Psychometric Properties of the Coercion Experience Scale in Patients with Mental Disorders in Iran

Psychometric Properties of the Coercion Experience Scale in Patients with Mental Disorders in Iran | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychometric Properties of the Coercion Experience Scale in Patients with Mental Disorders in Iran Kimia Karimi, Sevda Gardashkhani, Fatemeh Ebrahimi Belil This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4369224/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background People with mental disorders are a vulnerable part of society, and it is essential to defend the rights of these patients. The use of threats and coercion s in mental care is a controversial and important issue for research. Therefore, there is a need for a tool that health workers can also use to measure the experience of coercion in mental patients. The present study was conducted with the aim of investigating the psychometric properties of the Coercion Experience Scale among patients admitted to psychiatric departments in Iran. Methods This study is a methodological study that examines the psychometric properties of the Coercion Experience Scale in 264 psychiatric patients in psychiatric departments. The instrument's psychometric properties were examined to determine content validity, construct validity (factor analysis), and internal consistency. Results The results showed the confirmation of the 34-item and 7-factor model of The Coercion Experience Scale in mentally ill patients in Iran, which explained 63.71% of the total variance. The overall reliability of the tool was also obtained with the internal consistency method of 0.92. Conclusion The appropriate model of the Coercion Experience Scale in Iranian society is a scale with 34 items and 7 factors with the best conditions in terms of factorial structure and internal consistency, and it can be used as a screening tool for mental patients in Iran who need support after coercive and threatening interventions to avoid the consequences of traumatic experiences. coercion coercion experience validity reliability psychometric properties Background Preservation of human dignity, observance of ethics, and individual and social rights of humans are among the issues that have attracted the attention of different societies in recent years. In this context, the concept of the patient's rights and his support is also very important. In the topic of patient rights, one of the important topics is the observance of the rights of patients with mental disorders. Since people with mental disorders are a vulnerable part of society, it is necessary to defend the rights of these patients [ 1 ]. The World Health Organization (WHO) declares that all people with mental disorders have the right to use quality treatment, and they must be protected against any kind of inhuman and discriminatory treatment. One of these inhumane and discriminatory behaviors is threat and coercion [ 2 ]. The use of threats and coercion in mental and psychological care is a controversial and important issue for research [ 3 , 4 ]. Coercion means using one's authority to limit the authority of others. Coercion is a moral issue because its use deprives a person of his independence [ 5 ]. In the framework of coercion in health care, various types of coercive measures are included; for example, involuntary and forced admission of the patient to the hospital, forced drug treatments, and the use of physical activity restrictions are all part of coercive measures [ 6 , 7 ]. In countries that have laws for the compulsory hospitalization of mentally ill patients, the law allows mental health caregivers to admit people who are dangerous to themselves or others due to mental illness [ 8 ] or who cannot take care of themselves without their consent [ 9 , 10 ]. On the other hand, forced hospitalization of patients can have destructive effects on them [ 11 ]. Compulsory treatments can lead to distrust of patients, a decrease in satisfaction with received treatments, and a decrease in the level of interaction with mental health services [ 12 , 13 ]. However, the feeling of coercion in mental patients is only partially related to the type of hospital admission, and variables such as age, ethnicity (coercion is higher in non-white races), type of diagnosis, attitude towards the disease, and severity of symptoms are involved in this matter [ 14 , 15 ]. Statistics show that in Germany, between 2.8 and 8.44 percent of all psychiatric hospitalizations were compulsory. In Denmark, 5% of psychiatric hospitalization cases were like this [ 16 ]. On the other hand, studies show that the use of coercion causes serious harm to patients in less than one percent of cases and causes minor harm in 11 percent of cases, which requires first aid to treat patients. 5% of patients are threatened by using physical tools, and more than 18% of them are verbally threatened by the use of coercion [ 17 ]. Likewise, to provide more evidence about different types of coercive interventions, a tool to assess the subjective experience of patients during coercive interventions is needed. There is also a need for a tool that health workers can use to measure this experience of coercion in mental patients. The Coercion Experience Scale (CES) is a tool that Jan Bergk et al. introduced in 2010, which includes the following dimensions: humiliation, physical side effects, interpersonal separation, negative environmental effects, fear, and coercion. Each item has a score of 0–4 [ 18 ]. Since forced treatment in mental patients ultimately affects the interaction of the treatment staff and their level of satisfaction with health services, and according to the definition of the use of coercion and considering its importance in hospitals, studies show that so far, no research has been done inside the country in the case of validating the coercion experience scale tool. Also, by identifying patients who have experienced threats and forced treatment, its complications and adverse effects on mental health services can be prevented. Therefore, the present study was conducted with the aim of validating the Coercion Experience Scale for patients admitted to the psychiatric department of Fatemi Hospital in Ardabil. Methods The present study is a methodological study that examines the psychometric properties of the Coercion Experience Scale in patients with mental disorders hospitalized in Fatemi Hospital in Ardabil province. Patients aged 18 years and older, without mental illnesses threatening cognitive status, were included in the study. Data were collected from June to March 2022 from patients with mental disorders admitted to the psychiatric department of Fatemi Hospital in Ardabil province. The number of samples is almost 7 times the number of items [ 19 ] in the tool, which is 264. Tool The tool included demographic questions and the coercion experience scale, which were translated and back-translated according to Wild et al.'s method [ 20 ] after obtaining permission from the tool designer [ 18 ]. Then the final tool was used to collect information. After explaining the objectives of the study to the patients, it was conducted in the form of an interview. The Experience of Threat instrument was a 35-item tool designed to measure patients' experiences of coercive measures. The first two items