Is the continuum of coercion in psychiatry really a continuum? A statistical implication analysis

Formal coercion in psychiatry is widely studied, but less is known about informal coercion. Coercion is mostly viewed as a continuum, with formal coercion considered the most severe. The question of whether informal coercion might be perceived as even more severe remains unevaluated. We aimed to compare the perceived severity of formal coercion among psychiatric patients with four domains of severe informal coercion (finance, housing, criminal justice and child custody). A total of 456 psychiatric patients were evaluated using Rasch analysis and statistical implication analysis. All four domains of severe informal coercion were found to be more severe than formal coercion, with coercion involving child custody perceived as the most severe. The perceived seriousness of severe informal coercion may be a counter-example to the idea of a 'continuum of coercion'. The degree of severity of formal and informal coercion may not correspond to the lived experiences of the patients concerned.