Psychometric properties of the Turkish version of Staff Attitude to Coercion Scale.

BACKGROUND: The aim of this study was to provide the Turkish version of the Staff Attitude to Coercion Scale (SACS) and to determine its psychometric properties. METHODS: This is a descriptive and correlation design. The sample of this study consisted of 100 psychiatric staff members. The validity and reliability of the scale were assessed through translation procedures, content validity analysis, and confirmatory factor analysis (CFA). Reliability was further evaluated using Cronbach's alpha and item-total score correlations. RESULTS: The content validity index was found to be 0.93. The scale has a three-factor structure and the Cronbach's alpha values of the subscales are 0.70 for offence, 0.87 for safety and 0.74 for treatment, respectively. The Cronbach alpha reliability coefficient of the total scale was found to be 0.86. CONCLUSION: The Turkish version of the SACS showed good reliability and validity, and confirmatory factor analysis revealed the same factor structure with three factors as in the original SACS.

Informed consent and coercion in recruitment advertisements for oocyte donors.

BACKGROUND: As the use of donor eggs for in vitro treatment has increased, both medically affiliated and private donor egg agencies have turned to online advertisements to recruit donors. The American Society for Reproductive Medicine provides recommendations encouraging ethical recruitment of donors, however there is no formal regulation for the informed consent process for egg donor recruitment and compensation. Underrepresentation of risks and targeted financial incentives may pose a risk to the informed consent process. METHODS: Data from online advertisements for egg donors active between January 1 - August 31, 2020, were collected to analyze content related to risks, Covid-19 precautions, donor payment, and desired donor characteristics. Advertisements for egg donors on Google, Craigslist, and social media were analyzed. Primary outcomes included the mention of the risks of egg donation, including the risk of Covid-19 exposure, in donor egg advertisements. Secondary outcomes included language targeting specific donor characteristics and financial compensation. RESULTS: 103 advertisements were included. 35.9% (37/103) of advertisements mentioned some risk of the egg donation process, and 18.5% (19/103) mentioned risks or precautions related to Covid-19 exposure. Of advertisements for private donor egg agencies, 40.7% (24/59) mentioned any risk, compared to 29.6% (13/44) of medically affiliated egg donation programs; the difference was not statistically significant (p-value = 0.24). Agencies targeting students and donors of a specific race were more likely to offer payments over $10,000 for an egg donation cycle. Among advertisements offering over $20,000 for donor compensation, 72.7% (8/11) recruited women under the age of 21. CONCLUSION: Egg donor recruitment advertisements, for both medically affiliated programs and private agencies, were unlikely to mention risks including the risk of exposure to Covid-19. Non-medically affiliated private donor egg agencies were more likely to violate multiple American Society for Reproductive Medicine ethics guidelines, including offering higher than average compensation, and recruiting donors from young and vulnerable populations.

[Coercive control: Health, victims' rights and the ethics of care]. / Contrôle coercitif : santé, droits des victimes et éthique de soin.

This article provides healthcare professionals with an overview of research on coercive control, a paramount concept for understanding domestic violence, primarily targeting women and children. It aims to foster interdisciplinary dialogue and integrate advances into professional practices and (psycho)education. To this end, we present the conceptual evolution of coercive control and the perpetrators' behavioral patterns, their risks for victims and professionals, their devastating impact on the rights and biopsychosocial health of adult and child victims, and the challenges posed by technology, particularly generative artificial intelligence.

[Coercive control: From Diké to Hygée, a judicial and health revolution]. / Le contrôle coercitif : de Diké à Hygée, une révolution judiciaire et sanitaire.

By reversing the questions and focusing on the perpetrator's behavior, the notion of coercive control revolutionizes the apprehension and understanding of violence within the family for all its members. This heuristic approach, which represents a genuine paradigm shift, has legal, semiological and diagnostic effects. It creates a new professional ecosystem that enables us to respond differently to two fundamental missions: caring and justice.