were 0-100 visual analog scales, which were intended to assess the extent to which the patients recall compulsive actions (item 1) and the extent to which they were stressful (item 2). The rest of the items were according to a 5-point Likert scale, which included the following dimensions: humiliation, physical side effects, interpersonal separation, negative environmental effects, fear, and coercion, which had a score of 0–4 [ 18 ]. Study Design To determine the psychometric properties of the instrument, content, and face validity, construct validity (exploratory factor analysis and confirmatory factor analysis), and Cronbach's alpha were checked for reliability. To check the validity of the content, the opinions of 10 professors and experts in the field of psychometrics and psychology were used. To determine the face validity and answer the question of whether the scale of experience of coercion in mental patients apparently has validity or not. and in order to increase the credibility of the content, the process of determining face validity was carried out. This work was investigated by 15 patients with mental disorders and through face-to-face interviews. In this way, the items (questions) were scored on a Likert scale on a Likert scale in terms of the level of difficulty, appropriateness and ambiguity, ease of completing the tool, readability, easy understanding, grammar, writing style, and spelling. Face validity was determined by two quantitative and qualitative methods. In the qualitative method, the aim was to determine the appropriateness and relevance of the items, the ambiguity and insufficient perceptions, and the difficulty of understanding the concepts. In the quantitative method, the item impact formula was used to determine validity. In this method, the participants scored each item in terms of importance on a 5-point Likert scale (from very important to not important at all). Impact Score = Frequency (%)×Importance The meaning of frequency was the proportion of people who chose very important and important options, and the meaning of importance was the average score of each item from all respondents. If the impact score was greater than 1.5, the item was recognized as suitable for further analysis and was retained. All items had an impact score of more than 1.5. Also, the construct validity method was used using exploratory and confirmatory factor analysis. Cronbach's alpha was also used to determine the reliability of the tool. Data Analysis It was done with descriptive tests (mean, median, frequency, percentage, and standard deviation) and inferential tests (correlation and structural equation modeling) using SPSS version 22 and LISREL version 8.8 software. Results The mean and standard deviation of the age of the studied subjects were 39.19 ± 11.469. Also, the mean and standard deviation of the people who experienced forced measures and the stressfulness of those measures were 48.14 ± 35.59 and 46.17 ± 32.46, respectively. The average score on the whole scale was 59.97. Most of the people experiencing coercion with the diagnosis of aggression (33.3%) were male (59.1%). Other demographic characteristics of the research participants are given in Table 1 . Table 1 Demographic characteristics of research participants Variable Specifications Frequency (Percentage) Variable Specifications Frequency (Percentage) Sex Male Female 156 (59.1) 108 (40.9) Addiction Yes No 127 (48.1) 137 (51.9) Marital Status Single Married Divorced 119 (45.1) 93 (35.2) 52 (19.7) Diagnosis Aggression Panic Paranoid Suicide Bipolar Schizophrenia Obsession Depression Sleep disorder personality disorder 88 (33.3) 9 (3.4) 6 (2.3) 24 (9.1) 38 (14.4) 44 (16.7) 8 (3) 42 (15.9) 3 (1.1) 2 (0.8) Education Illiterate Elementary Guidance Diploma University 44 (17.7) 76 (28.8) 77 (29.2) 42 (15.9) 25 (9.5) History Of Physical Illness Yes No 53 (30.1) 211 (79.9 For content validity, Waltz and Bausell's content validity index and the opinions of 10 experts were used, and the content validity index of all items was 90–100. To investigate the structural validity of the feeling of threat scale, exploratory factor analysis was used. Principal component extraction and varimax rotation were used to perform exploratory factor analysis. The results of exploratory factor analysis showed that the results were in seven factors and explained 63.71% of the total variance. The value of KMO (Kaiser-Mayer-Olkin) was 0.874, and the value of Bartlett's test was also significant at the level of 0.000. The results of exploratory factor analysis and factor naming are given in Table 2 . Table 2 The results of exploratory factor analysis Factor Question Number Question Egien value Explained variation Humiliation 3 In what extend did you experience due to the intervention adverse effects on your human dignity? 188/10 874/30 4 In what extend did you experience due to the intervention restrictions of your ability to have contact with staff? 5 In what extend did you experience due to the intervention restrictions of your ability to move? 6 In what extend did you experience due to the intervention coercion? 7 In what extend did you experience due to the intervention restrictions of your freedom to decide things? 14 felt my dignity taken away. 17 I had to obey the orders of others. 20 Others made decisions on me. 25 I couldn’t move freely. 26 Having to attend to washing whilst being observed by aid of staff. 29 I felt dealt like an animal. 31 My wishes were not taken into account. 32 I was held by staff members. 33 I got medication against my will. 34 My functioning was hindered by side-effects of the medication. Interpersonal Separation 8 The restriction of contact with staff was … 651/2 034/8 9 The restrictions of your ability to move was.. 10 The applied coercion was… 11 The restrictions of your freedom to decide things was… Fear 12 I feared not getting enough air. 269/2 875/6 19 I was afraid I would be killed. 27 I was afraid I would die. 30 I feared the measure would last forever. Humiliating Environment 21 Passing urine or defecating was shameful. 994/1 041/6 23 Passing urine or defecating was uncomfortable. Coercion and confusion 22 I did not know what to expect. 584/1 799/4 24 could not understand why I was being treated that way. 35 Other stressors: Physical adverse effects 13 I suffered pain. 229/1 723/3 28 Poor condition of air in the room. 15 I was not able to sleep well. Negative environmental influences 16 The decor or lighting of the room were unpleasant. 