Patient-reported experience measures (PREMs), coercion, and mental health outcomes in psychiatric inpatient care: a national mixed-methods study comparing immigrant and majority populations.

Abstract

Background: Immigrants are at increased risk of mental health problems but underutilize specialist services and may face barriers to high-quality care. Evidence regarding their experiences in psychiatric inpatient settings remains limited. This study examined differences in patient experiences, coercion, and change in mental health between immigrant groups and the majority population and considered challenges in measuring and comparing patient-reported experiences across groups.

Methods: A national survey was conducted across Norwegian psychiatric inpatient institutions from January 2020 to June 2022. The Psychiatric Inpatient Patient Experience Questionnaire - Continuous Electronic Measurement (PIPEQ-CEM) was used with demographic, coercion, and mental health indicators. Linear regression examined associations between region-of-birth and key outcomes. Additionally, 390 comments from immigrant patients and 125 from Norwegian-born patients were thematically analyzed.

Results: Data from 8,184 patients (89.5% Norwegian-born) revealed few group differences in overall patient experience scores. However, some immigrant groups rated aspects-including initial welcome, privacy, and treatment benefit-lower than the majority population, in addition to higher levels of coercion and less improvement in mental health. Thematic analysis revealed immigrant-specific experiences related to expectations and prior knowledge of psychiatric care, belonging and trust, communication, and access to information.

Conclusions: While overall patient experience scores were largely similar, some immigrant groups reported higher coercion and less favorable mental health trajectories. Qualitative findings highlighted contextual factors that may shape how patients experience and report care. These results underline the importance of culturally sensitive psychiatric care delivery and culturally appropriate measurement of patient experiences across diverse populations.