[Psychotraumatic consequences of coercive control]. / Conséquences psychotraumatiques du contrôle coercitif.

Coercive control is a process of violence in which one person acts in such a way as to subject the other to persistent controlling behavior. In the majority of cases, these are men, and the targets are their spouses and children. The psychotraumatic consequences are innumerable, and need to be understood before they can be identified and treated. The repercussions of coercive control are numerous, whether somatic, psychological, familial, social, professional or academic. This article describes the psychotraumatic consequences for both the victim and the children.

[Child and adolescent psychiatry mobile team: what care for victims of coercive control?] / Équipe mobile de psychiatrie de l'enfant et de l'adolescent : quelle prise en soins pour les victimes de contrôle coercitif ?

In this article, the authors wish to offer the product of their reflections on the concept of coercive control, and share various findings from their day-to-day practice. The text should be read as an invitation to clinical reflection on the conceptualization of a specific form of abuse. Reflection on this approach, initially ignored by the authors, has enriched clinical thinking on certain care situations.

[Social support through the prism of coercive control]. / L'accompagnement social sous le prisme du contrôle coercitif.

Combating domestic violence involves mobilizing a myriad of players throughout the victim's life cycle, including children: health professionals, social workers, law enforcement officers, judges, associations, etc. The mechanisms behind this kind of violence are complex, and every professional needs to have a good understanding of them to be able to identify and provide support. To be more effective, the fight against domestic violence must continue to be thought through. For example, the Observatoire des Violences Intrafamiliales of the Conseil Départemental de l'Allier organized an awareness-raising day on a new concept - coercive control - which is set to make its entry into the Penal Code, and which could change everything.

[How can nurses help prevent coercive control?] / Quelle contribution des infirmiers à la prévention du contrôle coercitif ?

Able to work in any sector, with patients of any age and from any socioeconomic or cultural background, the state-qualified nurse is a front-line player, likely to come into contact with victims of violence between (ex) intimate partners. In the current context of growing awareness of the concept of coercive control, this caregiver has a vital role to play in preventing this health and social scourge.

Effect of coercive measures on mental health status in adult psychiatric populations: a nationwide trial emulation.

AIMS: Healthcare staff use coercive measures to manage patients at acute risk of harm to self or others, but their effect on patients' mental health is underexplored. This nationwide Swiss study emulated a trial to investigate the effects of coercive measures on the mental health of psychiatric inpatients at discharge. METHODS: We analysed retrospective longitudinal data from all Swiss adult psychiatric hospitals that provided acute care (2019-2021). The primary exposure was any coercive measure during hospitalization; secondary exposures were seclusion, restraint and forced medication. Our primary outcome was Health of the Nations Outcome Scale (HoNOS) score at discharge. We used inverse probability of treatment weighting to emulate random assignment to the exposure. RESULTS: Of 178,369 hospitalizations, 9.2% (n = 18,800) included at least one coercive measure. In patients exposed to coercive measures, mental health worsened a small but statistically significant amount more than in non-exposed patients. Those who experienced at least one coercive measure during hospitalization had a significantly higher HoNOS score (1.91-point, p < .001, 95% confidence interval [CI]: 1.73; 2.09) than those who did not experience any coercive measure. Results were similar for seclusion (1.60-point higher score, p < .001, 95% CI: 1.40; 1.79) and forced medication (1.97-point higher score, p < .001, 95% CI: 1.65; 2.30). Restraint had the strongest effect (2.83-point higher score, p < .001, 95% CI: 2.38; 3.28). CONCLUSIONS: Our study presents robust empirical evidence highlighting the detrimental impact of coercive measures on the mental health of psychiatric inpatients. It underscores the importance of avoiding these measures in psychiatric hospitals and emphasized the urgent need for implementing alternatives in clinical practice.

Coercion Authorship: Ubiquitous and Preventable.