111/1 365/3 18 The room was too cold or too warm. After exploratory factor analysis, confirmatory factor analysis was used to confirm the items of the tool. However, because question 35 (other stressors) had a low factor loading (0.36), it was removed from the model and re-examined. The fit indices showed the approval of the 34-item model of the instrument (Table 3 ). Table 3 Fit indices of the 34-item model of the Coercion Experience Scale (CES) Indicator NFI NNFI CFI IFI GFI RMSEA Model Estimates 0.9 0.92 0.93 0.93 0.76 0.088 Note : NFI: Normed Fit Index, NNFI: Non- Normed Fit Index, CFI: Comparative Fit Index, IFI: International Friction Index, GFI: Goodness of Fit Index, RMSEA: Root Mean Square Error of Approximation Table 4 Reliability results of the Coercion Experience Scale Scale Dimensions Humiliation Interpersonal Separation Fear Physical adverse effects Negative environmental influences Humiliating Environment Coercion and confusion Cronbach's alpha coefficient 0.92 0.93 0.71 0.57 0.57 0.87 0.52 Cronbach's alpha coefficient was used to determine the internal consistency, and the results showed the high reliability of the whole instrument (0.92). However, the dimensions of humiliation, interpersonal separation, fear, and humiliating environment had acceptable to excellent reliability, and the dimensions of adverse physical effects, negative physical environment, and coercion had poor reliability. Discussion The present study was conducted to investigate the psychometric properties of the coercion experience scale in mentally ill patients in Iran. For this purpose, content validity, construct validity (factorial structure), and internal consistency of the instrument were examined. The results showed the confirmation of the 34-item and 7-factor model of the coercion experience scale in mentally ill patients in Iran, which explained 63.71% of the total variance. Its dimensions included humiliation, interpersonal separation, fear, adverse physical effects, a negative physical environment, a humiliating environment, and coercion. Several studies have confirmed the 6-factor model of the tool according to different cultural and background factors. For example, in the study of Bergk et al. (2010), a 6-factor model with 35 items and 54.5% of the total variance was confirmed in Germany [ 18 ]. Also, in the study of Golay et al. (2019), the 6-factor and 35-item tool model has been confirmed in France [ 21 ]. It should be noted that Aguilera-Serrano et al. (2018) in Spain also confirmed the shortened version of the CES scale, which has 18 items [ 22 ]. The difference in the results of previous studies and the current study can be attributed to the differences between Western culture and Middle Eastern countries in dealing with mental illnesses. Also, social norms and stigmas related to mental health can influence people's willingness to disclose information or specific symptoms, leading to differences in outcomes. In this study, question 35 (other stressors) was removed from the model due to its low factor loading. The reason for this could be the unfamiliarity of the treatment staff with the process and symptoms of threats and coercion in mental patients, and as a result, less assessment of coercion and threats by health care workers. The overall Cronbach's alpha and the dimensions of the tool also confirmed the construct's validity, which ranged from 0.52 to 0.93. The highest internal similarity was related to the dimension of interpersonal separation (0.93), and the lowest was related to the dimension of coercion (0.52). Similar internal consistency has been obtained in several studies. In the study of Bergk et al. (2010), the highest internal similarity was related to the dimensions of humiliation (0.93) and separation (0.92), and the lowest was related to the dimension of fear (0.67) [ 18 ]. In Golay et al.'s study (2019), the lowest internal consistency was related to the dimensions of negative physical environment (0.63) and adverse physical effects (0.68), and the highest internal consistency was related to the dimensions of humiliation (0.94) and interpersonal separation (0.83) [ 21 ]. Limitations Among the limitations of the present study, firstly, we can mention the lack of diversity in the psychotic cases participating in the study, which is due to the lack of a specialized psychotic center in Ardabil. Secondly, applying forced interventions, pressures, and threats to patients in different countries may be somewhat different according to culture and background factors. Therefore, one should be careful when generalizing the results of the present study. Third, patients may have overreported the intensity of their experiences of restrictions and coercion to emphasize the need to reduce coercive and threatening interventions. Fourthly, the internal consistency of all items was excellent, while the three dimensions had low internal consistency, and since there is no gold standard in this field, the total internal consistency was considered appropriate. Despite these limitations, the present study is the first research that specifically examines coercion and threats in mental patients in Iran, makes the treatment staff and nurses familiar with it, and introduces a valid and reliable tool to investigate coercion and threats in Iran. Also, one of the strengths of the present study is the consideration of the type of diagnosed mental illness of the patients in the examined samples, which was not considered in previous studies. Conclusion The results showed that the appropriate model of the experience of coercion scale in Iranian society is a scale with 34 items and 7 factors with the best conditions in terms of factor structure and internal consistency. It can be used as a screening tool for mentally ill patients in Iran who need support after coercive and threatening interventions to avoid the consequences of traumatic experiences. More research is needed to identify the underlying factors and predictors of the experience of coercion and threat in psychiatric patients. Considering the importance of respecting the mutual rights of mentally ill people and society, compulsory hospitalization of mentally disordered patients includes a large part of the mental health law, and considering the shortcomings of the laws related to compulsory hospitalization in Iran, it is necessary to remove the shortcomings in this field, and the forced hospitalization process should be legalized. Also, by identifying patients who have experienced threats and forced treatment, its complications and adverse effects on mental health services can be prevented. Abbreviations WHO: World Health Organization CES: Coercion Experience Scale KMO: Kaiser-Mayer-Olkin Declarations Ethics approval and consent to participate The original study submitted for publication has been carried out in accordance with the Declaration of Helsinki. After obtaining permission from the ethics committee of Ardabil University of Medical Sciences (IR.ARUMS.REC.1400.062), people who met the entry criteria were selected. The objectives of the study, the method, and the optionality of participating in the study were explained to the patients, and then their informed consent was obtained. Patients were assured that the information collected was strictly confidential and the results are published collectively. Consent for publication Not applicable. Data availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author contributions FEB and SG designed the study. All authors were involved in the study implementation. FEB and SG conducted the statistical analyses. KK, FEB and SG wrote the complete draft of the manuscript, KK and SG revised earlier versions of the manuscript. All authors read and approved the final manuscript. Acknowledgment The present study was conducted under the supervision of the Ardabil University of Medical Sciences (IR.ARUMS.REC.1400.062). The authors express their gratitude and appreciation to all the patients, their families, the staff of the psychiatric department, the officials of Fatemi Hospital, the Research Vice-Chancellor of Ardabil University of Medical Sciences, and those who helped us in this study. References Abbasi M, Rashidian A, Arab M, Amini H, Hoseini M. 