Perceptions Of Coercion Research Articles

The Influence of False Evidence Ploy Variants on Perceptions of Coercion and Deception

ABSTRACT During custodial interrogations, law enforcement officers are permitted to use various methods of deception to entice a suspect to give a confession. Two of these commonly used methods include the False Evidence Ploy (FEP), and its less deceptive variant, the bluff tactic. While the bluff may appear to be less deceptive than the FEP, it also influences innocent suspects to confess. In the present study, participants were shown 1 of 6 possible videos that varied the type of deception (control/FEP/bluff) along with interrogation length (1/12 hours). Participants rated how deceptive and coercive the interrogation was and rendered guilt judgments. The results indicates that participants failed to distinguish between the FEP and the bluff in terms of either deceptiveness or coercion, and neither deception type nor interrogation length impacted guilt judgments. Judgments of deception, coercion, and guilt intercorrelated, but participants did not distinguish between the deception tactics in any of these measures. The implications for juror evaluations of videotaped confessions during trial and the potential for wrongful convictions are discussed.

Attitudes on breast feeding among persons with HIV who have given birth and their perceptions of coercion during counseling on safe infant feeding practices

ABSTRACT Persons with HIV can receive mixed messages about the safety of breastfeeding. We sought to assess if they felt coerced to formula feed when counseled about practices to reduce HIV transmission. Persons with HIV who had given birth were eligible to complete a survey to describe their experiences with infant feeding counseling and if they felt coerced to formula feed. An Iowa Infant Feeding Attitude Scale (IIFAS) assessed attitudes towards breastfeeding. Qualitative analyses were performed on narrative responses. One hundred surveys were collected from sites in Georgia, North Carolina, Pennsylvania, and South Carolina. The mean IIFAS score (n, 85) was 47 (SD 9.2), suggesting relatively favorable attitudes toward breastfeeding. Thirteen persons reported feeling coerced to formula feed. When controlling for choosing to give any breast milk, persons with any college education were more likely to report feeling coerced (aOR 9.8 [95% CI 1.8–52.5]). Qualitative analyses revealed three themes: perceiving breastfeeding as unsafe, engaging in shared decision-making, and resisting advice to formula feed. Persons with HIV desire to be counseled about safe infant feeding practices and have their questions answered without judgement. We highlight experiences of persons with HIV that reflect a need for a nuanced approach to infant feeding counseling.

The Effectiveness and Ethics of Incentives for Research Participation: Two Embedded Randomized Recruitment Trials

Background: Using financial incentives to improve research participation is controversial and variably regulated due to uncertainty regarding whether incentives serve as undue inducements by blunting peoples’ sensitivity to research risks, or unjust inducements by preferentially increasing enrollment among disadvantaged persons. Methods: Patients were randomly assigned to incentives of $0, $200, or $500 for participating in a trial comparing smoking cessation interventions, and to $0, $100, or $300 for participating in a trial evaluating an ambulation intervention. Each incentive trial was powered to rule out interactions between incentive size and perceived research risk (undue inducement), and between incentive size and income (unjust inducement), on the primary outcome of consenting to the parent trial. Findings: Incentives significantly increased enrollment among 654 patients in the smoking cessation trial (adjusted odds ratio (OR) for each increase in incentive = 1.70, 95% confidence interval (CI) = 1.34 – 2.17; p < 0.001), but not among 642 patients in the ambulation trial (adjusted OR = 0.88, 95% CI = 0.64 – 1.22; p = 0.45). In both trials, undue and unjust inducement were ruled out (upper confidence limits of ORs for undue inducement = 1.15 and 0.99, both p < 0.001; upper confidence limits of ORs for unjust inducement = 1.21 and 1.26, p = 0.011 and p < 0.001, respectively). In both trials, larger incentives were associated with more time spent reviewing consent forms (both p < 0.005). Incentives were not associated with perceived research risks, trial understanding, perceptions of coercion, or therapeutic misconceptions in either trial. Interpretation: Financial incentives increased trial enrollment in one of two trials, and did not produce undue or unjust inducement or other unintended consequences in either trial. Trial Registration: ClinicalTrials.gov number, NCT02697799. Funding Statement: National Cancer Institute. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: Approved by IRBs at the University of Pennsylvania and Northwestern University, using a waiver of the requirement for informed consent. The trials were also guided by an Ethics Advisory Board and overseen by a Data and Safety Monitoring Board (DSMB).

