Development of an instrument to measure patients’ attitudes towards involuntary hospitalization

Table 1 Demographics of the participating experts (n = 15)

Variable	mean (SD)
Age (yr)	52 (9.5)
Sex: Male/female	11/4
Years of experience as independent Psychiatrist, consultants, lawyers or advocate	22 (12.5)
Professorial experts’ professions	n
Psychiatrists affiliated with the University of Calgary	9
Professors of psychiatry	2
Associate Clinical Professors (U of C)	4
Assistant Professors	3
Mental Health Advocacy Staff	3
Community order coordinators	2
Lawyers of the Mental health Review Panel	1

Table 2 The administered version of the constructed attitudes towards involuntary admission scale

	1	2	3	4	5
Instructions: Please rate your perception about the following statements in relation to your involuntary admission to hospital (1 = strongly disagree and 5 = strongly agree)
I think that being detained as an involuntary patient has averted further harm to me
I believe that I was offered the opportunity to recover in a safe place
I could not recognize that I needed help when I was very ill
I felt that I was pressured excessively
My problem could have been managed without being pressured
I think that my hospitalization was not necessary at all
I think that my hospitalization was unfair
I think that hospitalization was against my rights
I felt that I was not heard
Hospitalization against my will posed a permanent threat to my independence
My problems might have been managed through a voluntary hospitalization
My problems might have been managed through a shorter hospitalization
This admission had a negative impact upon the relationship with my family
My relationship with my psychiatrist was negatively impacted by this involuntary admission
I felt that that my current or future job could be affected by being in hospital against my will
I know my rights as an involuntary patient
I was given passes and other privileges outside the unit when my doctors felt it was ok
Admission to hospital was a humiliating experience
I was given the chance to appeal my involuntary admission
Overall, I was treated with respect
I think my family should have been involved in the decision about my admission

Table 3 The Final version of the attitudes towards involuntary admission scale

	1	2	3	4	5
Please rate your perception about the following statements (1 = strongly disagree to 5 = strongly agree)
I think that hospitalization was against my rights
I felt that I was not heard
Admission to hospital was humiliating experience
I think that my hospitalization was unfair
My relationship with my psychiatrist was negatively impacted by this involuntary admission
This admission had a negative impact upon the relationship with my family
I felt that my current or future job could be affected by being in hospital against my will
My problem might have been managed through a shorter hospitalization
My problem might have been managed through a voluntary hospitalization
Hospitalization against my will posed a permanent threat to my independency
My problem could have being managed without being pressured
I felt that I was pressured excessively
I think that my hospitalization was not necessary at all
I think my family should have been involved in the decision about my admission
Please rate your perception about the following statements (1 = strongly agree to 5 = strongly disagree)
I know my rights as an involuntary patient
I was given the chance to appeal my involuntary admission
I think that being detained as an involuntary patient has averted further harm to me
I could not recognize that I need help when I was very ill
Overall, I was treated with respect
I believe that I was offered the opportunity to recover in a safe place
I was given passes and other privileges outside the unit when my doctors felt it was ok

Table 4 Demographics of patients (n = 80)

Categorical variables	Frequency (%)
Sex
Male	52 (65)
Female	28 (35)
Marital status
Single	48 (68)
Married	14 (17.5)
Divorced	17 (21.3)
Widow	1 (1.3)
Education
Elementary	4 (5.0)
Junior high	3 (3.8)
High school	35 (43.8)
College	20 (25.0)
University degree	18 (22.5)
Occupation
Unemployed	37 (46.3)
Own business	9 (11.3)
Non-skilled/temporary	3 (3.8)
Skilled	26 (32.5)
Professional	5 (6.3)
Brought to hospital by police
Yes	35 (43.8)
No	45 (56.2)
Psychiatric diagnosis
Mood disorders	33 (41.3)
Psychotic disorders	23 (28.7)
Alcohol and substance abuse	14 (17.5)
Adjustment disorder	10 (12.5)
Mechanical restraints
Mechanical restraints used	11 (13.8)
Mechanical restraints not used	69 (86.2)
Continuous variables	M (SD)
Age	37.7 (13.0)
Number of psychiatric admission	3.4 (2.9)
Number of involuntarily admission	2.2 (2.0)

Table 5 Experts’ ratings, and patient’s responses to the items (n = 21) of the attitudes towards involuntary admission scale

