The experience of admission to psychiatric hospital among Chinese adult patients in Hong Kong

Revisiting the psychometric properties of the McArthur admission experience survey: Validating the Portuguese version using a bifactor approach

Cultural factors play a significant role in shaping the perception of coercion during psychiatric admissions. The present study aimed to assess the psychometric properties of the Portuguese Admission Experience Survey(P-AES). The study employed a cross-sectional approach in five psychiatric departments in three regions of Portugal. A total of 208 patients participated in the survey. Reliability was assessed through internal consistency and test-retest procedures. Internal validity was analyzed using a two-parameter logistic item response model, exploring three models, including a bifactor model. Convergent validity was determined by correlating AES scores with the Coercion Ladder (CL), Client Assessment of Satisfaction (CAT), and Global Assessment of Functioning (GAF) scale. Discriminatory power was assessed by comparing scores between patients with voluntary and involuntary admission status. The P-AES demonstrated satisfactory internal consistency and test-retest reliability. The bifactor model exhibited superior fit compared to the one-factor and three-factor models. Correlations between P-AES and CL, as well as CAT scores, indicated good convergent validity. Additionally, P-AES scores were notably higher in patients with compulsory psychiatric hospital admission compared to those admitted voluntarily, confirming its discriminatory power. The bifactor model suggests that all three domains of the AES should be used to measure the subjective experience of coercion.

Experiences of coercion amongst involuntary mental health care users in KwaZulu-Natal, South Africa

Background

Involuntary admission is a common practice globally. Previous international studies reported that patients experienced high levels of coercion, threats and a range of negative emotions. Little is known about the patients' experience in South Africa. The aim of this study was to describe the patient's experiences of involuntary admission at two psychiatric hospitals in KwaZulu-Natal.

Methods

A cross-sectional descriptive quantitative study of patients admitted involuntarily was conducted. Demographic information was extracted from clinical records and interviews were conducted with consenting participants at discharge. The MacArthur Perceived Coercion Scale, the MacArthur Negative Pressures Scale, and the MacArthur Procedural Justice Scale, of the MacArthur Admission Experience Survey (short form) were utilized to describe participants' experiences.

Results

This study comprised 131 participants. The response rate was 95.6%. Most participants (n = 96; 73%) experienced high levels of coercion and threats (n = 110; 84%) on admission. About half (n = 61; 46.6%) reported that they felt unheard. Participants reported feeling sad (n = 68; 52%), angry (n = 54; 41.2%), and confused (n = 56; 42.7%). There was a significant association between good insight and a feeling of relief (p = 0.001), and between poor insight and feelings of anger (p = 0.041).

Conclusion

The findings of this study confirm that most patients who were admitted involuntarily experienced high levels of coercion, threats, and exclusion from the decision-making process. Patient involvement and control of the decision-making process must be facilitated to improve clinical and overall health outcomes. The need for involuntary admission must justify the means.

Nurses', patients', and informal caregivers' attitudes toward aggression in psychiatric hospitals: A comparative survey study

Attitudes toward aggression is a controversial phenomenon in psychiatry. This study examined and compared attitudes toward patient aggression in psychiatric hospitals from the perspectives of nurses, patients and informal caregivers and identified factors associated to these attitudes. A total of 2,424 participants completed a self-reported instrument regarding attitudes toward aggression (12-items Perception of Aggression Scale; POAS-S). We analysed data from nurses (n = 782), patients (n = 886), and informal caregivers (n = 765). Pearson's r correlations were used to examine associations between variables. Differences between group scores were analysed using ANOVA/MANOVA with post-hoc Sheffe tests. Multivariate logistic regression models and logistic regression analysis were used to examine the effects of respondents' characteristics on their attitudes toward aggression. Nurses had significantly more negative and less tolerant perceptions toward aggression (mean [SD] 47.1 [7.5], p<0.001) than the patients (mean [SD] 44.4 [8.2]) and the informal caregivers (mean [SD] 45.0 [6.9), according to the POAS-S total scores. The same trend was found with the dysfunction and function sub-scores (mean [SD] 25.3 [4.1] and 15.0 [3.6], respectively); the differences between the groups were statistically significant (p <0.001) when nurses' scores were compared to those of both the patients (mean [SD] 23.7 [5.3] and 14.0 [4.1], respectively) and the informal caregivers (mean [SD] 24.4 [4.2] and 13.9 [3.5], respectively). The study offers new understanding of aggressive behavior in different treatment settings where attitudes toward patient behavior raises ethical and practical dilemmas. These results indicate a need for more targeted on-the-job training for nursing staff, aggression management rehabilitation programs for patients, and peer-support programs for informal caregivers focused on patient aggression.

Terminology and assessment tools of psychosis: A systematic narrative review

AIM

Phenomena within the psychosis continuum that varies in frequency/duration/intensity have been increasingly identified. Different terms describe these phenomena, however there is no standardization within the terminology. This review evaluated the definitions and assessment tools of seven terms - (i) 'psychotic experiences'; (ii) 'psychotic-like experiences'; (iii) 'psychotic-like symptoms'; (iv) 'attenuated psychotic symptoms'; (v) 'prodromal psychotic symptoms'; (vi) 'psychotic symptomatology'; and (vii) 'psychotic symptoms'.

