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Results for “Coercion”

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PubMed1993

Two scales for measuring patients' perceptions for coercion during mental hospital admission.

Legal and extra-legal coercion are pervasive in mental hospital admission and there are sharp disputes about its appropriate role. This article presents two scales for measuring psychiatric patients' perceptions of coercion during hospital admission and reports data on these scales' internal consistency. We measure patients' perceptions of coercion by asking questions, in either an interview or questionnaire format, about their experience of lack of control, choice, influence, and freedom in hospital admission. Patients' responses to questions about their perceptions of coercion were highly internally consistent. The internal consistency of the scale was robust with respect to variation in site, instrument format, patient population, and interview procedure. Correspondence analysis was used to construct two numerical scales of perceived coercion.

Adolescent↗

PubMed2006

Differences in perceived coercion at admission to psychiatric hospitals in the Nordic countries.

BACKGROUND: International variation in compulsory admissions to psychiatric care has mainly been studied in terms of civil commitment rates. The objectives of this study were to compare and analyse the levels of perceived coercion at admission to psychiatric in-patient care among the Nordic countries and between centres within these countries, in relation to legal prerequisites and clinical practice. METHOD: From one to four centres each in Denmark, Iceland, Norway, Finland and Sweden, a total of 426 legally committed and 494 formally voluntarily admitted patients were interviewed within 5 days from admission. RESULTS: The proportion of committed patients reporting high levels of perceived coercion varied among countries (from 49% in Norway to 100% in Iceland), and in Sweden, only, among centres (from 29 to 90%). No clear variations in this respect were found among voluntary patients. A wide concept of coercion in the Civil Commitment Act and no legal possibility of detention of voluntary patients were associated to low levels of perceived coercion at admission among committed patients. CONCLUSION: For committed patients, differences in national legal prerequisites among countries were reflected in differences in perceived coercion. The results from Sweden also indicate that local care traditions may account for variation among centres within countries.

Adult↗

PubMedDate not supplied

Coercion and informed consent in research involving prisoners.

Prison-based research has been limited due to concern that prisoners may represent a vulnerable population secondary to possible coercion and limited capacity for voluntary informed consent. This study was designed to assess decisional capacity and susceptibility to coercion in prison research subjects. Subjects were 30 mentally ill prisoners and 30 healthy controls. The groups were compared on ability to provide informed consent to a hypothetical drug trial, susceptibility to possible coercion, neuropsychological functioning, and psychiatric symptoms. Results indicated that all controls and all but one of the prisoners demonstrated adequate capacity to consent to the hypothetical drug trial. However, when decisional capacity was measured quantitatively, prisoners performed significantly worse regarding two aspects of this ability. Regarding possible coercion, prisoners' main reasons for participating in research included avoiding boredom, meeting someone new, appearing cooperative in hopes of being treated better, and helping society. Neuropsychological functioning was strongly positively correlated with decisional capacity and negatively correlated with susceptibility to possible coercion, whereas psychiatric symptoms were only weakly correlated with these variables. In conclusion, a very high percentage of particularly vulnerable, mentally ill prisoners demonstrated adequate capacity to consent to research. Lower scores on a quantitative measure of decisional capacity suggest that extra care should be taken during the consent process when working with these subjects. The reasons prisoners gave for participating in our research indicated that the prison setting may have influenced their decision to participate, but that they were not actually coerced into doing so. Despite serious past incidents, ethicists will need to consider the possibility that prisoners have become an overprotected population.

Adult↗

PubMed2000

Sexual coercion among youth and young adults in Lima, Peru.

