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Open Access Research article

Evaluation of behavioral changes and subjective distress after exposure to coercive inpatient interventions

Irina Georgieva12*, Cornelis L Mulder34 and Richard Whittington5

Author Affiliations

1 Department of Psychiatry, Erasmus, MC, Rotterdam, 3000, CA, PO Box 2040, The Netherlands

2 Mental Health Center Western North-Brabant, Halsteren, The Netherlands

3 Research Center O3, Erasmus MC, Rotterdam, The Netherlands

4 Department of Psychiatry, Bavo-Europoort and Municipal Health Center Rotterdam, Rotterdam, The Netherlands

5 Institute of Psychology, Health and Society, University of Liverpool & Honorary Research Fellow, Mersey Care NHS Trust, Liverpool, United kingdom

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BMC Psychiatry 2012, 12:54  doi:10.1186/1471-244X-12-54

Published: 30 May 2012



There is a lack of evidence to underpin decisions on what constitutes the most effective and least restrictive form of coercive intervention when responding to violent behavior. Therefore we compared ratings of effectiveness and subjective distress by 125 inpatients across four types of coercive interventions.


Effectiveness was assessed through ratings of patient behavior immediately after exposure to a coercive measure and 24 h later. Subjective distress was examined using the Coercion Experience Scale at debriefing. Regression analyses were performed to compare these outcome variables across the four types of coercive interventions.


Using univariate statistics, no significant differences in effectiveness and subjective distress were found between the groups, except that patients who were involuntarily medicated experienced significant less isolation during the measure than patients who underwent combined measures. However, when controlling for the effect of demographic and clinical characteristics, significant differences on subjective distress between the groups emerged: involuntary medication was experienced as the least distressing overall and least humiliating, caused less physical adverse effects and less sense of isolation. Combined coercive interventions, regardless of the type, caused significantly more physical adverse effects and feelings of isolation than individual interventions.


In the absence of information on individual patient preferences, involuntary medication may be more justified than seclusion and mechanical restraint as a coercive intervention. Use of multiple interventions requires significant justification given their association with significant distress.

Coercive measures; Seclusion; Mechanical restraint; Involuntary medication; Coercion