Ethical Issues of Participating in Psychiatric Research on Coercion

Kjellin, Lars

doi:10.1002/9780470978573.ch16

Cited by 3 publications

(2 citation statements)

References 36 publications

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“…After complete description of the study to the subjects, written informed consent was obtained. Once written informed consent was received [14] , patients were asked to take part in interviews within a week after admission (baseline) and at one and three month follow-ups. All baseline interviews were conducted in the hospital.…”

Section: Methodsmentioning

confidence: 99%

Coerced Hospital Admission and Symptom Change—A Prospective Observational Multi-Centre Study

Kallert¹,

Katsakou

Adamowski

et al. 2011

PLoS ONE

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IntroductionCoerced admission to psychiatric hospitals, defined by legal status or patient's subjective experience, is common. Evidence on clinical outcomes however is limited. This study aimed to assess symptom change over a three month period following coerced admission and identify patient characteristics associated with outcomes.MethodAt study sites in 11 European countries consecutive legally involuntary patients and patients with a legally voluntary admission who however felt coerced, were recruited and assessed by independent researchers within the first week after admission. Symptoms were assessed on the Brief Psychiatric Rating Scale. Patients were re-assessed after one and three months.ResultsThe total sample consisted of 2326 legally coerced patients and 764 patients with a legally voluntary admission who felt coerced. Symptom levels significantly improved over time. In a multivariable analysis, higher baseline symptoms, being unemployed, living alone, repeated hospitalisation, being legally a voluntary patient but feeling coerced, and being initially less satisfied with treatment were all associated with less symptom improvement after one month and, other than initial treatment satisfaction, also after three months. The diagnostic group was not linked with outcomes.DiscussionOn average patients show significant but limited symptom improvements after coerced hospital admission, possibly reflecting the severity of the underlying illnesses. Social factors, but not the psychiatric diagnosis, appear important predictors of outcomes. Legally voluntary patients who feel coerced may have a poorer prognosis than legally involuntary patients and deserve attention in research and clinical practice.

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Section: Methodsmentioning

confidence: 99%

Coerced Hospital Admission and Symptom Change—A Prospective Observational Multi-Centre Study

Kallert¹,

Katsakou

Adamowski

et al. 2011

PLoS ONE

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“…The limitations of the present study stem from the sample size, which was not large, from the design and scope, which impeded the systematic and random collection of all the coercive measures experienced by all patients in each institution, and lastly from the vulnerability and the difficulty in obtaining consent from the patients involved. Because of their dual status as patients with psychiatric disorders and as prisoners may have rendered subjects more vulnerable [ 27 ], the range of coercive factors to which they were exposed may potentially have affected the subjects' ability to provide informed consent. In any event, the present study was merely observational, showing the utmost respect for patients' rights and aimed at improving and minimising the coercive measures applied, in accordance with Recommendation 10 of the Council of Europe's Committee of Ministers to member states concerning the protection of the human rights and dignity of persons with mental disorder, dated 22 September 2004.…”

Section: Discussionmentioning

confidence: 99%

Variables Associated with the Use of Coercive Measures on Psychiatric Patients in Spanish Penitentiary Centers

Girela

López²,

Ortega³

et al. 2014

BioMed Research International

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We have studied the use of coercive medical measures (forced medication, isolation, and mechanical restraint) in mentally ill inmates within two secure psychiatric hospitals (SPH) and three regular prisons (RP) in Spain. Variables related to adopted coercive measures were analyzed, such as type of measure, causes of indication, opinion of patient inmate, opinion of medical staff, and more frequent morbidity. A total of 209 patients (108 from SPH and 101 from RP) were studied. Isolation (41.35%) was the most frequent coercive measure, followed by mechanical restraint (33.17%) and forced medication (25.48%). The type of center has some influence; specifically in RP there is less risk of isolation and restraint than in SPH. Not having had any previous imprisonment reduces isolation and restraint risk while increases the risk of forced medication, as well as previous admissions to psychiatric inpatient units does. Finally, the fact of having lived with a partner before imprisonment reduces the risk of forced medication and communication with the family decreases the risk of isolation. Patients subjected to a coercive measure exhibited a pronounced psychopathology and most of them had been subjected to such measures on previous occasions. The mere fact of external assessment of compliance with human rights slows down the incidence of coercive measures.

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Service Users’ Perceptions About Their Hospital Admission Elicited by Service User–Researchers or by Clinicians

O’Donoghue

Roche²,

Ranieri³

et al. 2013

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OBJECTIVE Service users may express positive, ambivalent, or negative views of their hospital admission. The objective of this study was to determine whether the background of the interviewer-service user-researcher or clinician-influences the information elicited. The primary outcome was the level of perceived coercion on admission, and secondary outcomes were perceived pressures on admission, procedural justice, perceived necessity for admission, satisfaction with services, and willingness to consent to participate in the study. METHODS Participants voluntarily and involuntarily admitted to three hospitals in Ireland were randomly allocated to be interviewed at hospital discharge by either a service user-researcher or a clinician. Interviewers used the MacArthur Admission Experience Survey and the Client Satisfaction Questionnaire. RESULTS A total of 161 participants were interviewed. No differences by interviewer status or by admission status (involuntary or voluntary) were found in levels of perceived coercion, perceived pressures, procedural justice, perceived necessity, or satisfaction with services. Service users were more likely to decline to participate if their consent was sought by a service user-researcher (24% versus 8%, p=.003). CONCLUSIONS Most interviewees gave positive accounts of their admission regardless of interviewer status. The findings indicate that clinicians and researchers can be more confident that service users' positive accounts of admissions are not attributable to a response bias. Researchers can also feel more confident in directly comparing the results of studies undertaken by clinicians and by service user-researchers.

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Ethical Issues of Participating in Psychiatric Research on Coercion

Cited by 3 publications

References 36 publications

Coerced Hospital Admission and Symptom Change—A Prospective Observational Multi-Centre Study

Coerced Hospital Admission and Symptom Change—A Prospective Observational Multi-Centre Study

Variables Associated with the Use of Coercive Measures on Psychiatric Patients in Spanish Penitentiary Centers

Service Users’ Perceptions About Their Hospital Admission Elicited by Service User–Researchers or by Clinicians

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