PURPOSE: To determine the prevalence and correlates of sexual coercion in young adults in Lima, Peru. METHODS: Lifetime sexual coercion and that at first sexual experience were studied in 629 sexually active young people, drawn from representative samples of 611 adolescents and 607 young adults. RESULTS: Almost half of the young women and a quarter of the young men in the study reported sexual coercion. In multiple logistic regression analyses, men and women who reported having been coerced at heterosexual initiation also reported more lifetime sexually transmitted diseases and a lower age at first sex than those not reporting coercion. Men who reported coercion at heterosexual initiation also reported a lower number of lifetime heterosexual partners and less sexual knowledge than men not coerced. CONCLUSION: Experiencing heterosexual initiation as coercive appears to be a marker for a riskier sexual career for both genders and for future homosexual behavior in men.

Adolescent↗

PubMed1998

Nurses' narratives about using coercion in psychiatric care.

To illuminate nurses' experience of using coercion against psychiatric patients, a phenomenological hermeneutic study was conducted with seven registered nurses and seven enrolled mental nurses. The findings revealed that these nurses desired to be seen by themselves, their co-workers and patients as doing good, being good and providing good care but they experienced the use of coercion as not good. This conflict made it difficult for these nurses to question the use of coercion and consider alternative solutions. The theory of change by Watzlawick et al. (1974) served as a theoretical framework for the interpretation of all interviews regarded as one text. In order to explore alternatives to the use of coercion in psychiatric care, nurses need assistance to step outside the traditional way of regarding coercion in psychiatric care and seek to create new solutions.

Adult↗

PubMed1998

Subtle coercion in psychiatric practice.

Making nursing decision for patients who cannot communicate their own wishes and needs is a common problem in psychiatric and mental health nursing. The aim of this article is to present the findings of a qualitative study focused on situations in which patients do not cooperate with a nursing decision about what should be done for them. The design of the study utilized some steps associated with the grounded theory method. Data were collected from unstructured interviews with 10 British nurses with long experience in psychiatric nursing. By implementing the strategy of constant comparative analysis of the transcribed interviews, it was found that nurses use different types of subtle coercion in order to achieve their own goals for the patient. These goals were justified as being in the best interest of the patient. The main components of subtle coercion are part of a process consisting of: assessing a patient's competency for self-choice; acting strategically; modifying the principle af autonomy; justifying strategies; and reflecting ethically on the action taken. The study indicates that further empirical investigation of clinical situations involving subtle coercion is required. Particular attention should be paid to organizational factors and how these contribute to the use of subtle coercion. A specific question that needs to be theoretically and empirically explored is, can coercion be justified as 'ethically right' in some situations but not in others?

Choice Behavior↗

PubMed2005

What is heterosexual coercion? Interpreting narratives from young people in Mexico City.

Freedom from sexual coercion is frequently cited as essential for good sexual health. Sexual experiences cannot usually be observed directly, and interpretation of interview data is therefore crucial in our understanding of sexual behaviour. This paper explores the ways in which narratives can be used to understand sexual experiences, using coercion as a specific example. The narratives examined are from interviews with young people in low-income areas of Mexico City. This study demonstrates that sexual coercion is impossible to define objectively. In addition, the concept of coercion is focused too much on women, excluding men's negative sexual experiences, and can include events that the 'victims' do not see as coercive. Coercion is a highly subjective and fluid concept, limiting its value as a defining element of sexual health. An alternative way of conceptualising coercive experiences is suggested.

Adolescent↗

PubMed2003

The developmental antecedents of sexual coercion against women: testing alternative hypotheses with structural equation modeling.

