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Wullschleger A, Vandamme A, Mielau J, Stoll L, Heinz A, Bermpohl F, Bechdolf A, Stelzig M, Hardt O, Hauth I, Holthoff-Detto V, Mahler L, Montag C. Effect of standardized post-coercion review on subjective coercion: Results of a randomized-controlled trial. Eur Psychiatry 2021; 64:e78. [PMID: 34872630 PMCID: PMC8715283 DOI: 10.1192/j.eurpsy.2021.2256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Post-coercion review has been increasingly regarded as a useful intervention in
psychiatric inpatient setting. However, little is known about its effect on perceived
coercion. Methods A multicenter, two-armed, randomized controlled trial was conducted, aiming at
analyzing the effect of post-coercion review on perceived coercion. People with severe
mental disorders, who experienced at least one coercive measure during inpatient
treatment, were randomized using Zelen’s design to an intervention group receiving
standardized post-coercion review, or a control group treated as usual. The MacArthur
admission experience scale (AES) and the coercion ladder (CL) were used to assess
perceived coercion during inpatient treatment. The coercion experience scale (CES)
measured experienced coercion during the coercive intervention. Analyses of covariance
were performed to determine group differences. Results Of 422 randomized participants, n = 109 consented to participate in
the trial. A restricted intention-to-treat analysis of all individuals who consented
revealed no significant effect of the intervention on perceived coercion. A significant
interaction effect between the factors gender and intervention on the AES scores was
found. Sensitivity analysis revealed significant effects of the intervention on both AES
and CL scores and an interaction effect between intervention and gender, indicating a
higher efficacy in women. No effect of the intervention on CES scores was found. Conclusions Standardized post-coercion review sessions did not alleviate the subjective perception
of coercion in the total sample. However, post hoc analysis revealed a significant
effect of the intervention in women. Results indicate the need to further address
gender-specific issues related to coercion.
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Affiliation(s)
- A Wullschleger
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Thônex, Switzerland
| | - A Vandamme
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - J Mielau
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - L Stoll
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - A Heinz
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - F Bermpohl
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - A Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Hospital Am Urban and Vivantes Hospital im Friedrichshain/Charité Medicine Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - M Stelzig
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Wenckebach Clinic, Berlin, Germany
| | - O Hardt
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Clinic Neukölln, Berlin, Germany
| | - I Hauth
- Department of Psychiatry, Psychotherapy and Psychosomatics, St. Joseph Hospital Berlin-Weissensee, Berlin, Germany
| | - V Holthoff-Detto
- Department of Psychiatry, Psychotherapy and Psychosomatics, Alexianer Hospital Hedwigshöhe, St. Hedwig Kliniken Berlin, Berlin, Germany.,Medical Faculty, University of Technology, Dresden, Germany
| | - L Mahler
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychiatry, Clinics in the Theodor-Wenzel-Werk, Berlin, Germany
| | - C Montag
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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