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Violence in mental health care: the experiences of mental health nurses and psychiatrists. Journal of advanced nursing. 1999 Oct;30(4):934-41. https://doi.org/10.1046/j.1365-2648.1999.01163.x Bergk J, Flammer E, Steinert T. " Coercion Experience Scale"(CES)-validation of a questionnaire on coercive measures. BMC psychiatry. 2010 Dec;10:1-0. https://doi.org/10.1186/1471-244X-10-5 Polit, Denise F and Beck CT. Nursing research: Principles and methods. Lippincott Williams \& Wilkins; 2004. Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, Erikson P. Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR task force for translation and cultural adaptation. Value in health. 2005 Mar 1;8(2):94-104. https://doi.org/10.1111/j.1524-4733.2005.04054.x Golay P, Favrod J, Morandi S, Bonsack C. Psychometric properties of the French-language version of the Coercion Experience Scale (CES). Annals of general psychiatry. 2019 Dec;18:1-0. https://doi.org/10.1186/s12991-019-0230-x Aguilera-Serrano C, Guzman-Parra J, Miranda-Paez J, García-Spínola E, Torres-Campos D, Villagrán-Moreno JM, Moreno-Küstner B, García-Sanchez JA, Mayoral-Cleries F. Validation of a short version of the Coercion Experience Scale (CES-18): Psychometric characteristics in a Spanish sample. Psychiatry research. 2019 Feb 1;272:284-9. https://doi.org/10.1016/j.psychres.2018.12.126 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4369224","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":306420681,"identity":"98c54821-cbe3-45d3-b948-d73668b49b04","order_by":0,"name":"Kimia Karimi","email":"","orcid":"","institution":"Ardabil University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Kimia","middleName":"","lastName":"Karimi","suffix":""},{"id":306420683,"identity":"0a055097-8024-47a8-8f73-478117805654","order_by":1,"name":"Sevda Gardashkhani","email":"","orcid":"","institution":"Tabriz University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Sevda","middleName":"","lastName":"Gardashkhani","suffix":""},{"id":306420684,"identity":"6be5c33f-fd57-4866-bcb2-9522c552f5a7","order_by":2,"name":"Fatemeh Ebrahimi Belil","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYNACgxo5NvYGBmYStBQcM+bjOUCSlg/MifMkEojUIt9+9uEHBgM2YzbJN4afCypsGPjbuxPwajE4k24swWAgI8cmnWMsPeNMGoPEmbMb8GthACoC2yKdYyDN23aYwUAiF78W+f5nzD8YDJgT2yTPGP8mSgvDjTQ2CbAWCR4z4mwxuPGMzSLB4JgxG09amTXPmTQegn6R709jvvHhT42cfPvhzbd5Kmzk+Nt7CTgMBBLAJIcBiOQhrBwB2B+QonoUjIJRMApGEAAAR7Y8pXq2VgAAAAAASUVORK5CYII=","orcid":"","institution":"Ardabil University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Fatemeh","middleName":"Ebrahimi","lastName":"Belil","suffix":""}],"badges":[],"createdAt":"2024-05-04 16:42:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4369224/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4369224/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75333734,"identity":"4535d81d-ddd2-4d8c-8f1b-f7dab0fe7cc0","added_by":"auto","created_at":"2025-02-03 12:54:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":657749,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4369224/v1/5c2c5174-7035-4618-8d68-15c46ad9d4e0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Psychometric Properties of the Coercion Experience Scale in Patients with Mental Disorders in Iran","fulltext":[{"header":"Background","content":"\u003cp\u003ePreservation of human dignity, observance of ethics, and individual and social rights of humans are among the issues that have attracted the attention of different societies in recent years. In this context, the concept of the patient's rights and his support is also very important. In the topic of patient rights, one of the important topics is the observance of the rights of patients with mental disorders. Since people with mental disorders are a vulnerable part of society, it is necessary to defend the rights of these patients [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The World Health Organization (WHO) declares that all people with mental disorders have the right to use quality treatment, and they must be protected against any kind of inhuman and discriminatory treatment. One of these inhumane and discriminatory behaviors is threat and coercion [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The use of threats and coercion in mental and psychological care is a controversial and important issue for research [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Coercion means using one's authority to limit the authority of others. Coercion is a moral issue because its use deprives a person of his independence [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In the framework of coercion in health care, various types of coercive measures are included; for example, involuntary and forced admission of the patient to the hospital, forced drug treatments, and the use of physical activity restrictions are all part of coercive measures [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In countries that have laws for the compulsory hospitalization of mentally ill patients, the law allows mental health caregivers to admit people who are dangerous to themselves or others due to mental illness [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] or who cannot take care of themselves without their consent [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. On the other hand, forced hospitalization of patients can have destructive effects on them [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Compulsory treatments can lead to distrust of patients, a decrease in satisfaction with received treatments, and a decrease in the level of interaction with mental health services [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, the feeling of coercion in mental patients is only partially related to the type of hospital admission, and variables such as age, ethnicity (coercion is higher in non-white races), type of diagnosis, attitude towards the disease, and severity of symptoms are involved in this matter [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Statistics show that in Germany, between 2.8 and 8.44 percent of all psychiatric hospitalizations were compulsory. In Denmark, 5% of psychiatric hospitalization cases were like this [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. On the other hand, studies show that the use of coercion causes serious harm to patients in less than one percent of cases and causes minor harm in 11 percent of cases, which requires first aid to treat patients. 5% of patients are threatened by using physical tools, and more than 18% of them are verbally threatened by the use of coercion [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Likewise, to provide more evidence about different types of coercive interventions, a tool to assess the subjective experience of patients during coercive interventions is needed. There is also a need for a tool that health workers can use to measure this experience of coercion in mental patients. The Coercion Experience Scale (CES) is a tool that Jan Bergk et al. introduced in 2010, which includes the following dimensions: humiliation, physical side effects, interpersonal separation, negative environmental effects, fear, and coercion. Each item has a score of 0\u0026ndash;4 [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Since forced treatment in mental patients ultimately affects the interaction of the treatment staff and their level of satisfaction with health services, and according to the definition of the use of coercion and considering its importance in hospitals, studies show that so far, no research has been done inside the country in the case of validating the coercion experience scale tool. Also, by identifying patients who have experienced threats and forced treatment, its complications and adverse effects on mental health services can be prevented. Therefore, the present study was conducted with the aim of validating the Coercion Experience Scale for patients admitted to the psychiatric department of Fatemi Hospital in Ardabil.