A unified model of the origin of sexual aggression against women on both adult and juvenile sexual offender samples has been developed and successfully tested. This model proposed three major causal paths to sexual coercion against women. In the first path, physical and verbal abuse was hypothesized to produce callousness and lack of emotionality, which disinhibited sexual drive and sexual fantasies. These in turn disinhibited hostile sexual fantasies, and led to sexual coercion. In the second causal path, sexual abuse contributed directly to the disinhibition of sexual drive and sexual fantasies, which through hostile sexual fantasies led to sexual coercion. The third path operated through early antisocial behavior, including aggressive acts. It developed as a result of both physical/verbal abuse and callousness/lack of emotion. It in turn directly affected sexual coercion and worked indirectly through the hostile sexual fantasies path. In the present study, the anonymous responses of a group of 168 blue-collar, community males to an inventory (the Multidimensional Assessment of Sex and Aggression) were used in a structural equation model to test the validity of this model. Moreover, this model was pitted against (Malamuth's (1998)) two-path model. Whereas the three-path model had an excellent fit with the data (CFI =.951, RMSEA =.047), the two-path model fit less well (CFI =.857, RMSEA =.079). These results indicate the superiority of the three-path model and suggest that it constitutes a solid, empirically disconfirmable heuristic for the etiology of sexual coercion against women.

Adolescent↗

PubMed2006

Black markets, transplant kidneys and interpersonal coercion.

One of the most common arguments against legalising markets in human kidneys is that this would result in the widespread misuse that is present in the black market becoming more prevalent. In particular, it is argued that if such markets were to be legalised, this would lead to an increase in the number of people being coerced into selling their kidneys. Moreover, such coercion would occur even if markets in kidneys were regulated, for those subject to such coercion would not be able to avail themselves of the legal protections that regulation would afford them. Despite the initial plausibility of this argument, there are three reasons to reject it. Firstly, the advantages of legalising markets in human kidneys would probably outweigh its possible disadvantages. Secondly, if it is believed that no such coercion can ever be tolerated, markets in only those human kidneys that fail to do away with coercion should be condemned. Finally, if coercion is genuinely opposed, then legalising kidney markets should be supported rather than opposed, for more people would be coerced (ie, into not selling) were such markets to be prohibited.

Coercion↗

PubMed2003

Perceived coercion at hospital admission and adherence to mental health treatment after discharge.

The authors investigated whether mental health inpatients' perceptions of coercion were associated with later treatment adherence. Psychiatric inpatients receiving acute care at three sites were interviewed during their hospitalization and up to five times after discharge. Patients' perceptions of coercion were measured at admission. Adherence to medication and clinical treatment was measured every ten weeks for one year after discharge. Among the 825 patients who had a perceived coercion score and ten-week follow-up data and who reported that outpatient treatment was prescribed, perceived coercion scores were not associated with treatment adherence. The authors concluded that perceived coercion neither increases nor decreases psychiatric inpatients' medication adherence or use of treatment services after discharge.

Adolescent↗

PubMed2001

[Case-control study on sexual coercion and related risk factors in China].

OBJECTIVE: To find out the determinants of sexual coercion among adolescent abortion seekers in China. METHODS: Case-control study was adopted. Women seeking for abortion and ever having experienced sexual coercion were taken as case group and those who had never experienced sexual coercion as control group. Case-control study was carried out in 11 large hospitals in Beijing city from January 2000 to April 2000. RESULTS: The number of subjects in case group was 512, comparing to 517 in the control group. The mean age of subjects was 20.25 years with monthly income 881.2 RMB Yuan. The difference between case group and control group in income, occupation and age showed no statistical significance. The results of the study indicated that the factors which were more likely to be related to sexual coercion include lower educational level (chi(2) = 15.27, P < 0.01, OR: 1.71), not living with parents (chi(2) = 10.18, P < 0.01, OR: 1.50), mobile nature (chi(2) = 20.60, P < 0.01, OR: 1.78), experienced battery by partner (chi(2) = 6.79, P < 0.01, OR: 2.72), abused by her partner (chi(2) = 4.22, P < 0.05, OR: 1.71) multi-partners (chi(2) = 19.08, P < 0.01, OR: 2.17), sex after being drunk (chi(2) = 34.22, P < 0.01, OR: 5.04), and larger gaps of in age between male and female partners (chi(2) = 11.04, P < 0.01, OR: 2.17). CONCLUSION: Factors as, poor-educated, not living with parents, floating population, multi-partners, the inequality between male and female were more likely to increase the risk of sexual coercion.