Perceptions and understanding of research situations as a function of consent form characteristics and experimenter instructions

Two studies examined how research methodology affected participant behaviors. Study 1 tested (a) consent form perspective (1st, 2nd, or 3rd person) and (b) information on participants’ right to sue upon perceptions of coercion, ability to recall consent information, and performance on experimental tasks. Unexpectedly, participants who received instructions without the right to sue information had significantly better recall of their research rights. Study 2 manipulated (a) consent form complexity (presence or absence of jargon) and (b) the detail of verbal instructions (simple, elaborate); participants who received a consent form with simpler language spent more time on a difficult task, and participants in the elaborate instruction condition recalled more details. Together, these studies suggest (a) explaining the right to sue may actually be counterproductive; (b) providing a more detailed explanation may help participants remember procedural details; and (c) using jargon may decrease task performance.

Perceptions of coercion in interrogation: comparing expert and lay opinions

ABSTRACT When confessions are entered into evidence in criminal courts, issues of coercion and voluntariness are important and often contested matters. Occasionally, defense attorneys proffer expert witnesses to testify about the coercive pressures of an interrogation and the risk of a false confession. Such testimony is often ruled inadmissible on the grounds that it does not inform the jury beyond its common knowledge. In our effort to test this judicial assumption about common knowledge, we surveyed jury-eligible laypeople (n = 67) and social scientists specializing in interrogation and confessions (n = 54) regarding their opinions about the coerciveness of prohibited interrogation tactics, maximization techniques, minimization techniques, and suspect risk factors and compared their ratings with a set of independent t tests. Laypeople gave lower ratings to the coerciveness of all sets of items representing interrogation techniques, and lower ratings to the vulnerabilities associated with suspect risk factors, as compared to social science experts. The disparities between laypeople’s and experts’ perceptions of coercion in interrogations demonstrate that such issues are not fully within the common knowledge of prospective jurors, and suggest the need to provide jurors with expert witness guidance when tasked with evaluating confession evidence.

Coercion in Outpatients under Community Treatment Orders: A Matched Comparison Study.

Since the deinstitutionalization of psychiatric services around the world, the scope of outpatient psychiatric care has also increased to better support treatment access and adherence. For those with serious mental illness who may lack insight into their own illness, available interventions include coercive community practices such as mandated community treatment orders (CTOs). This paper examines the perceptions of coercion among service users treated with a CTO. We used a cross-sectional comparative design where service users treated under a CTO were matched to a comparison group of voluntary psychiatric outpatients. Both groups were receiving intensive community mental health services (n = 69 in each group). Participants were interviewed using a series of questionnaires aimed at evaluating their perceptions of coercion and other aspects of the psychiatric treatment. The level of coercion reported by service users treated under a CTO was significantly higher than that in the comparison group. However, in adjusted analyses, service users' perception of coercion, irrespective of their CTO status, was directly correlated with their previous experience with probation and inversely correlated with the sense of procedural justice in their treatment. Evaluation of psychiatric service users' experiences of coercion should consider their past and current involvement with other types of coercive measures, particularly history of probation. Clinicians may be able to minimize these experiences of coercion by incorporating procedural justice principles into their practice.

"Treat me with respect". A systematic review and thematic analysis of psychiatric patients' reported perceptions of the situations associated with the process of coercion.

Introduction There is a lack of research into psychiatric patients' perceptions of coercion that discriminates between different types of coercive measures, while also investigating patients' perceptions of undergoing coercion as a process. This knowledge is required to improve our understanding and provide a foundation for improving clinical practice. Aims To review existing research literature in order to investigate adult psychiatric patients' reported perceptions of situations before, during and after specific and defined types of coercive measures, and to investigate what patients perceive as moderating factors, in regard to the use of these coercive measures. Method A systematic review and thematic analysis of 26 peer-reviewed studies was undertaken. Results The analysis identified six themes and additional subthemes, where "interactions with professionals" and "communication" were predominant themes across the timeline of coercion. Altogether, themes were associated with either "positive or negative patient-perceived impact." Implications for practice Increased sensitivity to patients' views of the situation at each point in the process is desirable in order to respond to the patients' individual needs. Professionals also need to articulate concern and empathy towards the patient and to improve communication skills before, during and after a coercive incident. Use of de-escalation and noncoercive strategies is required. Relevance statement Coercion within psychiatric/mental health care remains controversial, and repeated international calls have recommended a reduction of their use. This review indicates that greater attention to how patients perceive the use of coercive measures (before, during, and after incidents) needs to be considered in order to improve the evidence-based and clinical practice.