Items of the constructed list of specifications patients’ and experts’ ratings of the	Experts ratings for the relevancy of itemsa		Patients’ responsesb
	Min-Max	mean (SD)	Min-Max	mean (SD)
I think that being detained as an involuntary patient has prevented further harm to me	3-5	4.6 (0.65)	1-5	3.1 (1.90)
I believe that I was offered the opportunity to recover in a safe place	3-5	4.5 (0.66)	1-5	3.9 (1.21)
I could not recognize that I needed help when I was very ill	4-5	4.8 (0.38)	1-5	2.7 (1.50)
I felt that I was pressured excessively	4-5	4.7 (0.44)	1-5	2.5 (1.46)
My problem could have been managed without being pressured	4-5	4.6 (0.65)	1-5	3.3 (1.38)
I think that my hospitalization was not necessary at all	4-5	4.5 (0.66)	1-5	2.4 (1.36)
I think that my hospitalization was unfair	3-5	4.4 (0.96)	1-5	2.4 (1.47)
I think that the hospitalization was against my rights	3-5	4.3 (0.63)	1-5	2.4 (1.45)
I felt that I was not heard	2-5	4.4 (0.96)	1-5	2.5 (1.45)
Hospitalization against my will posed a permanent threat to my independence	3-5	4.3 (0.63)	1-5	2.3 (1.50)
My problems might have been managed through a shorter hospitalization	2-5	4.3 (0.85)	1-5	3.6 (1.40)
My problems might have been managed through a voluntary hospitalization	3-5	4.6 (0.66)	1-5	2.9 (1.44)
This admission had a negative impact upon the relationship with my family	2-5	4.4 (0.96)	1-5	2.2 (1.41)
My relationship with my psychiatrist was negatively impacted by this involuntary admission	3-5	4.4 (0.65)	1-5	1.9 (1.29)
I felt that that my current or future job could be affected by being in hospital against my will	3-5	4.2 (1.2)	1-5	2.5 (1.48)
I know my rights as an involuntary patient	2-5	4.7 (0.48)	1-5	3.4 (1.51)
I was given passes and other privileges outside the unit when my doctors felt it was ok	3-5	4.5 (1.1)	1-5	4.3 (1.12)
Admission to hospital was a humiliating experience	1-5	4.3 (0.85)	1-5	2.6 (1.48)
I was given the chance to appeal my involuntary admission	4-5	4.5 (0.66)	1-5	3.2 (1.50)
Overall, I was treated with respect during this admission	2-5	4.6 (0.51)	1-5	3.9 (1.20)
I think my family should have been involved in the decision about my admission	1-5	4.6 (0.51)	1-5	3.2 (1.51)
Mean (SD) for the total samples	2.8-5	4.5 (0.70)	1-5	2.9 (1.2)

^aExperts’ responses: 1 = extremely irrelevant to 5 = very relevant;

^bStudents’ responses: 1 = strongly disagree to 5 = strongly agree.

Table 6 Experts’ ratings of the attitudes towards involuntary admission scale format

Experts’ ratings (n = 15)	Min-Max	mean (SD)
Clarity of the items (1 = not clear, 5 = very clear)	4-5	4.4 (0.65)
Absence of abrasive language (1 = presence of abrasive, 5 = absence of abrasive language	4-5	4.5 (0.52)
Comprehensiveness of the instrument (1 = not comprehensive, 5 = comprehensive)	4-5	4.5 (0.66)

Table 7 Rotated factor matrix, attitude towards involuntary hospitalization scale scores¹

Items perceptions of involuntary hospitalizations scale (n = 21)
Factors extracted	Factor loadings
	F1	F2	F3
I think that my hospitalization was unfair	0.80
I think that hospitalization was against my rights	0.71
I think that my hospitalization was not necessary at all	0.70
Hospitalization against my will posed a permanent threat to my independency	0.59
I felt that I was not heard	0.60
Admission to hospital was humiliating experience	0.58
I believe that I was offered the opportunity to recover in a safe place	0.56
This admission had a negative impact upon the relationship with my family	0.54
My relationship with my psychiatrist was negatively impacted by this involuntary admission	0.51
My problem might have been managed through a shorter hospitalization	0.51	0.46
I felt that my current or future job could be affected by being in hospital against my will	0.51
I think my family should have been involved in the decision about my admission	0.40
My problem might have been managed through a voluntary hospitalization		0.74
I could not recognize that I need help when I was very ill		0.65
My problem could have been managed without being pressured	0.39	0.52
I think that being detained as an involuntary patient has averted further harm to me		0.51
I was given the chance to appeal my involuntary admission			0.67
I was given passes and other privileges outside the unit when my doctors felt it was ok			0.59
I know my rights as an involuntary patient		0.55	0.56
Overall, I was treated with respect			0.56
I felt that I was pressured excessively			0.48
Internal consistency (Cronbach’s alpha) for each factor	0.85	0.68	0.57
Proportion of observed variance for each factor (%)	25.6	10.0	8.8

¹Principal components extraction, Varimax rotation with Kaiser Normalization. Rotation converged in twelve iterations, factor loadings < 0.35 have been excluded. Factor 1: Violations of legal rights and autonomy; Factor 2: Ambivalent perceptions; Factor 3: Appreciating procedural justice.

Table 8 Pearson product moment correlations between factor scores and client satisfaction questionnaire scores

PIH factors	Factor 2	Factor 3	Client satisfaction questionnaire
Factor 1	0.482	0.271	-0.442
Factor 2		0.362	-0.07
Factor 3			-0.21

¹Correlation is significant at the 0.05 level (2-tailed);

²Correlation is significant at the 0.01 level (2-tailed).