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.
Eur Psychiatry. 2021 Dec 7;64(1):e78. doi: 10.1192/j.eurpsy.2021.2256.
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.
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.
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.
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.
强制审查在精神科住院环境中已逐渐被视为一种有用的干预措施。然而，对于其对感知强制的影响知之甚少。
进行了一项多中心、双臂、随机对照试验，旨在分析强制审查后对感知强制的影响。患有严重精神障碍的人，在住院治疗期间至少经历过一次强制性措施，采用 Zelen 的设计随机分为干预组接受标准化的强制审查后，或对照组按常规治疗。使用 MacArthur 入院体验量表（AES）和强制量表（CL）评估住院期间的感知强制。使用强制体验量表（CES）测量强制干预期间的经历强制。采用协方差分析确定组间差异。
在 422 名随机参与者中，n=109 同意参加试验。对所有同意参加试验的个体进行的限制意向治疗分析显示，干预对感知强制没有显著影响。发现 AES 评分的性别和干预因素之间存在显著的交互作用。敏感性分析显示，干预对 AES 和 CL 评分均有显著影响，且干预与性别之间存在交互作用，表明女性的疗效更高。干预对 CES 评分无显著影响。
标准化的强制审查后干预并没有减轻总体样本的主观强制感知。然而，事后分析显示干预对女性有显著影响。结果表明需要进一步解决与强制相关的性别特定问题。
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