Coercion in Psychiatry: Exploring the Subjective Experience of Coercion Among Patients in Five Portuguese Psychiatric Departments.

The subjective experience of coercion may have a more significant impact on clinical outcomes than formal coercive measures. This study aimed to investigate the subjective experience of coercion among patients on admission in Portuguese psychiatric departments by assessing their perceived coercion, procedural justice, and negative pressures during admission. The study also investigated whether this subjective experience of coercion changed with time during admission, and the predictors of this change. Validated instruments, including the McArthur Admission Experience Survey (AES) and the Client Assessment of Treatment Scale, were used to collect information from 208 adults admitted to five public psychiatric inpatient departments in rural and urban regions of Portugal. About a third (32.24%, n = 49) of the sample had a legal involuntary admission status, while more than a third of them perceived their admission to be involuntary (40.13%, n = 61). The subjective experience of coercion was significantly higher among people who perceived their admission to be involuntary compared to people who perceived their admission to be voluntary (Median = 10, IQR = 5.5 vs. Median = 3, IQR = 6; p < 0.001). Satisfaction with their care was significantly inversely correlated with the subjective experience of coercion (p < 0.01). The changes in the subjective experience of coercion at the second assessment were predicted by the perceived admission status rather than the legal admission status, and the initial procedural justice (p < 0.05). The study findings highlight the importance of improving procedural justice in psychiatric admissions, regardless of the legal status of admission.

Prevalence and acceptability of psychological and/or economic intimate partner violence, and utilization of mental health services by its survivors in Lithuania.

BACKGROUND: Lithuania has one of the highest averages in the European Union when it comes to psychological and/or economic intimate partner violence (PE-IPV). IPV survivors are several times more likely to have mental health conditions than those without IPV experiences. The aim of this article is to study the prevalence, characteristics and attitudes of PE-IPV survivors in Lithuania, and the predictors of them accessing mental health services. METHODS: A cross-sectional study based on a national survey representative of the adult population. The survey was implemented by a third-party independent market research company employing an online survey panel. Logistic regression models were used in the analysis. RESULTS: Almost 50% of women in Lithuania experience PE-IPV. Females are significantly more likely to experience it than males. The vast majority of women find PE-IPV unacceptable; however, only one-third of survivors seek any type of help. Only one-tenth approach mental health services, with divorcees being at higher odds of doing so. CONCLUSIONS: Further research is needed to explore predictors and contextual factors of why IPV survivors seek mental healthcare, or not. Policy implications include the need to eliminate IPV and mental health stigma; develop accessible mental health services and effective treatment approaches.

Mental health conditions and utilisation of mental health services by survivors of physical intimate partner violence in Portugal: Results from the WHO world mental health survey.

The aim of this article is to study mental health conditions among survivors of severe physical intimate partner violence (IPV) and their utilisation of mental health services. This study is an integrated part of the World Mental Health Survey Initiative-Portugal, for which data was collected from a nationally representative adult sample using well-validated scales. Logistic regression models were used in the analysis. The most common statistically significant mental health conditions among IPV survivors were suicide ideation, PTSD, major depressive episode, and generalised anxiety disorder. More than one in three survivors developed PTSD. Suicide ideation was likely to occur after first experiencing IPV. Almost a half of survivors received specialised mental health treatment; in most cases, delivered by a psychiatrist. Over 60 % addressed their mental health issues consulting general physicians or other healthcare professionals. Those who experienced family violence in childhood had greater odds of also experiencing IPV; survivors of IPV with this experience were more likely to receive mental health treatment. The need to promote greater awareness and competencies of not only mental health professionals but also of general physicians and other healthcare professionals to provide support more effectively to survivors of any type of IPV deserves to be emphasised.

Revisiting the psychometric properties of the McArthur admission experience survey: Validating the Portuguese version using a bifactor approach.

Cultural factors play a significant role in shaping the perception of coercion during psychiatric admissions. The present study aimed to assess the psychometric properties of the Portuguese Admission Experience Survey(P-AES). The study employed a cross-sectional approach in five psychiatric departments in three regions of Portugal. A total of 208 patients participated in the survey. Reliability was assessed through internal consistency and test-retest procedures. Internal validity was analyzed using a two-parameter logistic item response model, exploring three models, including a bifactor model. Convergent validity was determined by correlating AES scores with the Coercion Ladder (CL), Client Assessment of Satisfaction (CAT), and Global Assessment of Functioning (GAF) scale. Discriminatory power was assessed by comparing scores between patients with voluntary and involuntary admission status. The P-AES demonstrated satisfactory internal consistency and test-retest reliability. The bifactor model exhibited superior fit compared to the one-factor and three-factor models. Correlations between P-AES and CL, as well as CAT scores, indicated good convergent validity. Additionally, P-AES scores were notably higher in patients with compulsory psychiatric hospital admission compared to those admitted voluntarily, confirming its discriminatory power. The bifactor model suggests that all three domains of the AES should be used to measure the subjective experience of coercion.

