to answer the question whether a formal status of admission to hospital may possibly reflect the presence or lack of coercion. Further in the article they review the tools needed to make a subjective assessment of coercion associated with admission and they present results of their research with the use of these tools. The authors also point to the fact that the patient's retrospective confirmation of the need for hospitalisation may be a basis for their involuntary commitment but it does not, however, have any influence on the moral assessment of the need for coercion. Moreover, it does not arise out of this that the patient has come to terms with involuntary commitment after its completion. The need, then, to minimize the patient's perception of coercion while committed, becomes a very important matter which should be taken into account during treatment. This is both related to the fact that the perception of coercion is an undesirable factor but also that it may negatively influence the patient's cooperation during treatment.

Coercion↗
PubMed1995

A study of the prevalence of sexual coercion in adolescent heterosexual dating relationships in a Quebec sample.

Very few studies which have addressed the issue of sexual violence in dating relationships have provided prevalence rates for coercion that is perpetrated and sustained for both sexes during adolescence, while adequately accounting for the totality of unwanted sexual experiences. The present study addresses these issues by examining the rates of perpetrated and sustained sexual coercion among 644 French-speaking adolescents between 15 and 19 years of age with heterosexual dating experience from Quebec (Canada). Chi-square analyses reveal that girls are more often the victims of coercion, while boys more frequently perpetrate it. However, some boys are victims of sexual coercion. The most frequently occurring unwanted sexual experiences are kissing, and petting or fondling. Verbal coercion, consisting of continual arguments and pressure, is the strategy most often used by those who perpetrate unwanted sexual experiences, and is the strategy most frequently reported by those who suffer it. More extreme forms of sexual violence are also reported, but at a lower rate. Such high rates of sexual coercion during adolescence, as observed in the present study within a culture which is increasingly open to issues regarding sexuality, argue strongly for the implementation of prevention and intervention programs within this age group.

Adolescent↗
PubMed1999

Informal coercion in the physical care of patients suffering from senile dementia or mental retardation.

This article discusses under what circumstances patients who are suffering from senile dementia or mental retardation should be submitted to coercive care, who should decide about this kind of coercion, and in what legal framework it should take place. A distinction is drawn between modest (i.e. of moderate degree) and meddlesome coercion. The use of modest coercion is defended. It is argued that medical personnel ought to decide exclusively about the use of modest coercion. However, no law should render legitimate the use of even modest coercion. It is conceded that to prohibit the use of a kind of coercion that is expected to take place is hypocrisy. It is argued that this is, however, an acceptable form of hypocrisy.

Alzheimer Disease↗
PubMed1995

Perceived coercion in mental hospital admission. Pressures and process.

BACKGROUND: Patients' perceptions of coercion in admission may affect their attitude toward subsequent treatment, including their inclination to adhere to treatment plans. This study looks at the determinants of patients' perceptions of coercion. METHODS: A sample of 157 patients admitted to a rural Virginia state hospital and a Pennsylvania community hospital were interviewed within 48 hours of admission about their experience of coming to the hospital. All subjects were 17 years or older. Diagnoses were diverse, and 42% were involuntarily committed. The interview gathered an open-ended description of the admission experience followed by a structured interview that included several measures. RESULTS: Perceptions of being respectfully included in a fair decision-making process ("procedural justice") and legal status were most closely associated with perceived coercion, and a significant relationship was found with perceived negative pressures, ie, force and threats. However, only procedural justice was related to the perception of coercion at both sites and with both voluntary and involuntary patients. CONCLUSIONS: Patients' feelings of being coerced concerning admission appears to be closely related to their sense of procedural justice. It may be that clinicians can minimize the experience of coercion even among those legally committed by attending more closely to procedural justice issues.

Adult↗
PubMed1991

Consent to mental health treatment: a theoretical analysis of coercion, freedom, and control.

Research has shown that substantial numbers of mental health patients may be coerced into 'voluntary' treatment. This article examines the concept of coercion to address the concerns of social scientists, treatment providers, and policy makers to know when coercion into treatment has occurred. This logically takes precedence over the second important question of whether or not coercion is desirable in some situations. A review of the scientific research on coercion and related topics of freedom, control, and choice leads to a theoretical framework in which coercion is defined in terms of opportunities to choose among courses of action. Implications of this analysis are drawn for mental health service delivery, mental health policy, and mental health research.

Choice Behavior↗