The Experienced Coercion Scale: Translation, Validation, and Evaluation of Psychometric Properties of a French-Language Version
Main Article Content
Abstract
Introduction: Perceived coercion refers to the subjective experience of coercion by individuals receiving mental healthcare. It has been shown to compromise their recovery process. The Experienced Coercion Scale (ECS) is a validated instrument designed to assess perceived coercion in mental health settings.
Objectives: This study aimed to translate, adapt, and evaluate the psychometric properties of a French-language version of the ECS among a sample of psychiatric inpatients from general and forensic settings in Quebec (Canada).
Method: A cross-sectional design was employed for this study. It was conducted across 7 general hospitals and specialized mental health institutions in Quebec, with a sample of 192 patients. Construct validity was assessed using exploratory factor analysis. Internal consistency was evaluated using Cronbach’s alpha (α) and McDonald’s omega (ω). Convergent validity was measured using a correlation matrix between scores on the Échelle de la coercition perçue (ECS-FR) and the French-language version of the Violence Prevention Climate scale (VPC-M-FR).
Results: The ECS-FR consists of 15 items across 2 subscales: (1) Restriction of Freedom, and (2) Dehumanization. The instrument demonstrated excellent internal consistency (Cronbach’s alpha = 0.93 and McDonald’s omega =0.93). Convergent validity was supported by a significant negative association between ECS-FR and VPC-M-FR scores (r = -0.63, p < 0.001), indicating that a higher perceived violence prevention climate was associated with lower levels of perceived coercion.
Discussion and Conclusion: The ECS-FR shows good psychometric properties. Its use across various inpatient mental health settings paves the way for further exploration of the factors underlying perceived coercion.
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References
Aguilera-Serrano, C., Guzman-Parra, J., Garcia-Sanchez, J. A., Moreno-Küstner, B., & Mayoral-Cleries, F. (2018). Variables Associated With the Subjective Experience of Coercive Measures in Psychiatric Inpatients: A Systematic Review. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 63(2), 129–144. https://doi.org/10.1177/0706743717738491
Aragonés-Calleja, M., & Sánchez-Martínez, V. (2025). Users’ Experience of Treatment and Coercion in an Inpatient Medium-Stay Psychiatric Rehabilitation Unit: A Mixed Methods Study. Journal of Psychiatric and Mental Health Nursing, 32(2), 467–481. https://doi.org/10.1111/jpm.13128
Baggio, S., Kaiser, S., Huber, C. G., & Wullschleger, A. (2024). Effect of coercive measures on mental health status in adult psychiatric populations: a nationwide trial emulation. Epidemiology and Psychiatric Sciences, 33, e35. https://doi.org/10.1017/S2045796024000416
Beeri, S., Baumberger, E., Zwakhalen, S., & Hahn, S. (2025). Conceptualisation of Informal Coercion in Inpatient Psychiatry: A Scoping Review. International Journal of Mental Health Nursing, 34(3), e70076. https://doi.org/10.1111/inm.70076
Bergk, J., Flammer, E., & Steinert, T. (2010). "Coercion Experience Scale"(CES) - validation of a questionnaire on coercive measures. BMC Psychiatry, 10, 1–10. https://doi.org/10.1186/1471-244X-10-5
Billé, V., Lessard-Deschênes, C., Sergerie-Richard, S., Désilets, M., Tansey, J., & Goulet, M. H. (2024). Informal coercion in inpatient mental healthcare: a scoping review protocol. BMJ Open, 14(2), e079549. https://doi.org/10.1136/bmjopen-2023-079549
Boateng, G. O., Neilands, T. B., Frongillo, E. A., Melgar-Quiñonez, H. R., & Young, S. L. (2018). Best Practices for Developing and Validating Scales for Health, Social, and Behavioral Research: A Primer. Frontiers in Public Health, 6, 149. https://doi.org/10.3389/fpubh.2018.00149
Brown, T. A. (2015). Confirmatory Factor Analysis for Applied Research (2nd ed.). Guilford publications.
Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, & Social Sciences and Humanities Research Council of Canada. (2022). Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans – TCPS 2 (Publication No. RR4-2/2023E-PDF). https://ethics.gc.ca/eng/policy-politique_tcps2-eptc2_2022.html
Chieze, M., Hurst, S., Kaiser, S., & Sentissi, O. (2019). Effects of Seclusion and Restraint in Adult Psychiatry: A Systematic Review. Frontiers in Psychiatry, 10, 491. https://doi.org/10.3389/fpsyt.2019.00491
Corbière, M., & Fraccaroli, F. (2020). La conception, la validation, la traduction et l’adaptation culturelle d’outils de mesure. In M. Corbière & N. Larivière (Eds.), Méthodes qualitatives, quantitatives et mixtes : Dans la recherche en sciences humaines, sociales et de la santé (2nd ed., pp. 721-722, 740-748). Presses de l’Université du Québec.