"That's Kind of One of Our Jobs": Sexual Activity as a Form of Care Work Among Women with Sexual Difficulties.

Willing engagement in unwanted or undesired sexual activity, often associated with fulfilling a partner's needs or sustaining intimate relationships, is common. Acquiescence with undesired sexual activity can be conceptualized as sexual care work, that is, domestic "labor" that women undertake with the goal of caring for their partners' well-being. Drawing on interviews with 53 women with dyspareunia (pain experienced during intercourse) and low desire, the aim of this study was to examine how women with sexual difficulties engage in sexual care work, the implications of the inability to perform such work for gender identity, and the ways in which sexual care work may blur the lines between women's perceptions of coercion and consent. The women in this study engaged in sexual activity for a number of reasons, including the pursuit of intimacy, to care for their partner, and to fulfill their perceived sexual obligations. Sexual compliance was conceptualized as a form of work, similar to other forms of unpaid care work such as housework or childcare, which negatively affected women's gender identities when it could not be performed. For many women, sex was simultaneously wanted and unwanted, contributing to women's ambivalence regarding the meaning of consent. Further exploration of these issues may lead to a better understanding of how gender is achieved through normative sexuality.

Service users' perspective of their admission: a report of study findings.

The 'Service Users' Perspective of their Admission' study examined voluntarily and involuntarily admitted services users' perception of coercion during the admission process and whether this was associated with factors such as the therapeutic alliance, satisfaction with services, functioning and quality of life. This report aims to collate the findings of the study. The study was undertaken across three community mental health services in Ireland. Participants were interviewed before discharge and at 1 year using the MacArthur Admission Experience. Caregivers of participants were interviewed about their perception of coercion during the admission. A total of 161 service users were interviewed and of those admitted involuntarily, 42% experienced at least one form of physical coercion. Service users admitted involuntarily reported higher levels of perceived coercion and less procedural justice than those admitted voluntarily. A total of 22% of voluntarily admitted service users reported levels of perceived coercion comparable with involuntarily admitted service users and this was associated with treatment in a secure ward or being brought to hospital initially under mental health legislation. In comparison with the service user, caregivers tended to underestimate the level of perceived coercion. The level of procedural justice was moderately associated with the therapeutic relationship and satisfaction with services. After 1 year, 70% experienced an improvement in functioning and this was not associated with the accumulated level of coercive events, when controlled for confounders. This study has provided valuable insights into the perceptions of coercion and can help inform future interventional studies aimed at reducing coercion in mental health services.

Perception of Coercion Among Patients With a Psychiatric Community Treatment Order: A Literature Review.

Various forms of compulsory psychiatric community treatment orders (CTOs) are commonly utilized internationally. CTOs remain contentious because of the ethical implications of coercing patients to receive treatment. Understanding patients' experience of CTOs can assist in the development of more patient-centered and recovery-focused community care. This review examined the relationship between CTOs and patients' perceptions of coercion in the literature. A search of key terms relating to CTOs and patients' perceptions of coercion was conducted of relevant databases from their inception to March 31, 2014. Publications were included if they were peer reviewed, reported on original research, surveyed or interviewed patients who were or had been subject to a CTO, and were written in English. Factors influencing patients' perceptions of coercion, including the regional context of the studies, were identified. Twenty-three primary research articles, reporting on 14 studies from seven countries, were included. Evidence indicated that CTOs may contribute to a patient's sense of coercion, with marked variations among studies in the levels of coercion. Contextual factors, including perceptions of alternatives to CTOs, the presence of additional forms of leverage in patients' lives, and the process of CTO initiation and enforcement, may mitigate or enhance perceptions of coercion. Coercive elements of CTOs may be reduced through increased patient access to information, better working relationships with service providers, and accessible, fair processes. The coercive aspects of CTOs should be seen as part of a broader understanding of the daily pressures and leverage applied in outpatient psychiatric treatment.

Perceptions of Coercion in Plea Bargaining

This paper contains five new psychological studies analyzing lay perceptions of what constitutes coercion in the plea bargaining process. We investigate what an average citizen without particular legal or moral training thinks is appropriate, in contrast to plea bargaining laws and practices as they currently exist. We find that there is a base perception of coercion by prosecutors negotiating plea bargains. We also find specific factors in the prosecutor's behavior and the defendant's situation that make the plea bargaining process seem more coercive.