Use of coercion in mental healthcare services in Nigeria: Service providers' perspective.

BACKGROUND: There is increasing advocacy to reduce coercive practices in mental healthcare. Little research has been done on the topic in developing countries. AIMS: To explore what mental health professionals in Nigeria think about coercion, why it is used, and what contextual factors influence its use in mental healthcare services. METHODS: Semi-structured interviews were carried out with 16 doctors and 14 nurses from two psychiatric hospitals in two regions of Nigeria. The audio-recorded interviews were analyzed thematically with the aid of MAXQDA software. RESULTS: Three broad categories relating to the perception of, reasons for, and barriers/facilitators to the use of coercion were derived. Coercion was viewed as being for the best interests of patients, a means to an end, and effective for achieving desired outcomes. Safety was both a reason to use a coercive measure and a deterrent to using specific coercive measures thought to be unsafe. The socio-cultural context, obsolete mental health legislation, staff shortages, and attitudes were factors influencing the use of coercion in mental healthcare. CONCLUSION: Coercion was perceived to be ultimately beneficial in mental health practice. There is need for a new mental health legislation and more resources for mental health care in Nigeria to address the problem of coercion.

Cross-sectional survey data on the socio-demographic characteristics associated with substance use among internal displaced persons in Maiduguri, Nigeria.

Regression analysis was carried out to examine the association between certain socio-demographic characteristics and substance use among internally displaced persons (IDPs). Using an adapted version of the Drug Use Disorder Identification Test (DUDIT) instrument, cross-sectional survey data were obtained from 520 IDPs living in three camps located in Maiduguri, Borno state of Nigeria. The data were analyzed using Statistical Package for Social Sciences software version 21.0. Specifically, this article provides data about the participants' demographic characteristics, the types of substances they use, reasons for using such substances, and the prevalence of substance use. This dataset can offer valuable multivariate information for future research agendas in similar, or closely related study populations. This cross-sectional dataset is also valuable for policymakers who are seeking ways to intervene in the substance use problem, as well as other associated social vices, affecting the vulnerable population of IDPs.

Zero Tolerance for Coercion? Historical, Cultural and Organisational Contexts for Effective Implementation of Coercion-Free Mental Health Services around the World.

Coercion of service users/patients when receiving care and treatment has been a serious dilemma for mental health services since at least the 18th century, and the debate about how best to minimise or even eradicate compulsion remains intense. Coercion is now, once again and rightly, at the top of the international policy agenda and the COST Action 'FOSTREN' is one example of a renewed commitment by service user advocates, practitioners and researchers to move forward in seriously addressing this problem. The focus of service improvement efforts has moved from pure innovation to practical implementation of effective interventions based on an understanding of the historical, cultural and political realities in which mental health services operate. These realities and their impact on the potential for change vary between countries across Europe and beyond. This article provides a novel overview by focusing on the historical, cultural and political contexts which relate to successful implementation primarily in Europe, North America and Australasia so that policy and practice in these and other regions can be adopted with an awareness of these potentially relevant factors. It also outlines some key aspects of current knowledge about the leading coercion-reduction interventions which might be considered when redesigning mental health services.

Contextual factors influencing the use of coercive measures in Portuguese mental health care.

The use of coercive measures in mental health care is an important indicator of the quality of care being provided, and non-patient-related factors are increasingly recognized to contribute to their use. The study aimed to explore the perspectives of mental health care professionals who have first-hand experience with the use of coercion on the contextual factors that influence the use of coercion in the Portuguese mental health care. Five focus group discussions were conducted among 23 doctors and 17 nurses from five psychiatric departments in urban and rural regions of Portugal. Discussions were audio recorded, transcribed, and analyzed with the aid of MAXQDA. Four broad themes related to insufficient resources, staff-related factors, inefficient services, and socio-legal factors were derived. Participants highlighted how inadequate structures, staff shortages, staff attitudes, a lack of training, restrictive ward rules, an inefficient organization of services, the mental health legislation, and public attitudes contributed to the use of coercive measures. The COVID-19 pandemic complicated existing shortfalls in the system and increased the use of coercive measures. The study confirms that the use of coercive measures in mental health care is influenced by factors that are independent of patient characteristics. Addressing existing systemic problems is crucial for the successful implementation of interventions to reduce coercion in mental health care.