Corderoy, A., Kisely, S., Zirnsak, T., & Ryan, C. J. (2024). The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review. Psychiatry, psychology, and law: an interdisciplinary journal of the Australian and New Zealand Association of Psychiatry, Psychology and Law, 32(5), 734–781. https://doi.org/10.1080/13218719.2024.2346734
Fiorillo, A., Giacco, D., De Rosa, C., Kallert, T., Katsakou, C., Onchev, G., Raboch, J., Mastrogianni, A., Del Vecchio, V., Luciano, M., Catapano, F., Dembinskas, A., Nawka, P., Kiejna, A., Torres-Gonzales, F., Kjellin, L., Maj, M., & Priebe, S. (2012). Patient characteristics and symptoms associated with perceived coercion during hospital treatment. Acta Psychiatrica Scandinavica, 125(6), 460–467. https://doi.org/10.1111/j.1600-0447.2011.01809.x
Fossum, S. Ø., Moen, Ø. L., Gonzalez, M. T., Schröder, A., & Skundberg-Kletthagen, H. (2024). Investigating the Associations between Patient-Reported Quality of Care and Perceived Coercion: A Norwegian Cross-Sectional Study. Issues in Mental Health Nursing, 45(8), 784–793. https://doi.org/10.1080/01612840.2024.2361336
Gardner, W., Hoge, S. K., Bennett, N., Roth, L. H., Lidz, C. W., Monahan, J., & Mulvey, E. P. (1993). Two scales for measuring patients’ perceptions for coercion during mental hospital admission. Behavioral Sciences & the Law, 11(3), 307–321. https://doi.org/10.1002/bsl.2370110308
Goulet, M.-H., Desmarais, M., Pariseau-Legault, P., Larue, C., Jean-Baptiste, F., Turcotte, J.-S., & Crocker, A. (2021). Violence Prevention Climate Scale: Translation, Adaptation, and Psychometric Assessment of the French Canadian Version. Science of Nursing and Health Practices / Science infirmière et pratiques en santé, 4(2), 67–85. https://doi.org/10.7202/1086402ar
Goulet, M. H., Latulippe, M., Pariseau-Legault, P., Hallett, N., & Crocker, A. G. (2023). Violence Prevention Climate in Civil and Forensic Mental Health Settings: Common Goal, Different Views?. International Journal of Forensic Mental Health, 22(3), 233–242. https://doi.org/10.1080/14999013.2022.2150335
Goulet, M. H., & Larue, C. (2017). A case study: Seclusion and restraint in psychiatric care. Clinical Nursing Research, 27(7), 853–870. https://doi.org/10.1177/1054773817713177
Guzmán-Parra, J., Aguilera-Serrano, C., García-Sanchez, J. A., García-Spínola, E., Torres-Campos, D., Villagrán, J. M., Moreno-Küstner, B., & Mayoral-Cleries, F. (2019). Experience coercion, post-traumatic stress, and satisfaction with treatment associated with different coercive measures during psychiatric hospitalization. International Journal of Mental Health Nursing, 28(2), 448–456. https://doi.org/10.1111/inm.12546
Haugom, E. W., Stensrud, B., Beston, G., Ruud, T., & Landheim, A. S. (2022). Experiences of shared decision making among patients with psychotic disorders in Norway: a qualitative study. BMC Psychiatry, 22(1), 192. https://doi.org/10.1186/s12888-022-03849-8
Hotzy, F., Spiess, M., Ruflin, R., Schneeberger, A., Traber, R., Morandi, S., Jaeger, M., & Theodoridou, A. (2023). Association between perceived coercion and perceived level of information in involuntarily admitted patients: Results from a multicenter observational study in Switzerland. International Journal of Law and Psychiatry, 91, 101934. https://doi.org/10.1016/j.ijlp.2023.101934
Høyer, G., Kjellin, L., Engberg, M., Kaltiala-Heino, R., Nilstun, T., Sigurjónsdóttir, M., & Syse, A. (2002). Paternalism and autonomy: a presentation of a Nordic study on the use of coercion in the mental health care system. International Journal of Law and Psychiatry, 25(2), 93–108. https://doi.org/10.1016/s0160-2527(01)00108-x
Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: a Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118
Husum, T. L., Legernes, E., & Pedersen, R. (2019). “A plea for recognition” Users’ experience of humiliation during mental health care. International Journal of Law and Psychiatry, 62, 148–153. https://doi.org/10.1016/j.ijlp.2018.11.004
Indregard, A. M. R., Nussle, H. M., Hagen, M., Vandvik, P. O., Tesli, M., Gather, J., & Kunøe, N. (2024). Open-door policy versus treatment-as-usual in urban psychiatric inpatient wards: a pragmatic, randomised controlled, non-inferiority trial in Norway. The Lancet. Psychiatry, 11(5), 330–338. https://psycnet.apa.org/doi/10.1016/S2215-0366(24)00039-7
JASP Team. (2025). JASP (Version 0.19.3.0) [Computer software], https://jasp-stats.org/
Jordan, J. T., & McNiel, D. E. (2020). Perceived Coercion During Admission Into Psychiatric Hospitalization Increases Risk of Suicide Attempts After Discharge. Suicide & Life-Threatening Behavior, 50(1), 180–188. https://doi.org/10.1111/sltb.12560
Katsakou, C., Marougka, S., Garabette, J., Rost, F., Yeeles, K., & Priebe, S. (2011). Why do some voluntary patients feel coerced into hospitalisation? A mixed-methods study. Psychiatry Research, 187(1-2), 275–282. https://doi.org/10.1016/j.psychres.2011.01.001
Lessard-Deschênes, C., Goulet, M. H., & Pariseau-Legault, P. (2022). Factors associated with perceived coercion in adults receiving psychiatric care: a scoping review protocol. BMJ Open, 12(10), e065393. https://doi.org/10.1136/bmjopen-2022-065393
Lessard-Deschênes, C., Pariseau-Legault, P., Billé, V., Sergerie-Richard, S., Hudson, E., Silva, B., Drouin, J.-S., Désilets, M., & Goulet, M.-H. (2025). Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review. Healthcare, 13(15), 1868. https://doi.org/10.3390/healthcare13151868
Lessard-Deschênes, C., Pariseau-Legault, P., & Goulet, M. H. (2024). Does mental health practice benefit from procedural justice theory? A critical analysis on the opportunities and pitfalls of procedural justice to address coercion and human rights issues in psychiatry. Aporia, 16(1), 8–20. https://doi.org/10.18192/aporia.v16i1.6947
Li C. H. (2016). Confirmatory factor analysis with ordinal data: Comparing robust maximum likelihood and diagonally weighted least squares. Behavior Research Methods, 48(3), 936–949. https://doi.org/10.3758/s13428-015-0619-7
Lim, W. M. (2024). A typology of validity: content, face, convergent, discriminant, nomological and predictive validity. Journal of Trade Science, 12(3), 155–179. https://doi.org/10.1108/JTS-03-2024-0016
Lind, E. A., & Tyler, T. R. (1988). The social psychology of procedural justice. Springer Science & Business Media.
Madadizadeh, F., & Bahariniya, S. (2025). Tutorial on Internal Consistency Assessment by Cronbach’s Alpha and McDonald’s Omega. Perioperative Care and Operating Room Management, 41, 100568. https://doi.org/10.1016/j.pcorm.2025.100568
Martinez, D., Brodard, A., Silva, B., Diringer, O., Bonsack, C., Morandi, S., & Golay, P. (2022). Satisfaction and Perceived Coercion in Voluntary Hospitalisations: Impact of Past Coercive Experiences. The Psychiatric Quarterly, 93(4), 971–984. https://doi.org/10.1007/s11126-022-10005-8
Morandi, S., Silva, B., Pauli, G., Martinez, D., Bachelard, M., Bonsack, C., & Golay, P. (2024). How do decision making and fairness mediate the relationship between involuntary hospitalisation and perceived coercion among psychiatric inpatients?. Journal of Psychiatric Research, 173, 98–103. https://doi.org/10.1016/j.jpsychires.2024.03.017
Netemeyer, R. G., Bearden, W. O., & Sharma, S. (2003). Scaling procedures: Issues and applications. Sage.
