Coercion in Psychiatric Care: Systematic Review of Correlates and Themes

OBJECTIVE: This study systematically examined the empirical literature on the themes and correlates of coercion as defined by the subjective experience of patients in psychiatric care. METHODS: The study was a systematic review of the literature on coercion as covered in MEDLINE, PsycINFO, and CINAHL. From qualitative studies, themes that the authors identified were extracted. From quantitative studies, correlational and outcome data were extracted. RESULTS: The final analysis included 27 articles. Themes related to perceived coercion were almost all negative. Correlation and outcome data were insufficiently homogeneous to allow meaningful combined statistical analysis. There was no strong quantitative evidence that the experience of coercion is negatively or positively associated with psychopathology or general well-being. CONCLUSIONS: Coercion was commonly felt by patients as dehumanizing. Compulsory actions likely to increase perceived coercion had mixed correlates, and it was therefore difficult to predict who is at greatest risk of experiencing coercion as a "side effect" of intervention. Clinicians should routinely consider that all patients have the potential to experience an intervention as coercive.