Beyond Patient Characteristics: A Narrative Review of Contextual Factors Influencing Involuntary Admissions in Mental Health Care.

Variations in the rates of involuntary admission (IA) reflect the influence of unexplained contextual variables that are typically too heterogeneous to be included in systematic reviews. This paper attempts to gather and analyze factors unrelated to the patients that have been linked to IA. The articles included in this review were selected by iteratively searching four electronic databases (PubMed, PsychINFO, EMBASE, and Web of Science). A total of 54 studies from 19 different countries and regions, including 14 European countries, the United States, Canada, China, Vietnam, and Taiwan, were selected. The factors were categorized as service-related factors, impactful events, seasonal and temporal factors, mental health legislation, staff factors, and public attitudes. The factors rarely act in isolation but rather interact and reinforce each other, causing a greater influence on IA. This paper explains how these factors present opportunities for robust and sustainable interventions to reduce IAs. The paper also identifies future directions for research, such as examining the effects of economic recessions. Enhancing global reporting standards is essential to validate future research and support further in-depth studies. The complexity of the factors influencing IA and the implicit role of society suggest that resolving it will require social change.

A qualitative integrative analysis of service users' and service providers' perspectives on ways to reduce coercion in mental health care.

PURPOSE: The movement to develop and implement non-coercive alternatives in the provision of mental health care is gaining momentum globally. To strengthen the basis of potential interventions that will be contextually relevant, and to complement the body of literature which is largely from high-income settings, the current study sought to explore the suggestions of service users and providers in Nigeria on how to reduce the use of coercive measures in mental health settings. METHODS: Semi-structured interviews with 30 mental health professionals and four focus group discussions among 30 service users from two psychiatric hospitals in Nigeria were conducted. The data were analyzed thematically with the aid of MAXQDA. RESULTS: The suggestions proposed by service users and mental health professionals were within the broad themes of communication, policies and legislation, and increased resources. Service users felt that improved communication, home consultations, non-legal advocates and clear rules and legislation would reduce the use of coercion, while service providers suggested increased public mental health literacy, better interpersonal relationships with patients, increased resources for mental health care, more research on the topic and regulation of coercive measures. CONCLUSION: Many of the suggestions from this study reinforce strategies already in place to decrease coercion in other settings. However, additional recommendations that are relevant to the study setting, such as enhancing public mental health literacy, mental health legislation reform and increasing access to mental health services, deserve further consideration.

Depression Among Immigrant Nigerians in Canada.

Immigrant status, especially a few years post arrival, is a major risk factor for depression in populations that have been adequately studied. While information on depression among Asian migrants, including those from India, China and Philippines, in Canada have been reported in previous studies, there is inadequate information about depression among Nigerian immigrants who make up the largest percentage of African migrants and black population residing in Canada. A cross-sectional study was conducted among 187 Nigerian immigrants in Canada. Participants completed the Patient Health Questionnaire (PHQ-9). Descriptive and multivariate logistic regression analyses were carried out using IBM SPPS. About half (51.7%, n = 91) of the participants screened positive to the PHQ-9. Being female, unmarried, not being at all satisfied with the decision to migrate, and having stayed for more than 10 years in Canada significantly increased the risk of screening positive to depression. More than half of the participants screened positive for depression, suggesting an important mental health concern and the potential need for intervention. This population differed from other immigrant populations from previous studies because the absence of social support, satisfaction with employment status, and perceived discrimination did not significantly predict a positive screen for depression in this study.

Healthcare professionals' perceived stigmatization about direct care of COVID-19 Patients: development and validation of the discrimination about COVID-19 (DisCOV-19) instrument.

Background: The novel coronavirus disease 2019 (COVID-19) is a public health concern worldwide. Healthcare professionals are among the most vulnerable groups in the fight against COVID-19 because they are directly involved in the care of at-risk persons and patients with Covid-19. Objectives: This study aimed to measure the level to which healthcare workers feel that they can be discriminated due to their involvement in the direct care of COVID-19 patients. Methods: A cross-sectional online survey was conducted among healthcare professionals in Nigeria. A nineteen-item discrimination against COVID-19 (DisCOV-19) questionnaire was developed and validated for the study. Descriptive statistics and One-Way Analysis of Variance were used for data analysis. P<0.05 was considered statistically significant. Results: Out of the 286 healthcare practitioners that participated in the study, 58.4% and 30.1% were pharmacists and physicians, respectively. The majority of the participants were at least "moderately concerned" about disability (60.9%), death (71.7%), unknown complications (65.1%), and risk of infecting family members and friends (83.2%) if asked to provide care for COVID-19 patients. The physicians had a significantly higher mean discrimination score compared to the pharmacists (p=0.041). Pharmacists had a significantly lower mean discrimination score than the nurses (p=0.011). Conclusions: Many of the healthcare professionals reported a certain level of concern and perceived that they could face some forms of discrimination for providing care to COVID-19 patients.