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe present study is a methodological study that examines the psychometric properties of the Coercion Experience Scale in patients with mental disorders hospitalized in Fatemi Hospital in Ardabil province. Patients aged 18 years and older, without mental illnesses threatening cognitive status, were included in the study. Data were collected from June to March 2022 from patients with mental disorders admitted to the psychiatric department of Fatemi Hospital in Ardabil province. The number of samples is almost 7 times the number of items [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] in the tool, which is 264.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eTool\u003c/h2\u003e \u003cp\u003eThe tool included demographic questions and the coercion experience scale, which were translated and back-translated according to Wild et al.'s method [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] after obtaining permission from the tool designer [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Then the final tool was used to collect information. After explaining the objectives of the study to the patients, it was conducted in the form of an interview. The Experience of Threat instrument was a 35-item tool designed to measure patients' experiences of coercive measures. The first two items were 0-100 visual analog scales, which were intended to assess the extent to which the patients recall compulsive actions (item 1) and the extent to which they were stressful (item 2). The rest of the items were according to a 5-point Likert scale, which included the following dimensions: humiliation, physical side effects, interpersonal separation, negative environmental effects, fear, and coercion, which had a score of 0\u0026ndash;4 [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Design\u003c/h3\u003e\n\u003cp\u003eTo determine the psychometric properties of the instrument, content, and face validity, construct validity (exploratory factor analysis and confirmatory factor analysis), and Cronbach's alpha were checked for reliability. To check the validity of the content, the opinions of 10 professors and experts in the field of psychometrics and psychology were used. To determine the face validity and answer the question of whether the scale of experience of coercion in mental patients apparently has validity or not. and in order to increase the credibility of the content, the process of determining face validity was carried out. This work was investigated by 15 patients with mental disorders and through face-to-face interviews. In this way, the items (questions) were scored on a Likert scale on a Likert scale in terms of the level of difficulty, appropriateness and ambiguity, ease of completing the tool, readability, easy understanding, grammar, writing style, and spelling. Face validity was determined by two quantitative and qualitative methods. In the qualitative method, the aim was to determine the appropriateness and relevance of the items, the ambiguity and insufficient perceptions, and the difficulty of understanding the concepts. In the quantitative method, the item impact formula was used to determine validity. In this method, the participants scored each item in terms of importance on a 5-point Likert scale (from very important to not important at all).\u003c/p\u003e \u003cp\u003eImpact Score\u0026thinsp;=\u0026thinsp;Frequency (%)\u0026times;Importance\u003c/p\u003e \u003cp\u003eThe meaning of frequency was the proportion of people who chose very important and important options, and the meaning of importance was the average score of each item from all respondents. If the impact score was greater than 1.5, the item was recognized as suitable for further analysis and was retained. All items had an impact score of more than 1.5. Also, the construct validity method was used using exploratory and confirmatory factor analysis. Cronbach's alpha was also used to determine the reliability of the tool.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eIt was done with descriptive tests (mean, median, frequency, percentage, and standard deviation) and inferential tests (correlation and structural equation modeling) using SPSS version 22 and LISREL version 8.8 software.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean and standard deviation of the age of the studied subjects were 39.19\u0026thinsp;\u0026plusmn;\u0026thinsp;11.469. Also, the mean and standard deviation of the people who experienced forced measures and the stressfulness of those measures were 48.14\u0026thinsp;\u0026plusmn;\u0026thinsp;35.59 and 46.17\u0026thinsp;\u0026plusmn;\u0026thinsp;32.46, respectively. The average score on the whole scale was 59.97. Most of the people experiencing coercion with the diagnosis of aggression (33.3%) were male (59.1%). Other demographic characteristics of the research participants are given in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of research participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecifications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (Percentage)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSpecifications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFrequency (Percentage)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e156 (59.1)\u003c/p\u003e \u003cp\u003e108 (40.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAddiction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e127 (48.1)\u003c/p\u003e \u003cp\u003e137 (51.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003cp\u003eMarried\u003c/p\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119 (45.1)\u003c/p\u003e \u003cp\u003e93 (35.2)\u003c/p\u003e \u003cp\u003e52 (19.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAggression\u003c/p\u003e \u003cp\u003ePanic\u003c/p\u003e \u003cp\u003eParanoid\u003c/p\u003e \u003cp\u003eSuicide\u003c/p\u003e \u003cp\u003eBipolar\u003c/p\u003e \u003cp\u003eSchizophrenia\u003c/p\u003e \u003cp\u003eObsession\u003c/p\u003e \u003cp\u003eDepression\u003c/p\u003e \u003cp\u003eSleep disorder\u003c/p\u003e \u003cp\u003epersonality disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e88 (33.3)\u003c/p\u003e \u003cp\u003e9 (3.4)\u003c/p\u003e \u003cp\u003e6 (2.3)\u003c/p\u003e \u003cp\u003e24 (9.1)\u003c/p\u003e \u003cp\u003e38 (14.4)\u003c/p\u003e \u003cp\u003e44 (16.7)\u003c/p\u003e \u003cp\u003e8 (3)\u003c/p\u003e \u003cp\u003e42 (15.9)\u003c/p\u003e \u003cp\u003e3 (1.1)\u003c/p\u003e \u003cp\u003e2 (0.