METHODS

EMBASE, MEDLINE, and CINAHL were searched during February-March 2019. Inclusion criteria included 1989-2019, full text, human, and English. Papers with no explicit definition or assessment tool, duplicates, conference abstracts, systematic reviews, meta-analyses, or no access were excluded.

RESULTS

A total of 2238 papers were identified and of these, 627 were included. Definitions and assessment tools varied, but some trends were found. Psychotic experiences and psychotic-like experiences were transient and mild, found in the general population and those at-risk. Psychotic-like symptoms were subthreshold and among at-risk populations and non-psychotic mental disorders. Attenuated psychotic symptoms were subthreshold but associated with distress, risk, and help-seeking. Prodromal psychotic symptoms referred to the prodrome of psychotic disorders. Psychotic symptomatology included delusions and hallucinations within psychotic disorders. Psychotic symptoms was the broadest term, encompassing a range of populations but most commonly involving hallucinations, delusions, thought disorder, and disorganization.

DISCUSSION

A model for conceptualizing the required terms is proposed and future directions needed to advance this field of research are discussed.

[Coercive stress in psychiatric intensive care unit: What link with insight?]

The aim of this work was to study the correlations between the coercive experience level in patients in a psychiatric intensive care unit and clinical insight. We included 40 patients without specific diagnosis criteria at the end of their hospitalization in the intensive care unit. We assessed patients with the Coercion Experience Scale (CES) to measure their coercive stress level, and the Scale to Assess Unawareness of Mental Disorder (SUMD) which measures clinical insight. A total of 42.5 % of our sample suffered from mood disorders, 50 % suffered from psychotic disorders and 7.5 % from other disorders. On the one hand, we found that patients' coercive stress level was neither correlated with the awareness of their mental disorder nor with the awareness of social consequences of their mental disorder. On the other hand, we found that coercive stress level was significantly correlated with patients' awareness of treatment efficacy and that the specific CES factor measuring coercion showed a strong trend to significantly correlate with patients' awareness of treatment efficacy. These results seem to show that education about benefits of treatment is a key point to improve patients' coercive stress in a psychiatric intensive care unit, more than an education about awareness of the mental disorder itself.

The Admission Experience Survey Italian Version (I-AES): A factor analytic study on a sample of 156 acute psychiatric in-patients

Coercive treatments are often regarded as an inevitable and yet highly debated feature of psychiatric care. Perceived coercion is often reported by patients involuntarily committed as well as their voluntary counterparts. The Admission Experience Survey (AES) is a reliable tool for measuring perceived coercion in mental hospital admission. We developed the Italian AES (I-AES) through translation back-translation and administered it to 156 acutely hospitalized patients (48% women, 69% voluntarily committed) in two university hospitals in Rome (Policlinico Umberto I, Sant'Andrea Hospital). A principal component analysis (PCA) with equamax rotation was conducted. The I-AES showed good internal consistency (Cronbach's alpha = 0.90); Guttmann split-half reliability coefficient was 0.90. AES total score significantly differed between voluntary and involuntary committed patients (5.08 ± 4.1 vs. 8.1 ± 4.9, p < .05). PCA disclosed a three-factor solution explaining 59.3 of the variance. Some discrepancies were found between the factor structure of the I-AES and the original version. I-AES total score was positively associated with numbers of previous involuntarily hospitalization (r = 0.20, p < .05) and psychiatric symptoms' severity (r = 0.22, p < .02). I-AES and its proposed new factor structure proved to be reliable to assess perceived coercion in mental hospital admission. Consequently, it may represent a helpful instrument for the study and reduction of patients' levels of perceived coercion.

Admission experiences of psychiatric patients in tertiary care: An implication toward Mental Health Care Bill, 2013

Background:

Coercion is not uncommon phenomenon among mental health service users during their admission into psychiatric hospital. Research on perceived coercion of psychiatric patients is limited from India.

Aim:

To investigate perceived coercion of psychiatric patients during admission into a tertiary care psychiatric hospital.

Materials and Methods:

This was a cross-sectional descriptive survey carried out among randomly selected psychiatric patients (n = 205) at a tertiary care center. Data were collected through face-to-face interviews using structured questionnaire.

Results:

Our findings revealed that participants experienced low levels of coercion during their admission process. However, a majority of the participants were threatened with commitment (71.7%) as well as they were sad (67.8%), unpleased (69.7%), confused (73.2%), and frightened (71.2%) with regard to hospitalization into a psychiatric hospital. In addition, the participants expressed higher levels of negative pressures (mean ± standard deviation, 3.76 ± 2.12). Participants those were admitted involuntarily (P > 0.001), diagnosed to be having psychotic disorders (P > 0.003), and unmarried (P > 0.04) perceived higher levels of coercion.

