Violence drives German psychiatric staff to accept coercion
A nationwide survey of 1,585 German psychiatric staff found that exposure to workplace violence and insecurity is linked to more accepting attitudes toward coercive measures.
A nationwide survey of 1,585 German psychiatric staff found that exposure to workplace violence and insecurity is linked to more accepting attitudes toward coercive measures. The study, published in Comprehensive Psychiatry, surveyed staff across 16 federal states between March and June 2023.
Survey Scope and Demographics
The AttCo project collected anonymous responses from psychiatric professionals in all German federal states. Respondents had an average age of 42 years and an average of 13 years of work experience. Women comprised 65% of the sample, 64% worked in adult psychiatry, and 79% were employed in inpatient settings.
| Demographic | Value |
|---|---|
| Average age | 42 years |
| Average work experience | 13 years |
| % Women | 65% |
| % Adult psychiatry | 64% |
| % Inpatient | 79% |
Violence and Support
During the past six months, 70% of participants reported verbal assault, with 19% experiencing it at least once weekly. Physical assault was reported by 26% of staff, and 2% encountered it weekly. Support after assault mainly involved team and individual debriefings; psychological counseling was offered to only 11% of respondents, while 27% received no support.
| Violence Type | % of Participants | Weekly Frequency |
|---|---|---|
| Verbal assault | 70% | 19% |
| Physical assault | 26% | 2% |
| Support: Team debriefing | 100% (most common) | - |
| Support: Individual debriefing | 100% (most common) | - |
| Support: Psychological counseling | 11% | - |
| No support | 27% | - |
Coercion Observed and Applied
In the same six-month period, 79% of staff had observed coercive measures, and 26% had seen them weekly. Forty-seven percent had personally applied coercion, with 9% doing so weekly. The study used a 0-to-100 rating scale to assess the frequency of these practices.
| Coercion Activity | % of Participants | Weekly Frequency |
|---|---|---|
| Observed coercion | 79% | 26% |
| Applied coercion | 47% | 9% |
Factors Influencing Attitudes
Regression analyses revealed that older staff, those working in forensic psychiatry, and those with heightened feelings of insecurity were less critical of coercive measures. Likewise, frequent exposure to physical violence and a heavier emotional burden from verbal assault correlated with more accepting attitudes. In contrast, greater years of experience and a higher emotional burden from witnessing coercion were linked to more critical views.
The authors, Klara Czernin, Anna Oster, Lieselotte Mahler, and Josef Severin Baumgartner, noted that subjective factors such as work experience, violence exposure, and emotional burden shape staff perspectives on coercion. They suggested that enhancing violence prevention, improving de-escalation strategies, and offering individualized support after distressing incidents could reduce insecurity and shift attitudes.
The study’s design limits causal inference, and all data were self-reported, raising the possibility of reporting bias. The sensitive nature of coercion may have prompted socially desirable responses.
The paper, “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,” was authored by Klara Czernin, Anna Oster, Lieselotte Mahler, and Josef Severin Baumgartner.