Predictors of fertility awareness among selected married women of childbearing age in Nigeria: a cross-sectional survey.

Background: Increased fertility awareness can help infertile couples to achieve pregnancy. Objectives: This study aimed to determine both the predictors and levels of fertility awareness among married Nigerian women of childbearing age. Methods: A nationwide cross-sectional survey. Data were collected via online and face to face questionnaires. Descriptive and inferential analysis were done with SPSS 25. Results: Most respondents married between ages 24-29 years old (40%) and just over half had good fertility awareness (53%). The associated factors were age at menarche (X2 = 9.962, p = 0.007), geopolitical zone of residence (X2 = 17.301, p = 0.008), level of education (X2 = 64.843, p < 0.001), employment status (X2 = 9.319 p = 0.025) menstrual cycle charting (X2 = 66.392, p < 0.001), use of internet to increase awareness (X2 = 39.849, p < 0.001) and books (X2 = 58.855, p < 0.001). Fertility awareness was lower for those with secondary education than postgraduates (AOR=0.213, 95% CI 0.116-0.390, p < 0.001). Moreover, the odds of having good fertility awareness were less in those who did not chart their menstrual cycle (AOR=0.363, 95% CI 0.245-0.538, p < 0.001). Conclusion: Menstrual cycle charting and level of education were predictors of fertility awareness.

Experiences and perceptions of coercive practices in mental health care among service users in Nigeria: a qualitative study.

BACKGROUND: People with mental health problems are more vulnerable to a broad range of coercive practices and human rights abuses. There is a global campaign to eliminate, or at the very least decrease, the use of coercion in mental health care. The use of coercion in psychiatric hospitals in developing countries is poorly documented. The primary aim of this study was to explore service users' perceptions and experiences of coercion in psychiatric hospitals in Nigeria. METHODS: Four focus group discussions were carried out among 30 service users on admission in two major psychiatric hospitals in Nigeria. The audio recordings were transcribed verbatim and then analyzed thematically with the aid of MAXQDA software. RESULTS: The Focus group participants included 19 males and 11 females with a mean age of 34.67 ± 9.54. Schizophrenia was the most common diagnosis (40%, n = 12) and had a secondary school education (60%, n = 18). The focus group participants perceived coercion to be a necessary evil in severe cases but anti-therapeutic to their own recovery, an extension of stigma and a vicious cycle of abuse. The experience of involuntary admission revolved mainly around deception, maltreatment, and disdain. Participants in both study sites narrated experiences of being flogged for refusing medication. Mechanical restraint with chains was a common experience for reasons including refusing medications, to prevent absconding and in other cases, punitively. The use of chains was viewed by participants as dehumanizing and excruciatingly painful. CONCLUSION: The experiences of coercion by participants in this study confirm that human rights violations occur in large psychiatric hospitals and underscore the need for mental health services reform. The use of coercion in this context reflects agelong underinvestment in the mental health care system in the country and obsolete mental health legislation that does not protect the rights of people with mental health problems. The study findings highlight an urgent need to address issues of human rights violations in psychiatric hospitals in the country.

Social anxiety disorder and childhood adversities in Portugal: Findings from the WHO world mental health survey initiative.

Social anxiety disorder (SAD) is one of the most underrecognized and undertreated common mental disorders. This study aimed to describe its epidemiology and to understand the association between childhood adversities and SAD in the context of Portugal's collectivist culture. Data about SAD, childhood adversities, socio-demographic variables were collected from a nationally representative sample using well-validated scales employed for the World Mental Health Survey. Logistic and linear regression models were carried out to explore the association between childhood adversities and SAD prevalence and age of onset. The estimated lifetime prevalence of SAD was 4.68% and the 12-month prevalence was 3.14%. The mean age of onset was 13.6 ± 8.79. People with a college education had 3.42 higher odds of having SAD compared to people with no education or a primary school education. Most childhood adversities significantly increased the odds of a lifetime prevalence of SAD. Parental Maladjustment increased the odds of SAD when gender, age, and education were adjusted. The study findings show a relatively high prevalence of SAD in Portugal and confirms that females, younger people, students, and single people are more likely to have SAD. The study highlights the need to address experiences of parental maladjustment in interventions for people with SAD in Portugal.