Caregivers' perceptions of coercion in psychiatric hospital admission

While knowledge on service users' perspective on their admissions to psychiatric wards has improved substantially in the last decade, there is a paucity of knowledge of the perspectives of caregivers. This study aimed to determine caregiver's perception of the levels of perceived coercion, perceived pressures and procedural justice experienced by service users during their admission to acute psychiatric in-patient units. The perspective of caregivers were then compared to the perspectives of their related service users, who had been admitted to five psychiatric units in Ireland. Caregivers were interviewed using an adapted version of the MacArthur admission experience interview. Sixty-six caregivers participated in this study and the majority were parents. Seventy one percent of service users were admitted involuntarily and nearly half had a diagnosis of schizophrenia or schizoaffective disorder. Caregivers of involuntarily admitted individuals perceived the service users' admission as less coercive than reported by the service users. Caregivers also perceived a higher level of procedural justice in comparison to the level reported by service users. Reducing the disparity of perceptions between caregivers and service users could result in caregivers having a greater understanding of the admission process and why some service users may be reluctant to be admitted.

Prisoner Participation in Psychiatric-related Research: Perceptions of Coercion and Exploitation

Introduction Worldwide, over 10.2 million people are incarcerated. In Europe and the United States, prisoners experience higher rates of psychiatric illness than the general population. Clinical research may help improve the range and quality of psychiatric services in prison. Yet given the history of research abuses against prisoners, and ongoing concern that prisoners may be coerced or exploited by researchers, U.S. and European regulations greatly restrict prisoner research. Scant data exists on whether prisoners view modern clinical research as coercive or exploitative. Aim/Objective To improve our understanding of how prisoners view their participation in psychiatric-related clinical research, we sought to identify whether prisoners perceive their research participation as coercive or exploitative. Methods 70 participants from six psychiatric-related clinical research studies in the U.S. were recruited and asked to rate their agreement with several statements regarding study participation. Results No prisoner felt threatened by someone to enroll, and only 1 felt pressured by someone to enroll. One felt taken advantage of by the study, and 2 felt exploited by the study. All but 1 agreed that prisoners should have more access to research in general. Conclusions On balance, prisoners from this group do not perceive their study participation as coerced or exploitative and desire greater research opportunities. Given the urgent need for research studies that can address the complex psychiatric problems prisoners face, a better understanding of prisoner views toward research elsewhere in the U.S. and Europe is needed. Such work could support the easing of restrictions on prisoner research.

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

BackgroundDespite 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.MethodsSystematic 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.ResultsOut 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).ConclusionsThe 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.

Predictors of Perceived Coercion in Patients Admitted for Psychiatric Hospitalization and the Stability of these Perceptions over Time

The origins of patients’ perceptions of coercion during short-term psychiatric hospitalization are varied. The purpose of this study was to elucidate the characteristics of patients that are associated with higher levels of perceived coercion and to determine whether these perceptions remain stable one year after admission. One hundred and twenty-five patients were recruited within three days of admission to the acute units at the Alfred Hospital Inpatient Psychiatry Department, Melbourne, Australia. In the initial recruitment phase, patients’ perceptions of coercion, psychiatric symptoms and interpersonal style were assessed using the Macarthur Admission Experience Scale, the Brief Psychiatric Rating Scale-18 and the Impact Message Inventory–Circumplex. Admission status (voluntary versus involuntary) and demographic characteristics were also assessed. Follow-up assessments were conducted approximately one year later. Results suggest that a significant but small positive correlation existed between perceived coercion and a Hostile–Dominant interpersonal style at initial recruitment. Females reported significantly higher perceptions of coercion than males, but admission status and severity of psychiatric symptoms were unrelated to perceived coercion. Despite perceptions of coercion appearing to lessen over time, there is a need for specific interventions for these patients during their admission to hospital. There was a statistically significant decrease in perceived coercion over time.

Working alliance and its relationship to outcomes in a randomized controlled trial (RCT) of antipsychotic medication.

