The development, validation, and feasibility of the Experienced Coercion Scale.

Abstract

Existing scales for experienced coercion have limitations. We developed and validated a short self-report form for experienced coercion for use across care settings, care phases, and care measures. In Stage 1, we developed an item pool, based on the literature, patient accounts, interviews, and expert feedback. Stages 2 and 3 consisted of 2 cross-sectional studies, with patients from acute and nonacute inpatient wards, outpatient care, and supported housing. In Stage 2, patients (N = 212) responded to the Coercion Ladder and the experienced coercion items from Stage 1. We selected 20 items for Stage 3 based on item performance in typically coercive versus voluntary care settings, each items' relation to the Coercion Ladder score, and with regard to the component structure from principal component analysis (PCA). In Stage 3, we collected and examined item responses and clinical and coercion data from a new sample of patients (N = 219). We selected 15 items based on factor loadings to form part of the final Experienced Coercion Scale (ECS). The internal consistency was high and score distribution approached the normal curve. ECS sum scores correlated strongly with scores on the Coercion Ladder. In a regression analysis, demographic variables, diagnosis, duration of treatment, and care setting did not predict ECS scores, while legal status and continuing involuntary medication significantly predicted scores. In this initial study, the ECS scores showed promising psychometric properties, suggesting it can be used across care settings and is suitable for research and service evaluation. (PsycINFO Database Record

‘It's unbelievably humiliating’—Patients' expressions of negative effects of coercion in mental health care

“…The level of experienced coercion, as measured by the ECS and the CL, was in a similar range in reports from adult samples. On the ECS, adolescents under coercion scored 2.4 points, while patients under involuntary care in a Norwegian adult sample scored 2.2 points [32]. The scores for voluntary patients were 1.5 and 1.3 points in the adolescent and adult samples, respectively.…”

“…'It's unbelievably humiliating' -Patients' expressions of negative effects of coercion in mental health care. International Journal of Law and Psychiatry,49,[147][148][149][150][151][152][153] Paper 2 Nyttingnes, O., Holmén, A., Rugkåsa, J., & Ruud, T. (2016). The Development, Validation, and Feasibility of the Experienced Coercion Scale (ECS).…”

“…The Experienced Coercion Scale (ECS) has 15 agreement-rated five-point Likert items, and the score range is 0-4. Items are applicable across care phases, care settings, and forms of coercion, focusing on patients' negative evaluations and feelings [32]. For both scales, we defined high experienced coercion as a score above the midpoints [> 5 on CL, > 2 on the ECS).…”

A cross-sectional study of experienced coercion in adolescent mental health inpatients

“…This may sacrifice reliability, as found in other iterations of Cantril’s approach [ 39 ], but should be directly applicable to adolescent mental health care and adolescents’ understanding of the word ‘coercion.’ The Experienced Coercion Scale (ECS) has 15 agreement-rated five-point Likert items, and the score range is 0–4. Items are applicable across care phases, care settings, and forms of coercion, focusing on patients’ negative evaluations and feelings [ 33 ]. We calculated average sumscore from valid item responses.…”

“…Our main study aims were to establish the level of experienced coercion and test candidate predictor variables in a sample of hospitalized adolescents. Based on existing findings for adults [ 32 , 33 ] and how formal coercion is used for adolescents [ 1 , 5 ] we hypothesized that younger age, use of formal coercion (involuntary care, coercive treatment or measures), eating disorders, and lower global psychosocial functioning would predict higher experienced coercion. However, as eating disorders [ 1 ] and lower psychosocial functioning [ 34 ] are associated with increased use of formal coercion, we expected these clinical variables to lose significance when controlled for use of formal coercion.…”