Adult↗

PubMed2001

Experience of sexual coercion among adolescents in Ibadan, Nigeria.

This study surveyed 1,025 adolescent students and apprentices in Ibadan, Nigeria, to document their sexual behaviour and experience of sexual coercion including verbal threats, unwanted touch, unwanted kiss, assault, deception, drugging, attempted rape, and rape. Sixty five per cent of male and 48% of female apprentices were sexually experienced, compared to 32% of male and 24% of female students. More males than females reported sex with multiple partners and contact with a sex worker while females had exchanged sex for money and gifts. Fifty five per cent of all the subjects had been victims of at least one type of sexual coercion, the commonest being unwanted kiss and touch of breasts (47%). Although both males and females were victims of coercion, females were disproportionately affected--68% of female students and 70% of apprentices had experienced one coercive behaviour, compared to 42% of male students and 40% of apprentices. Female apprentices fared worst, with 19% of them raped. The main perpetrators of the coercion were persons well known to the victims including neighbours, peers and boy/girlfriends. We recommend multiple intervention programs including skills training for young persons, sensitisation workshop for training health workers, and media advocacy for the public to challenge stereotypes that favour sexual coercion of adolescents.

Adolescent↗

PubMed1998

Coercion in psychiatric care: what have we learned from research?

The use of coercion to assure that people with a mental illness receive treatment has been the focus one of the longest running controversies among mental health professionals. Until quite recently, however, this debate has been almost entirely based on abstract principles. Empirical research concerning coercion was quite limited. Recently, however, research in this field has blossomed. The development of a validated measure of perceived coercion has spawned a variety of new studies. A five-nation study in Scandinavia has begun the difficult task of assessing the impact of different legal systems and systems of care on perceived coercion. Two new studies have used random assignment designs to study the impact of outpatient commitment. This article reviews these and other studies and describes what they do, and do not, tell us about coercion in mental health treatment.

Ambulatory Care↗

PubMed2001

Case-controlled study on relevant factors of adolescent sexual coercion in China.

This was a case-controlled study to determine factors related to sexual coercion among adolescent abortion seekers in China. We considered the abortion-seeking women who had experienced sexual coercion as the case group and the abortion-seeking women who had never experienced sexual coercion as the control group. The results of the study indicated that the factors more likely to be related to sexual coercion include lower educational level [odds ratio (OR) = 1.55], not living with parents (OR) = 1.57, floating population (OR = 1.63), beaten by her partner (OR = 2.87), abused by her partner (OR = 1.84), multiple partners (OR = 2.10), sex after excessive drinking (OR = 5.02), younger age at first intercourse (OR = 1.68), and large difference in age between men and women (OR = 2.02). The relevant factors most likely to be associated with sexual coercion are poorly educated, not living with parents, floating population, multiple partners, younger age at first sex, and inequality between men and women.

Abortion, Induced↗

PubMed2001

Childhood sexual abuse, adolescent sexual coercion and sexually transmitted infection acquisition among homeless female adolescents.

OBJECTIVE: To examine the relationship between childhood experiences of sexual abuse, sexual coercion during adolescence, and the acquisition of sexually transmitted infections (STIs) in a population of homeless adolescents. METHOD: Homeless adolescent females (N = 216) from a northwestern United States city were recruited by street outreach workers for a longitudinal study of STI epidemiology. Baseline data on childhood abuse and recent history of sexual coercion were used to predict physiologically confirmed STI acquisition over the subsequent 6 months. RESULTS: About 38% of all girls reported a history of childhood sexual abuse (CSA). Girls with a history of CSA were more likely to report recent sexual coercion. In turn, sexual coercion in the last three months was significantly associated with a higher number of sexual partners (but not with a greater frequency of intercourse or with lower rates of condom use). Number of sexual partners significantly predicted the future acquisition of an STI within 6 months. CONCLUSIONS: Interventions to reduce risky sexual behaviors in homeless adolescent females may need to consider the impact of CSA, particularly on the number of sexual partners during adolescence. However, it also should be noted that engagement in intercourse often results from coercion and is not voluntary in this population.