BackgroundLong acting injections (LAI) have been associated with perceptions of coercion in cross sectional studies but there have been no longitudinal studies of the effects on clinical relationships with newer depot medications.MethodRandomized controlled trial with (50) participants with a diagnosis of schizophrenia randomized to risperidone LAI or oral atypical antipsychotic medication. The main outcome was the Working Alliance Inventory (WAI) with background variables (symptoms, side effect, social functioning, quality of life) measured before randomization and at two years.ResultsAt follow-up (14 risperidone LAI and 16 oral medication) analyses including predictors of missing data and baseline score showed a trend for those on risperidone LAI to reduce WAI score and those on oral medication showing no change. Sensitivity analyses showed (i) a significant detrimental effect of LAI on WAI and (ii) the pattern of results was not affected by change in symptoms over the study.ConclusionThis is the first study to show that the prescription of depot atypical depot medication is associated with detrimental effects on clinical relationships after 2 years of continual treatment.

Adverse Impact of Coercive Treatments on Psychiatric Inpatients’ Satisfaction with Care

Consumers' satisfaction with inpatient mental health care is recognized as a key quality indicator that prospectively predicts functional and clinical outcomes. Coercive treatment experience is a frequently cited source of dissatisfaction with inpatient care, yet more research is needed to understand the factors that influence consumers' perceptions of coercion and its effects on satisfaction, including potential "downstream" effects of past coercive events on current treatment satisfaction. The current study examined associations between objective and subjective indices of coercive treatments and patients' satisfaction with care in a psychiatric inpatient sample (N=240). Lower satisfaction ratings were independently associated with three coercive treatment variables: current involuntary admission, perceived coercion during current admission, and self-reported history of being refused a requested medication. Albeit preliminary, these results document associations between patients' satisfaction ratings and their subjective experiences of coercion during both current and prior hospitalizations.

Examining Attitudes about and Influences on Research Participation among Forensic Psychiatric Inpatients

Although a growing body of research has examined various types of coercive practices that may occur among psychiatric patients over the years, almost no attention has been given to coercive influences that may occur specifically in the context of recruitment into research projects. Particularly for those who are institutionalized (e.g., in-patient insanity acquittees), there are significant concerns that their autonomous decision-making to consent or not may be significantly impaired due to the highly restrictive and controlled environment in which they live. This exploratory study sought to examine patients' perceptions of coercive influences by presenting them with hypothetical research vignettes regarding possible recruitment into either a biomedical or social-behavioral research project. Among 148 multi-ethnic male and female participants across two facilities, participants reported relatively minimal perceptions that their autonomous decision-making would be impacted or that various potentially coercive factors (e.g., pressures from staff) would impair their free choice to participate (or not) in such research. To the extent that such perceptions of coercion did occur, they were moderately associated with patients' more general personality traits and attitudinal variables, such as alienation and external locus of control. Limitations of this study and their implications for future research are discussed.

Perceptions of Coercion, Discrimination and Other Negative Experiences in Postpartum Contraceptive Counseling for Low-income Minority Women

Using in-depth qualitative methods, we investigated negative contraception counseling experiences, including those felt to be coercive or discriminatory, in a population of postpartum urban minority women. Brief surveys and semi-structured interviews were conducted with 30 consenting postpartum women who had received care at a Medicaid-funded obstetrics clinic. In-person one-on-one interviews were then reviewed for themes using an iterative process of qualitative analysis. In this sample of African American (63%) and Hispanic (37%) women (median age 26), 73% had unplanned pregnancies. Features of negative counseling experiences included having insufficient, non-physician-directed and impersonal counseling. Most women had experienced episodes of poor communication with providers; 10 described feeling coerced or perceiving racially-based discrimination in counseling. Negative experiences with contraceptive counseling may affect contraception utilization. Contraceptive education should respect each individual's autonomy, culture, and values.

The impact of interpersonal style and perceived coercion on aggression and self-harm in personality-disordered patients admitted to a secure psychiatric hospital

Recent research on aggressive behaviour in psychiatric hospitals has emphasised the importance of the interaction between characteristics of patients and the hospital environment. Interpersonal style, a key component of personality and personality disorder, has emerged as a potentially important characteristic that may be relevant to a patient's interactions with the hospital environment. Interpersonal style affects how patients relate to others and how they respond to the demands of treatment. This study explored the impact of interpersonal style and perceptions of staff coercion on aggression and self-harm. Participants were 39 patients with personality disorder admitted involuntarily to a secure psychiatric hospital. Results showed that perceptions of coercion were high but unrelated to aggression and self-harm. Interpersonal style did not relate to perceived coercion. However, patients with a more coercive interpersonal style, as measured by the Chart of Interpersonal Reactions in Closed Living Environments, were more likely to self-harm and/or act aggressively. Possible implications for the treatment of aggressive individuals and the prevention of aggressive behaviour are made.