Open Access Open Badges Research article

Methodological and ethical challenges in studying patients’ perceptions of coercion: a systematic mixed studies review

Päivi Soininen12*, Hanna Putkonen23, Grigori Joffe4, Jyrki Korkeila56 and Maritta Välimäki17

Author Affiliations

1 Department of Nursing Science, University of Turku, Turku, Finland

2 Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Area, Kellokoski Hospital, Tuusula, Finland

3 Vanha Vaasa Hospital, Vaasa, Finland

4 Department of Psychiatry, Hospital District of Helsinki and Uusimaa, Helsinki University Central Hospital, Helsinki, Finland

5 Faculty of Medicine, University of Turku, Turku, Finland

6 Hospital District of Satakunta, Pori, Finland

7 Turku University Hospital, Turku, Finland

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BMC Psychiatry 2014, 14:162  doi:10.1186/1471-244X-14-162

Published: 4 June 2014



Despite improvements in psychiatric inpatient care, patient restrictions in psychiatric hospitals are still in use. Studying perceptions among patients who have been secluded or physically restrained during their hospital stay is challenging. We sought to review the methodological and ethical challenges in qualitative and quantitative studies aiming to describe patients’ perceptions of coercive measures, especially seclusion and physical restraints during their hospital stay.


Systematic mixed studies review was the study method. Studies reporting patients’ perceptions of coercive measures, especially seclusion and physical restraints during hospital stay were included. Methodological issues such as study design, data collection and recruitment process, participants, sampling, patient refusal or non-participation, and ethical issues such as informed consent process, and approval were synthesized systematically. Electronic searches of CINALH, MEDLINE, PsychINFO and The Cochrane Library (1976-2012) were carried out.


Out of 846 initial citations, 32 studies were included, 14 qualitative and 18 quantitative studies. A variety of methodological approaches were used, although descriptive and explorative designs were used in most cases. Data were mainly collected in qualitative studies by interviews (n = 13) or in quantitative studies by self-report questionnaires (n = 12). The recruitment process was explained in 59% (n = 19) of the studies. In most cases convenience sampling was used, yet five studies used randomization. Patient’s refusal or non-participation was reported in 37% (n = 11) of studies. Of all studies, 56% (n = 18) had reported undergone an ethical review process in an official board or committee. Respondents were informed and consent was requested in 69% studies (n = 22).


The use of different study designs made comparison methodologically challenging. The timing of data collection (considering bias and confounding factors) and the reasons for non-participation of eligible participants are likewise methodological challenges, e.g. recommended flow charts could aid the information. Other challenges identified were the recruitment of large and representative samples. Ethical challenges included requesting participants’ informed consent and respecting ethical procedures.

Methodology; Ethics; Coercion; Inpatient; Perception