Coercion authorship (CA), typically enforced by principal investigators, has detrimental effects on graduate students, young researchers, and the entire scientific endeavor. Although CA is ubiquitous, its occurrence and major determinants have been mainly explored among graduate students and junior scientists in Sweden, Norway, and Denmark where the ratio of CA ranged from 13 to 40%. In addition to lacking comparable figures, developing countries usually lack institutional plans for promoting integrity and effective deterrents against CA and other malpractices. Hence, universities and research centers therein must publish their authorship policies and implement specific strategies to instruct graduate students, junior scientists, and experienced researchers on integrity, publishing ethics, and responsible authorship. Finally, I remark that the primary responsibility of principal researchers to promote fair authorship practices and discourage unfair ones is even greater when it comes to CA due to the asymmetrical power relationship between senior authors and novice scientists.

Rates and risk factors of coercive measure use in inpatient child and adolescent mental health services: a systematic review and narrative synthesis.

Reducing the use of coercive measures in inpatient child and adolescent mental health services (CAMHS) requires an understanding of current rates and associated factors. We conducted a systematic review of research published between Jan 1, 2010, and Jan 10, 2024, addressing rates and risk factors for mechanical, physical, or pharmacological restraint, seclusion, or forced tube feeding in inpatient CAMHS. We identified 30 studies (including 39 027 patients or admissions) with low risk of bias. Median prevalence was 17·5% for any coercive measure, 27·7% for any restraint, and 6·0% for seclusion. Younger age, male sex, ethnicity or race other than White, longer stay, and repeated admissions were frequently linked to coercive measure use. Variable rates and conflicting risk factors suggest that patient traits alone are unlikely to determine coercive measure use. More research, especially in the form of nationwide studies, is needed to elucidate the impact of care and staff factors. Finally, we propose reporting guidelines to improve comparisons over time and settings.

Pathways to experienced coercion during psychiatric admission: a network analysis.

BACKGROUND: In mental health care, experienced coercion, also known as perceived coercion, is defined as the patient's subjective experience of being submitted to coercion. Besides formal coercion, many other factors have been identified as potentially affecting the experience of being coerced. This study aimed to explore the interplay between these factors and to provide new insights into how they lead to experienced coercion. METHODS: Cross-sectional network analysis was performed on data collected from 225 patients admitted to six psychiatric hospitals. Thirteen variables were selected and included in the analyses. A Gaussian Graphical Model (GGM) using Spearman's rank-correlation method and EBICglasso regularisation was estimated. Centrality indices of strength and expected influence were computed. To evaluate the robustness of the estimated parameters, both edge-weight accuracy and centrality stability were investigated. RESULTS: The estimated network was densely connected. Formal coercion was only weakly associated with both experienced coercion at admission and during hospital stay. Experienced coercion at admission was most strongly associated with the patients' perceived level of implication in the decision-making process. Experienced humiliation and coercion during hospital stay, the most central node in the network, was found to be most strongly related to the interpersonal separation that patients perceived from staff, the level of coercion perceived upon admission and their satisfaction with the decision taken and the level of information received. CONCLUSIONS: Reducing formal coercion may not be sufficient to effectively reduce patients' feeling of being coerced. Different factors seemed indeed to come into play and affect experienced coercion at different stages of the hospitalisation process. Interventions aimed at reducing experienced coercion and its negative effects should take these stage-specific elements into account and propose tailored strategies to address them.

Tidligere kriminalitet og psykisk helsehjelp hos personer med soningserfaring som blir dømt til tvungent psykisk helsevern.

