An Exploratory Study about Factors and Outcomes Associated with the Experience of Coercive Measures in Mental Health Settings.

Abstract

Coercive measures are commonly used in mental health settings despite their negative effects. The subjective experience of coercion varies widely, and its short- and long-term health impacts are not well understood. This study aimed to analyze the association between different types of coercive measures experienced during psychiatric hospitalization, the subjective experience of coercion, and both short- and long-term health outcomes. The study included 111 patients from two mental health units who experienced coercive measures (mechanical restraint, involuntary medication, or both). Perceived coercion was assessed during hospitalization. Short-term outcomes (post-traumatic stress and treatment satisfaction) were evaluated before discharge, while long-term outcomes (functionality improvement, risk of readmission, and suicidal behavior) were assessed at five-year follow-up. Perceived coercion was associated with higher post-traumatic stress (p < 0.001) and lower satisfaction with treatment (p < 0.001) in the short term. In the long term, perceived coercion showed no association with functionality, readmission risk, or suicidal behavior. However, combined coercive measures were linked to lower functionality improvement (p = 0.028) and higher readmission risk (p = 0.028) compared to involuntary medication alone. The findings suggest that efforts to reduce negative subjective experiences associated with coercive measures may improve patient satisfaction and reduce trauma risk during hospitalization. Combined coercive measures may be a risk factor for poorer long-term outcomes and should be carefully considered.