Center for Psychiatry Suedwuerttemberg, Ulm University, Ravensburg-Weissenau, Germany.
BMC Psychiatry. 2010 Jan 14;10:5. doi: 10.1186/1471-244X-10-5.
Although the authors of a Cochrane Review on seclusion and mechanical restraint concluded that "there is a surprising and shocking lack of published trials" on coercive interventions in psychiatry, there are only few instruments that can be applied in trials. Furthermore, as main outcome variable safety, psychopathological symptoms, and duration of an intervention cannot meet the demand to indicate subjective suffering and impact relevant to posttraumatic stress syndromes. An instrument used in controlled trials should assess the patients' subjective experiences, needs to be applicable to more than one intervention in order to compare different coercive measures and has to account for the specific psychiatric context.
The primary version of the questionnaire comprised 44 items, nine items on restrictions to human rights, developed on a clinical basis, and 35 items on stressors, derived from patients' comments during the pilot phase of the study. An exploratory factor analysis (EFA) using principal axis factoring (PAF) was carried out. The resulting factors were orthogonally rotated via VARIMAX procedure. Items with factor loadings less than .50 were eliminated. The reliability of the subscales was assessed by calculating Cronbach.
Data of 102 patients was analysed. The analysis yielded six factors which were entitled "Humiliation", "Physical adverse effects", "Separation", "Negative environment", "Fear" and "Coercion". These six factors explained 54.5% of the total variance. Cronbach alpha ranged from .67 to .93, which can be interpreted as a high internal consistency. Convergent and discriminant validity yielded both highly significant results (r = .79, p < .001, resp. r = .38, p < .001).
The "Coercion Experience Scale" is an instrument to measure the psychological impact during psychiatric coercive interventions. Its psychometric properties showed satisfying reliability and validity. For purposes of research it can be used to compare different coercive interventions. In clinical practice it can be used as a screening instrument for patients who need support after coercive interventions to prevent consequences from traumatic experiences. Further research is needed to identify possible diagnostic, therapeutic or prognostic implications of the total score and the different subscales.
Current Controlled Trials ISRCTN70589121.
尽管 Cochrane 综述的作者关于禁闭和机械约束得出结论，认为“在精神病学中的强制性干预方面，发表的试验令人惊讶地缺乏”，但只有少数工具可用于试验。此外，作为主要的结局变量安全性、精神病理学症状和干预的持续时间，无法满足表示主观痛苦和与创伤后应激综合征相关的影响的需求。在对照试验中使用的工具应评估患者的主观体验，需要适用于多种干预措施，以便比较不同的强制性措施，并考虑到特定的精神科背景。
问卷的主要版本包括 44 个项目，其中 9 个关于人权限制的项目是基于临床基础开发的，35 个关于应激源的项目是从研究的试点阶段患者的评论中得出的。采用主成分因子分析（PAF）进行探索性因子分析（EFA）。通过 VARIMAX 程序对产生的因子进行正交旋转。因子负荷小于.50 的项目被删除。通过计算 Cronbach 来评估子量表的可靠性。
分析了 102 名患者的数据。分析产生了六个因子，分别为“侮辱”、“身体不良影响”、“分离”、“负面环境”、“恐惧”和“强制”。这六个因素解释了总方差的 54.5%。Cronbach alpha 范围从.67 到.93，可以解释为高度内部一致性。收敛和判别效度均产生了非常显著的结果（r =.79，p <.001，resp。r =.38，p <.001）。
“强制体验量表”是一种测量精神病学强制性干预期间心理影响的工具。其心理测量学特性显示出令人满意的可靠性和有效性。出于研究目的，可以使用它来比较不同的强制性干预措施。在临床实践中，它可以用作强制性干预后需要支持的患者的筛查工具，以防止创伤经历的后果。需要进一步研究以确定总评分和不同子量表的可能诊断、治疗或预后意义。
当前对照试验 ISRCTN70589121。