Newton-Howes, G., & Stanley, J. (2012). Prevalence of perceived coercion among psychiatric patients: literature review and meta-regression modelling. The Psychiatrist, 36(9), 335–340. https://doi.org/10.1192/pb.bp.111.037358
Nyttingnes, O., Rugkåsa, J., Holmén, A., & Ruud, T. (2017). The development, validation, and feasibility of the Experienced Coercion Scale. Psychological Assessment, 29(10), 1210–1220. https://doi.org/10.1037/pas0000404
Nyttingnes, O., Ruud, T., & Rugkåsa, J. (2016). 'It’s unbelievably humiliating'-Patients’ expressions of negative effects of coercion in mental health care. International Journal of Law and Psychiatry, 49(Pt A), 147–153. https://doi.org/10.1016/j.ijlp.2016.08.009
O’Callaghan, A. K., Plunkett, R., & Kelly, B. D. (2021). The association between perceived coercion on admission and formal coercive practices in an inpatient psychiatric setting. International Journal of Law and Psychiatry, 75, 101680. https://doi.org/10.1016/j.ijlp.2021.101680
O’Donoghue, B., Roche, E., Shannon, S., Lyne, J., Madigan, K., & Feeney, L. (2014). Perceived coercion in voluntary hospital admission. Psychiatry Research, 215(1), 120–126. https://doi.org/10.1016/j.psychres.2013.10.016
Paradis-Gagné, E., Pariseau-Legault, P., Goulet, M. H., Jacob, J. D., & Lessard-Deschênes, C. (2021). Coercion in psychiatric and mental health nursing: A conceptual analysis. International Journal of Mental Health Nursing, 30(3), 590–609. https://doi.org/10.1111/inm.12855
Pariseau-Legault, P., Vallée-Ouimet, S., Jacob, J.-D., & Goulet, M.-H. (2020). Intégration des droits humains dans la pratique du personnel infirmier faisant usage de coercition en santé mentale : recension systématique des écrits et méta-ethnographie. Recherche en soins infirmiers, 142(3), 53–76. https://doi.org/10.3917/rsi.142.0053
Pelto-Piri, V., Kjellin, L., Hylén, U., Valenti, E., & Priebe, S. (2019). Different forms of informal coercion in psychiatry: a qualitative study. BMC Research Notes, 12(1), 1–4. https://doi.org/10.1186/s13104-019-4823-x
Raykov, T., & Marcoulides, G. A. (2010). Introduction to psychometric theory. Routledge.
Rosseel, Y. (2012). lavaan: An R Package for Structural Equation Modeling. Journal of Statistical Software, 48(2), 1–36. https://doi.org/10.18637/jss.v048.i02
Sampogna, G., Luciano, M., Del Vecchio, V., Pocai, B., Palummo, C., Fico, G., Giallonardo, V., De Rosa, C., & Fiorillo, A. (2019). Perceived Coercion Among Patients Admitted in Psychiatric Wards: Italian Results of the EUNOMIA Study. Frontiers in Psychiatry, 10, 316. https://doi.org/10.3389/fpsyt.2019.00316
Sheehan, K. A., & Burns, T. (2011). Perceived coercion and the therapeutic relationship: a neglected association?. Psychiatric services (Washington, D.C.), 62(5), 471–476. https://doi.org/10.1176/ps.62.5.pss6205_0471
Silva, B., Bachelard, M., Amoussou, J. R., Martinez, D., Bonalumi, C., Bonsack, C., Golay, P., & Morandi, S. (2023a). Feeling coerced during voluntary and involuntary psychiatric hospitalisation: A review and meta-aggregation of qualitative studies. Heliyon, 9(2), e13420. https://doi.org/10.1016/j.heliyon.2023.e13420
Silva, B., Bachelard, M., Bonsack, C., Golay, P., & Morandi, S. (2023b). Exploring Patients’ Feeling of Being Coerced During Psychiatric Hospital Admission: A Qualitative Study. The Psychiatric Quarterly, 94(3), 411–434. https://doi.org/10.1007/s11126-023-10039-6
Theodoridou, A., Schlatter, F., Ajdacic, V., Rössler, W., & Jäger, M. (2012). Therapeutic relationship in the context of perceived coercion in a psychiatric population. Psychiatry Research, 200(2-3), 939–944. https://doi.org/10.1016/j.psychres.2012.04.012
Tingleff, E. B., Bradley, S. K., Gildberg, F. A., Munksgaard, G., & Hounsgaard, L. (2017). “Treat me with respect”. A systematic review and thematic analysis of psychiatric patients’ reported perceptions of the situations associated with the process of coercion. Journal of Psychiatric and Mental Health Nursing, 24(9-10), 681–698. https://doi.org/10.1111/jpm.12410
United Nations High Commissioner for Human Rights. (2017). Mental health and human rights: Report of the United Nations High Commissioner for Human Rights. https://docs.un.org/en/A/HRC/34/32
Verbeke, E., Vanheule, S., Cauwe, J., Truijens, F., & Froyen, B. (2019). Coercion and power in psychiatry: A qualitative study with ex-patients. Social Science & Medicine (1982), 223, 89–96. https://doi.org/10.1016/j.socscimed.2019.01.031
Watkins, M. W. (2018). Exploratory Factor Analysis: A Guide to Best Practice. Journal of Black Psychology, 44(3), 219–246. https://doi.org/10.1177/0095798418771807