Nigeria's mental health and substance abuse bill 2019: Analysis of its compliance with the United Nations convention on the rights of persons with disabilities.

Countries are struggling with reconciling their national mental health legislation with the CRPD approach, which stresses equality as the focal point of legislation, policies, and practices that affect people with disabilities. Several failed attempts have been made over the last two decades to update Nigeria's obsolete mental health legislation. The most recent attempt is the Mental Health and Substance abuse Bill 2019, which aims to protect the rights of people with mental health needs. It addresses many areas neglected by previous bills, such as non-discrimination of people with mental and substance use problems in the exercise of their civil, political, economic, social, full employment, religious, educational, and cultural rights. It categorically prohibits the use of seclusion in the treatment of people with mental health problems, makes provision for service users to be members of the Mental health review tribunal and allows for the protection of privacy and confidentiality of information about people with mental health problems. While keeping to most of WHO's recommendations for mental health legislation, the bill diverges from the CRPD's recommendations by allowing forced admission and treatment based on mental capacity, substitute decision-making by legal representatives or closest relatives, and non-prohibition of coercive practices. The bill does not make provisions for advance directives and is silent on informed consent to participate in research. Despite the bill's deficiencies, it would be a significant step forward for the country, whose current mental health legislation is the Lunacy Act of 1958. Although the CRPD has left it unclear how countries, especially low resource countries, should go about creating a workable legal framework, it is clear that all countries are expected to join the current global effort to eliminate, or at least reduce to the barest minimum, the use of coercion in mental health care. We expect that future revisions of this bill will examine its limitations in light of Nigeria's socio-cultural context.

The effect of classroom lectures and a movie recommendation on pharmacy students' attitudes and social distancing toward people with schizophrenia.

INTRODUCTION: Stigma and negative attitudes toward people with mental health disorders can impair the provision of pharmaceutical care. The purpose of the study was to assess the effect of classroom lectures on mental health disorders and a movie recommendation on pharmacy students' attitudes and stigma toward persons with schizophrenia (PwS). METHODS: The study consisted of a presurvey and postsurvey carried out among final-year pharmacy students of the University of Nigeria Nsukka. A survey comprising 3 sections on sociodemographic details, attitudes toward PwS, and a social distance scale was given to conveniently sampled students before and after lectures on schizophrenia. Students were encouraged to watch a movie about the experiences of a PwS after the first lecture. RESULTS: One hundred seventy-nine students (of the 200 sampled, response rate 91.1%) agreed to participate and completed the survey instrument before the clinical lecture, whereas 108 students who took part in the presurvey participated in the postsurvey (response rate of 76.0%). The overall mean negative attitude score reduced from 2.79 ± 0.412 to 2.72 ± 0.357. The overall mean social distance score increased from 2.48 ± 0.415 to 2.49 ± 0.467, indicating increased stigma. In both presurveys and postsurveys, people with a friend or relative with schizophrenia had a lower mean negative attitude score compared with those who did not. People who had watched the movie recommendation (n = 85) had a higher mean negative attitude (2.74 vs 2.67, P = .433) and a lower social distance toward PwS (2.57 vs 2.48, P = .415). DISCUSSION: Classroom lectures on mental health among pharmacy students might not significantly improve the overall attitudes and social distance toward PwS. Schools of pharmacy should consider alternative formats of teaching mental health-related topics, such as contact with real patients and simulation.

Aftermath of COVID-19: Forestalling Irreparable Medical Brain Drain in Sub-Saharan Africa.

With the escalation of the novel coronavirus disease (COVID-19) across the globe, shortages in the already scarce medical workforce are imminent. Historically, more developed economies have looked abroad to augment their health systems. This paper aims to offer plausible solutions on how to avert future medical brain drain from sub-Saharan Africa (SSA) in the aftermath of COVID-19. We opine that emigration of medical workers from low-resource settings to more industrialized regions should be viewed by the destination countries as both a moral and an ethical issue. Countries in SSA must generally provide good leadership, diversify their economies, and ensure adequate security. Specifically, there are needs to improve health care workers' remuneration, provide more opportunities for specialization, and reduce waiting time for employment. It is our opinion that such multisectoral and multi-modal approaches will effectively halt and even reverse the on-going brain drain in the region, converting it to brain gain.