The Development, Validation, and Feasibility of the Experienced Coercion Scale

Existing scales for experienced coercion have limitations. We developed and validated a short self-report form for experienced coercion for use across care settings, care phases, and care measures. In Stage 1, we developed an item pool, based on the literature, patient accounts, interviews, and expert feedback. Stages 2 and 3 consisted of 2 cross-sectional studies, with patients from acute and nonacute inpatient wards, outpatient care, and supported housing. In Stage 2, patients (N = 212) responded to the Coercion Ladder and the experienced coercion items from Stage 1. We selected 20 items for Stage 3 based on item performance in typically coercive versus voluntary care settings, each items' relation to the Coercion Ladder score, and with regard to the component structure from principal component analysis (PCA). In Stage 3, we collected and examined item responses and clinical and coercion data from a new sample of patients (N = 219). We selected 15 items based on factor loadings to form part of the final Experienced Coercion Scale (ECS). The internal consistency was high and score distribution approached the normal curve. ECS sum scores correlated strongly with scores on the Coercion Ladder. In a regression analysis, demographic variables, diagnosis, duration of treatment, and care setting did not predict ECS scores, while legal status and continuing involuntary medication significantly predicted scores. In this initial study, the ECS scores showed promising psychometric properties, suggesting it can be used across care settings and is suitable for research and service evaluation. Public Significance Statement It is possible to measure how much coercion mental health patients feel with a new 15-item questionnaire, which can be used both in inpatient and outpatient treatment. The Experienced Coercion Scale will make it easier to compare the coerciveness of different forms of mental health care or to find out how experienced coercion change as the care proceeds.