Background: In the period 2002-2020, a total of 431 people were sentenced to coercive mental health care. Many of these had served time in prison, either previously or in connection with the criminal acts that led to the current sentences. This study examines the background, criminal history and mental health status of individuals before they committed the offences that led to their imprisonment. Material and method: Data from the Norwegian Correctional Service's Register of Imprisonments, the Register of Convictions, the Norwegian Patient Registry and Statistics Norway were used to study former prisoners who were sentenced to coercive mental health care in the period 2002-2020, who had served prison terms. Results: Among 286 former prisoners who were sentenced to coercive mental health care, 246 (86.0 %) had previous convictions, and 140 (49.0 %) had previously had criminal charges dropped due to doubt as to criminal culpability. Previous psychiatric illness in the last two years was studied in 186 individuals. Of these, 151 (81.2 %) had undergone treatment in the mental health service, with psychotic disorders (106/186 (57.0 %)) and substance use disorders (109/186 (58.6 %)) being the most common diagnoses. Interpretation: Former prisoners who are sentenced to coercive mental health care tend to have an extensive criminal and mental health care history prior to committing criminal acts that lead to coercive mental health care.

A woman in her thirties with confusion. / En kvinne i 30-årene med forvirring.

Background: Coercion is rare in cancer treatment. We present a case where a young woman received gamma knife radiosurgery and immunochemotherapy under compulsory institutional care. Case presentation: A previously healthy patient in her thirties was admitted to hospital due to confusion, apathy, weight loss and sleep disturbance. She had difficulties expressing herself and spoke with considerable latency. A brain MRI revealed a tumour of 23 mm in the left-side centrum semiovale and perifocal oedema, while a CT scan showed a 5.6 cm tumour in the right upper lobe and enlarged mediastinal lymph nodes. She was diagnosed with non-small cell lung cancer, no actionable mutations, PD-L1 <75 %. When she did not wish to return to the hospital to undergo gamma knife radiosurgery, she was readmitted under a formal decision to use coercion, and remained under institutional care for over six months. Today she is fully recovered and has no cancer progression almost five years after diagnosis. Interpretation: This case report illustrates the challenges of brain metastases and use of coercion during cancer treatment, both for the patient and healthcare personnel. There is a need for thorough interdisciplinary discussions and to establish as early as possible a shared understanding of the intention and scope of the forced treatment.

"Letting themselves go during care" - exploring patient autonomy during co-designed intrapartum care in a Beninese maternity ward.

BACKGROUND: Patient autonomy is central to the provision of respectful maternity care. Enabling women to make decisions free of discrimination and coercion, and respecting their privacy and confidentiality can contribute to positive childbirth experiences. This study aimed to deepen the understanding of how patient autonomy is reflected through social practices during intrapartum care in Benin. METHODS: Semi-structured interviews with women and midwives, a focus-group discussion with women's birth companions, and non-participant observations in the delivery room were conducted within the frame of the ALERT research project. This study analysed data through a reflexive thematic analysis approach, in line with Braun and Clarke. RESULTS: We identified two themes and five sub-themes. Patient autonomy was systemically suppressed over the course of birth as a result of the conditions of care provision, various forms of coercion and women's surrendering of their autonomy. Women used other care practices, such as alternative medicine and spiritual care, to counteract experiences of limited autonomy during intrapartum care. CONCLUSIONS: The results pointed to women's experiences of limited patient autonomy and their use of alternative and spiritual care practices to reclaim their patient autonomy. This study identified spiritual autonomy as an emergent dimension of patient autonomy. Increasing women's autonomy during childbirth may improve their experiences of childbirth, and the provision of quality and respectful maternity care.

Obedience induces agentic shifts by increasing the perceived time between own action and results.

The concept of 'agentic shift,' introduced by Stanley Milgram, suggests that obedience reduces the sense of agency. In a recent study simulating the seminal work of Milgram, Caspar et al., 2016 examined this idea in a financial harm context. They demonstrated that, compared to situations of voluntary decision-making, coercion increases the perceived time between action and outcomes-suggested as a marker of diminished agency. Importantly, in this study, participants were agent and victim (relying on a reciprocal relationship) and first experienced free choices, followed by forced choices. This diverts from Milgram's original study, where participants were no victims but only agents who were forced to harm. The current study replicates and extends findings from the 2016 study by Caspar et al. in an online meeting setting, where participants served only as agents-similar to the original Milgram studies-while controlling the order of free and forced choice blocks. Substantiating earlier findings, forced choices reduced temporal binding (increased time interval estimations) compared to free choices independent of the order. We briefly discuss the importance of replications of coercion effects on the sense of agency, particularly in online decision-making settings.

