Staff attitudes towards coercion in psychiatry: The role of violence, emotional burden, and insecurity – Evidence from a nationwide study using multiple regression and moderation analyses

Compr Psychiatry. 2026 May 11;148:152711. doi: 10.1016/j.comppsych.2026.152711. Online ahead of print.

ABSTRACT

OBJECTIVE: The use of coercive measures in psychiatry varies significantly across countries, regions, and departments. While patient-related factors have been extensively studied, staff-related factors remain insufficiently understood. The study aimed to examine mental health professionals` attitudes towards coercion and the influence of variables such as workplace violence, emotional burden, and insufficient support for staff.

METHODS: This cross-sectional, prospective study included 1585 staff members from adult psychiatry, child and adolescent psychiatry, and forensic psychiatry departments. Staff attitudes towards coercion, the frequency and burden of verbal and physical violence, support after such events, as well as the frequency and perceived burden of taking part in and witnessing coercive measures were assessed using a structured questionnaire and the validated Staff Attitude to Coercion Scale. A multiple linear regression model was conducted using SPSS, and moderation analyses were performed to explore interactions between variables.

RESULTS: Regression model was significant (F(df = 16;1302) = 16.633, p < 0.001) and older age, working in forensic psychiatry, greater feelings of insecurity, more frequent physical violence and greater emotional burden from verbal violence, and more frequent use of coercive measures were significantly associated with less critical attitudes towards coercion. In contrast, more years of work experience and greater emotional burden from witnessing coercive measures were associated with more critical attitudes.

CONCLUSION: Subjective staff characteristics such as work experience, exposure to violence and emotional burden influence staff attitudes to coercion considerably. Notably, the use of coercive measures and the burden due to coercion constitute important influences on staff perspectives. Improving violence prevention and de-escalation strategies, integrating emotions and self-perceptions into debriefings, and providing individualised support for staff following distressing incidents might help reduce feelings of insecurity.

PMID:42144004 | DOI:10.1016/j.comppsych.2026.152711