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003cp\u003eElementary\u003c/p\u003e \u003cp\u003eGuidance\u003c/p\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (17.7)\u003c/p\u003e \u003cp\u003e76 (28.8)\u003c/p\u003e \u003cp\u003e77 (29.2)\u003c/p\u003e \u003cp\u003e42 (15.9)\u003c/p\u003e \u003cp\u003e25 (9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHistory Of\u003c/p\u003e \u003cp\u003ePhysical Illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e53 (30.1)\u003c/p\u003e \u003cp\u003e211 (79.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFor content validity, Waltz and Bausell's content validity index and the opinions of 10 experts were used, and the content validity index of all items was 90\u0026ndash;100. To investigate the structural validity of the feeling of threat scale, exploratory factor analysis was used. Principal component extraction and varimax rotation were used to perform exploratory factor analysis. The results of exploratory factor analysis showed that the results were in seven factors and explained 63.71% of the total variance. The value of KMO (Kaiser-Mayer-Olkin) was 0.874, and the value of Bartlett's test was also significant at the level of 0.000. The results of exploratory factor analysis and factor naming are given in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe results of exploratory factor analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuestion Number\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuestion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEgien value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eExplained variation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"14\" rowspan=\"15\"\u003e \u003cp\u003eHumiliation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn what extend did you experience due to the intervention adverse effects on your human dignity?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"10\" rowspan=\"11\"\u003e \u003cp\u003e188/10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"10\" rowspan=\"11\"\u003e \u003cp\u003e874/30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn what extend did you experience due to the intervention restrictions of your ability to have contact with staff?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn what extend did you experience due to the intervention restrictions of your ability to move?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn what extend did you experience due to the intervention coercion?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn what extend did you experience due to the intervention restrictions of your freedom to decide things?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003efelt my dignity taken away.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI had to obey the orders of others.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOthers made decisions on me.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI couldn\u0026rsquo;t move freely.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHaving to attend to washing whilst being observed by aid of staff.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI felt dealt like an animal.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMy wishes were not taken into account.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI was held by staff members.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI got medication against my will.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMy functioning was hindered by side-effects of the medication.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eInterpersonal Separation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe restriction of contact with staff was \u0026hellip;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e651/2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e034/8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe restrictions of your ability to move was..\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe applied coercion was\u0026hellip;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe restrictions of your freedom to decide things was\u0026hellip;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eFear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI feared not getting enough air.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e269/2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e875/6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI was afraid I would be killed.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI was afraid I would die.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI feared the measure would last forever.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHumiliating Environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePassing urine or defecating was shameful.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e994/1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e041/6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePassing urine or defecating was uncomfortable.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCoercion and confusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI did not know what to expect.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e584/1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e799/4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ecould not understand why I was being treated that way.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOther stressors:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePhysical adverse effects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI suffered pain.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e229/1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e723/3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePoor condition of air in the room.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI was not able to sleep well.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNegative environmental influences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe decor or lighting of the room were unpleasant.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e111/1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e365/3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe room was too cold or too warm.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAfter exploratory factor analysis, confirmatory factor analysis was used to confirm the items of the tool. However, because question 35 (other stressors) had a low factor loading (0.36), it was removed from the model and re-examined. The fit indices showed the approval of the 34-item model of the instrument (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFit indices of the 34-item model of the Coercion Experience Scale (CES)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndicator\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNFI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNNFI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCFI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIFI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGFI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRMSEA\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel Estimates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cb\u003eNote\u003c/b\u003e: NFI: Normed Fit Index, NNFI: Non- Normed Fit Index, CFI: Comparative Fit Index, IFI: International Friction Index, GFI: Goodness of Fit Index, RMSEA: Root Mean Square Error of Approximation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReliability results of the Coercion Experience Scale\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScale Dimensions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHumiliation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInterpersonal Separation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePhysical adverse effects\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNegative environmental influences\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHumiliating Environment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCoercion and confusion\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCronbach's alpha coefficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCronbach's alpha coefficient was used to determine the internal consistency, and the results showed the high reliability of the whole instrument (0.92). However, the dimensions of humiliation, interpersonal separation, fear, and humiliating environment had acceptable to excellent reliability, and the dimensions of adverse physical effects, negative physical environment, and coercion had poor reliability.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study was conducted to investigate the psychometric properties of the coercion experience scale in mentally ill patients in Iran. For this purpose, content validity, construct validity (factorial structure), and internal consistency of the instrument were examined. The results showed the confirmation of the 34-item and 7-factor model of the coercion experience scale in mentally ill patients in Iran, which explained 63.71% of the total variance. Its dimensions included humiliation, interpersonal separation, fear, adverse physical effects, a negative physical environment, a humiliating environment, and coercion. Several studies have confirmed the 6-factor model of the tool according to different cultural and background factors. For example, in the study of Bergk et al. (2010), a 6-factor model with 35 items and 54.5% of the total variance was confirmed in Germany [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Also, in the study of Golay et al. (2019), the 6-factor and 35-item tool model has been confirmed in France [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. It should be noted that Aguilera-Serrano et al. (2018) in Spain also confirmed the shortened version of the CES scale, which has 18 items [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The difference in the results of previous studies and the current study can be attributed to the differences between Western culture and Middle Eastern countries in dealing with mental illnesses. Also, social norms and stigmas related to mental health can influence people's willingness to disclose information or specific symptoms, leading to differences in outcomes. In this study, question 35 (other stressors) was removed from the model due to its low factor loading. The reason for this could be the unfamiliarity of the treatment staff with the process and symptoms of threats and coercion in mental patients, and as a result, less assessment of coercion and threats by health care workers. The overall Cronbach's alpha and the dimensions of the tool also confirmed the construct's validity, which ranged from 0.52 to 0.93. The highest internal similarity was related to the dimension of interpersonal separation (0.93), and the lowest was related to the dimension of coercion (0.52). Similar internal consistency has been obtained in several studies. In the study of Bergk et al. (2010), the highest internal similarity was related to the dimensions of humiliation (0.93) and separation (0.92), and the lowest was related to the dimension of fear (0.67) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In Golay et al.'s study (2019), the lowest internal consistency was related to the dimensions of negative physical environment (0.63) and adverse physical effects (0.68), and the highest internal consistency was related to the dimensions of humiliation (0.94) and interpersonal separation (0.83) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eAmong the limitations of the present study, firstly, we can mention the lack of diversity in the psychotic cases participating in the study, which is due to the lack of a specialized psychotic center in Ardabil. Secondly, applying forced interventions, pressures, and threats to patients in different countries may be somewhat different according to culture and background factors. Therefore, one should be careful when generalizing the results of the present study. Third, patients may have overreported the intensity of their experiences of restrictions and coercion to emphasize the need to reduce coercive and threatening interventions. Fourthly, the internal consistency of all items was excellent, while the three dimensions had low internal consistency, and since there is no gold standard in this field, the total internal consistency was considered appropriate. Despite these limitations, the present study is the first research that specifically examines coercion and threats in mental patients in Iran, makes the treatment staff and nurses familiar with it, and introduces a valid and reliable tool to investigate coercion and threats in Iran. Also, one of the strengths of the present study is the consideration of the type of diagnosed mental illness of the patients in the examined samples, which was not considered in previous studies.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results showed that the appropriate model of the experience of coercion scale in Iranian society is a scale with 34 items and 7 factors with the best conditions in terms of factor structure and internal consistency. It can be used as a screening tool for mentally ill patients in Iran who need support after coercive and threatening interventions to avoid the consequences of traumatic experiences. More research is needed to identify the underlying factors and predictors of the experience of coercion and threat in psychiatric patients.\u003c/p\u003e \u003cp\u003eConsidering the importance of respecting the mutual rights of mentally ill people and society, compulsory hospitalization of mentally disordered patients includes a large part of the mental health law, and considering the shortcomings of the laws related to compulsory hospitalization in Iran, it is necessary to remove the shortcomings in this field, and the forced hospitalization process should be legalized. Also, by identifying patients who have experienced threats and forced treatment, its complications and adverse effects on mental health services can be prevented.