Conclusion:

The present study showed that more formal coercion was experienced by the patients those got admitted involuntarily. On the contrary, participants with voluntary admission encountered informal coercion (negative pressures). There is an urgent need to modify the Mental Health Care (MHC) Bill so that treatment of persons with mental illness is facilitated. Family member plays an important role in providing MHC; hence, they need to be empowered.

The impact of caregivers on the effectiveness of an early community mental health detection and intervention programme in Hong Kong

AIM

The prevalence rate of mental illness in Chinese communities is high, but Chinese clients tend to underutilize mental health services. Caregivers may play an important role in mental health early detection and intervention, but few studies have investigated their roles in community mental health services. This study compared the effectiveness of an early detection and intervention programme, the Community Mental Health Intervention Project, for two groups in the context of Hong Kong - clients with and without caregivers.

METHOD

A comparison group pre-post-test design was adopted. A total of 170 service users joined this study, including 100 with caregivers and 70 without caregivers.

RESULTS

Both groups showed a significant decrease in psychiatric symptoms and increase in community living skills; the group without caregivers indicated a greater reduction in psychiatric symptoms. Different social work intervention components had different predictive effects on these changes.

CONCLUSION

The Community Mental Health Intervention Project is an effective early detection and intervention programme in working with Hong Kong Chinese people who are suspected of having mental health problems, especially for those without caregivers.

Validation of the Chinese version of Perception of Care in an acute psychiatric ward in Hong Kong

INTRODUCTION

This study aimed to validate and culturally adapt the Perception of Care (PoC) for patients receiving acute psychiatric inpatient services in Hong Kong.

METHODS

The PoC was translated and culturally adapted into a written Chinese version (C-PoC). Subjects completed C-PoC, Chinese version of Admission Experience Survey (C-AES) and World Health Organization Quality of Life Measure (WHOQOL-BREF). They were then rated by assessors with Brief Psychiatric Rating Scale (BPRS), Hamilton Rating Scale for Depression, Hamilton Rating Scale for Anxiety and Extrapyramidal Symptom Rating Scale. Explorative factor analysis and correlation between C-PoC, WHOQOL-BREF and C-AES served as the theoretical basis of construct validity. Multivariate analysis was used to identify predictors of satisfaction.

RESULTS

The C-PoC has a four-factor structure that resembles the original scale with demonstrating satisfactory construct validity and test-re-test reliability. Psychiatric symptom ratings did not predict any satisfaction ratings. Extrapyramidal symptoms predicted poorer satisfaction. Younger patients with affective diagnoses had better satisfaction.

DISCUSSION

The C-PoC is a psychometrically sound translation of the original scale. The current study paves the way for further studies among Chinese-speaking communities on the determinants and implications of patients' satisfaction by offering a psychometrically sound and yet concise instrument.

Perceived coercion and need for hospital admission among psychiatric in-patients: figures from a Pakistani tertiary care hospital

In Pakistan, an increasing proportion of psychiatric patients present to community health services as crisis admissions, with their relatives as the main decision makers. Patients are bound to perceive this process as coercive. Farnham & James (2000) report that elements of coercion are found even in voluntary hospital admission, in the form of verbal persuasion, physical force and threats of commitment. Few patients consider hospitalisation justified and most view the process of admission negatively (Swartz et al, 2003; Katsakou & Priebe, 2006; Priebe et al, 2009).

Perceived coercion and need for hospital admission among psychiatric in-patients: figures from a Pakistani tertiary care hospital

In Pakistan, an increasing proportion of psychiatric patients present to community health services as crisis admissions, with their relatives as the main decision makers. Patients are bound to perceive this process as coercive. Farnham & James (2000) report that elements of coercion are found even in voluntary hospital admission, in the form of verbal persuasion, physical force and threats of commitment. Few patients consider hospitalisation justified and most view the process of admission negatively (Swartz et al, 2003; Katsakou & Priebe, 2006; Priebe et al, 2009).

Compulsory treatment in psychiatry

PURPOSE OF REVIEW

Compulsory treatment is a common, yet controversial, practice in psychiatry. This paper reviews recent studies on the use of compulsory measures in hospital, the community and special populations.

RECENT FINDINGS

Researchers continue to examine the rates and patterns of involuntary hospitalization. However, they have extended their investigations to care in the community, acknowledging it as the primary locus of treatment for most patients. Research shows that the implementation of community mental health legislation presents complex clinical and practical issues that require further investigation. Recognition that compulsory treatment is an objective event which is subjectively experienced by patients, families and clinicians has led to research investigating stakeholder views. The therapeutic relationship has been found to be an important modifier of the experience of compulsory treatment. Recent studies have also focused on specific coercive practices, such as forced medication and seclusion, and the use of these in patient subgroups, including those with eating disorders and adolescents. The debate about whether compulsory treatment is ethical continues in the literature.

SUMMARY

Compulsory treatment in psychiatry remains an ethically and clinically contentious issue. As ethical concerns are generally countered by the argument that compulsory measures can lead to beneficial clinical outcomes, further empirical investigation in this area is required.