Investigating the Associations between Patient-Reported Quality of Care and Perceived Coercion: A Norwegian Cross-Sectional Study.

Patient perspectives on the quality of care received are fundamental to mental health care. This study aimed to investigate the association between patient-reported mental health care quality, perceived coercion, and various demographic, clinical, and ward-related factors. Using a cross-sectional design, data were collected from 169 patients in Norwegian mental health wards using the quality in psychiatric care-inpatient (QPC-IP) instrument and experienced coercion scale (ECS). The analysis revealed a consistent pattern in which patients with higher perceived coercion consistently rated lower quality on all QPC-IP dimensions. The significant findings of the multiple regression models further supported this association. Beyond coercion, the factors influencing quality ratings include self-reported treatment results, participation in treatment planning, and knowledge of complaint procedures. Emphasizing the pivotal role of coercion in enhancing mental health care quality, these findings contribute to a nuanced understanding of patient experiences and underscore the importance of patient participation in mental health care improvement efforts.

Parent's use of coercive control practices with food is associated with poorer emotion regulation and increased emotional overeating in preschoolers.

Emotional overeating is defined as eating in response to emotions. Around the preschool years, there is a shift from emotional undereating to overeating, which suggests environmental influences in the development of overeating. The use of food by parents to control their child's emotions, rather than to teach them appropriate emotion regulation strategies, may impact the child's ability to regulate their own emotions, resulting in emotional overeating. We hypothesized that such coercive control practices with food by parents would be associated with poorer ability of the child to regulate their own emotions, which in turn would lead to increased emotional overeating, but not emotional undereating. Mothers of four- and five-year-olds (N = 221) were recruited through MTurk and Prolific to complete online questionnaires measuring food parenting practices (Comprehensive Feeding Style Questionnaire and Parent Feeding Style Questionnaire), child emotion regulation (Emotion Regulation Checklist), and child emotional eating (Child Eating Behavior Questionnaire). Several mediation models were tested. Parent's use of food to control emotions and behavior was associated with higher levels of emotional overeating, which was mediated by poorer child emotion regulation. However, child emotion regulation did not mediate the association between parent's use of food to control emotions and behavior and the child's emotional undereating. Taken together, these models suggest that parent's use of coercive control with food may lead to child emotional overeating, but not emotional undereating, by teaching children to regulate their emotions through eating rather than more adaptive regulation strategies. Future experimental and longitudinal studies are needed to directly test the nature and direction of these associations and whether coercive control with food teaches children to overeat in response to their emotions in lieu of using appropriate emotion regulation strategies.

The ethics of overriding patient refusals during 5150s and other involuntary psychiatric holds.

Involuntary psychiatric holds, such as the 5150 hold in California, allow for an individual to be taken into custody for evaluation and treatment for up to 72 h when they present a risk of danger to themselves. 5150s and other coerced holds present a bioethical tension as patient autonomy is overridden to provide psychiatric care. I discuss two arguments that aim to provide ethical justifications for overriding patient autonomy during 5150 holds: the "clinical benefit" and "lack of capacity" arguments. By demonstrating that these arguments do not always hold, I argue that overriding patient autonomy during 5150 holds is not always ethical and can be harmful. Lastly, I make recommendations for the 5150 and similar involuntary psychiatric holds to minimize harmful breaches of patient dignity: creating consistent field guidelines for assessing prehospital capacity, educating prehospital providers about the potential harms of 5150s, and utilizing existing support structures within the social context of the patient when they have capacity to refuse further prehospital care.