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eWHO: World Health Organization\u003c/p\u003e\n\u003cp\u003eCES: Coercion Experience Scale\u003c/p\u003e\n\u003cp\u003eKMO: Kaiser-Mayer-Olkin\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe original study submitted for publication has been carried out in accordance with the Declaration of Helsinki. After obtaining permission from the ethics committee of Ardabil University of Medical Sciences (IR.ARUMS.REC.1400.062), people who met the entry criteria were selected. The objectives of the study, the method, and the optionality of participating in the study were explained to the patients, and then their informed consent was obtained. Patients were assured that the information collected was strictly confidential and the results are published collectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFEB and SG designed the study. All authors were involved in the study implementation. FEB and SG conducted the statistical analyses. KK, FEB and SG wrote the complete draft of the manuscript, KK and SG revised earlier versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study was conducted under the supervision of the Ardabil University of Medical Sciences (IR.ARUMS.REC.1400.062). The authors express their gratitude and appreciation to all the patients, their families, the staff of the psychiatric department, the officials of Fatemi Hospital, the Research Vice-Chancellor of Ardabil University of Medical Sciences, and those who helped us in this study.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbbasi M, Rashidian A, Arab M, Amini H, Hoseini M. 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World Psychiatry. 2005 Oct;4(3):168. \u003c/li\u003e\n\u003cli\u003eRiecher-R\u0026ouml;ssler A, R\u0026ouml;ssler W. Compulsory admission of psychiatric patients in a national and international comparison--incidence and factors of influence. Fortschritte der Neurologie-psychiatrie. 1992 Oct 1;60(10):375-82. \u003cem\u003ehttps://doi.org/10.1055/s-2007-999157\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eBluglass, R., Bauden, P. and Wilker, N. Principles and Practice of Forensic Psychiatry. Churchill Livingstone, Edinburgh.1990. \u003c/li\u003e\n\u003cli\u003eEngleman NB, Jobes DA, Berman AL, Langbein LI. Clinicians\u0026apos; decision making about involuntary commitment. Psychiatric services. 1998 Jul;49(7):941-5. \u003cem\u003ehttps://doi.org/10.1176/ps.49.7.941\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eWay BB, Banks S. Clinical factors related to admission and release decisions in psychiatric emergency services. Psychiatric services. 2001 Feb;52(2):214-8. \u003cem\u003ehttps://doi.org/10.1176/appi.ps.52.2.214\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eStrack KM, Schulenberg SE. Understanding empowerment, meaning, and perceived coercion in individuals with serious mental illness. Journal of clinical psychology. 2009 Oct;65(10):1137-48. \u003cem\u003ehttps://doi.org/10.1002/jclp.20607\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eLuciano M, Sampogna G, Del Vecchio V, Pingani L, Palumbo C, De Rosa C, Catapano F, Fiorillo A. Use of coercive measures in mental health practice and its impact on outcome: a critical review. Expert review of neurotherapeutics. 2014 Feb 1;14(2):131-41. \u003cem\u003ehttps://doi.org/10.1586/14737175.2014.874286\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eGolay P, Semlali I, Beuchat H, Pomini V, Silva B, Loutrel L, Thonney J, Fassasi Gallo S, Morandi S, Bonsack C. 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Violence in mental health care: the experiences of mental health nurses and psychiatrists. Journal of advanced nursing. 1999 Oct;30(4):934-41. \u003cem\u003ehttps://doi.org/10.1046/j.1365-2648.1999.01163.x\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eBergk J, Flammer E, Steinert T. \u0026quot; Coercion Experience Scale\u0026quot;(CES)-validation of a questionnaire on coercive measures. BMC psychiatry. 2010 Dec;10:1-0. \u003cem\u003ehttps://doi.org/10.1186/1471-244X-10-5\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003ePolit, Denise F and Beck CT. Nursing research: Principles and methods. Lippincott Williams \\\u0026amp; Wilkins; 2004. \u003c/li\u003e\n\u003cli\u003eWild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, Erikson P. Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR task force for translation and cultural adaptation. Value in health. 2005 Mar 1;8(2):94-104. \u003cem\u003ehttps://doi.org/10.1111/j.1524-4733.2005.04054.x\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eGolay P, Favrod J, Morandi S, Bonsack C. Psychometric properties of the French-language version of the Coercion Experience Scale (CES). Annals of general psychiatry. 2019 Dec;18:1-0. \u003cem\u003ehttps://doi.org/10.1186/s12991-019-0230-x\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eAguilera-Serrano C, Guzman-Parra J, Miranda-Paez J, Garc\u0026iacute;a-Sp\u0026iacute;nola E, Torres-Campos D, Villagr\u0026aacute;n-Moreno JM, Moreno-K\u0026uuml;stner B, Garc\u0026iacute;a-Sanchez JA, Mayoral-Cleries F. Validation of a short version of the Coercion Experience Scale (CES-18): Psychometric characteristics in a Spanish sample. Psychiatry research. 2019 Feb 1;272:284-9. \u003cem\u003ehttps://doi.org/10.1016/j.psychres.2018.12.126\u003c/em\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"coercion, coercion experience, validity, reliability, psychometric properties","lastPublishedDoi":"10.21203/rs.3.rs-4369224/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4369224/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePeople with mental disorders are a vulnerable part of society, and it is essential to defend the rights of these patients. The use of threats and coercion s in mental care is a controversial and important issue for research. Therefore, there is a need for a tool that health workers can also use to measure the experience of coercion in mental patients. The present study was conducted with the aim of investigating the psychometric properties of the Coercion Experience Scale among patients admitted to psychiatric departments in Iran.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study is a methodological study that examines the psychometric properties of the Coercion Experience Scale in 264 psychiatric patients in psychiatric departments. The instrument's psychometric properties were examined to determine content validity, construct validity (factor analysis), and internal consistency.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe results showed the confirmation of the 34-item and 7-factor model of The Coercion Experience Scale in mentally ill patients in Iran, which explained 63.71% of the total variance. The overall reliability of the tool was also obtained with the internal consistency method of 0.92.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe appropriate model of the Coercion Experience Scale in Iranian society is a scale with 34 items and 7 factors with the best conditions in terms of factorial structure and internal consistency, and it can be used as a screening tool for mental patients in Iran who need support after coercive and threatening interventions to avoid the consequences of traumatic experiences.\u003c/p\u003e","manuscriptTitle":"Psychometric Properties of the Coercion Experience Scale in Patients with Mental Disorders in Iran","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-31 06:45:11","doi":"10.21203/rs.3.rs-4369224/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"aa258d07-f3f3-4387-90e8-441dda76ead4","owner":[],"postedDate":"May 31st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-05T13:39:35+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-31 06:45:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4369224","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4369224","identity":"rs-4369224","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}