Adolescent↗

PubMed2002

Perceived verbal conflict behaviors associated with physical aggression and sexual coercion in dating relationships: a gender-sensitive analysis.

We studied perceived partner verbal behaviors associated with participants' use of dating aggression. Men's reports of their partners' demanding, controlling, and psychologically abusive behaviors during conflicts were expected to predict men's perpetration against partners. In contrast, women's reports of their partners' withdrawal were expected to predict women's perpetration. Data were collected from heterosexual undergraduates (N = 223) in exclusive dating relationships. Participants' reports of partner demands and partner psychological abuse were associated with participants' use of physical aggression and sexual coercion. Reports of partner withdrawal and partner controlling behaviors were associated with participants' sexual coercion only. Significant moderating effects of gender emerged. As expected, partner demands, controlling behaviors, and psychological abuse were associated with physical aggression and sexual coercion in men, but not women. Partner withdrawal was associated with sexual coercion in both women and men. We conclude that gender-sensitive approaches are necessary to understand and prevent verbal conflict patterns associated with physical aggression and sexual coercion in intimate relationships.

Adolescent↗

PubMed1995

Male and female sexual victimization in dating relationships: gender differences in coercion techniques and outcomes.

Previous research on dating sexual coercion defines females as victims and males as perpetrators. This study expands on a trend to include male victims of sexual coercion in order to contrast their experiences with female victims. Results from 422 Midwestern, college students reveal a phenomenal amount of sexual coercion is occurring. Although women report more victimization, both males and females in the study reported coercion resulting in sexual behaviors ranging from kissing to intercourse. Coercive tactics targeted in this study included: intoxication, blackmail, lies, false promises, guilt, threats to end the relationships, persistent touching, being held down, detainment, threat of physical force, use of force, and use of weapon. Multivariate analysis of variance (MANOVA) revealed that women were more likely to experience unwanted sexual behavior when the following coercive tactics were used: detainment, persistent touching, lies, and being held down. Men were more likely to report unwanted sexual behavior ranging from kissing to intercourse when female dates used blackmail, or a weapon. Low frequency of the weapon item renders this finding less significant. Chi-square results reveal a pattern of coercing women into more extreme behaviors, such as intercourse, while men report coercion ending in milder behavior, such as unwanted kissing or touching.

Adult↗

PubMed1995

Heterosexual and homosexual coercion, sexual orientation and sexual roles in medical students.

Rape has been conceptualized on a dimension of normal male behavior. The Koss and Oros (1982) study used a questionnaire that allowed men to respond only as sexual aggressors of women, and women only as victims of men. Medical students' responses to a modified questionnaire, in which both sexes reported being aggressors and/or victims, revealed that relatively comparable proportions of men and women were victims of coercive experiences: 35% of women and 30% of men experiencing constant physical attempts to have sexual activity. Forms of coercion not involving threat or use of force were more common, more exclusively heterosexual, and carried out by more equivalent percentages of men and women. 15% of women and 12% of men felt initially coerced into sexual activity but then enjoyed it. Threat or use of force to attempt to or to obtain intercourse were employed by 4% of men and 2% of women and experienced by 5% of both sexes. Half the male victims and female aggressors and a quarter of the male aggressors and female victims who reported such coercion stated it was homosexual. The ratio of homosexual/heterosexual feelings reported by male, but not female, students correlated with the degree of the homosexual coercion they both carried out and experienced. The degree of sexual coercion carried out by men and women correlated with their masculine sex role scores, suggesting, if the dimensional concept of rape is valid, that rape is on a continuum with masculine rather than male behaviors.

Adult↗