Accumulated coercion and short-term outcome of inpatient psychiatric care.
BACKGROUND
The knowledge of the impact of coercion on psychiatric treatment outcome is limited. Multiple measures of coercion have been recommended. The aim of the study was to examine the impact of accumulated coercive incidents on short-term outcome of inpatient psychiatric care


METHODS
233 involuntarily and voluntarily admitted patients were interviewed within five days of admission and at discharge or after maximum three weeks of care. Coercion was measured as number of coercive incidents, i.e. subjectively reported and in the medical files recorded coercive incidents, including legal status and perceived coercion at admission, and recorded and reported coercive measures during treatment. Outcome was measured both as subjective improvement of mental health and as improvement in professionally assessed functioning according to GAF. Logistic regression analyses were performed with patient characteristics and coercive incidents as independent and the two outcome measures as dependent variables


RESULTS
Number of coercive incidents did not predict subjective or assessed improvement. Patients having other diagnoses than psychoses or mood disorders were less likely to be subjectively improved, while a low GAF at admission predicted an improvement in GAF scores


CONCLUSIONS
The results indicate that subjectively and professionally assessed mental health short-term outcome of acute psychiatric hospitalisation are not predicted by the amount of subjectively and recorded coercive incidents. Further studies are needed to examine the short- and long-term effects of coercive interventions in psychiatric care.
Kjellin
Lars
L
School of Health and Medical Sciences, Psychiatric Research Centre, Orebro University, Orebro, Sweden. lars.kjellin@orebroll.se
Wallsten
Tuula
T
D000328:Adult; D010054:Brief Psychiatric Rating Scale / Q000706:statistics & numerical data; D003068:Coercion; D003134:Commitment of Persons with Psychiatric Disorders; D005260:Female; D005555:Forensic Psychiatry; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010343:Patient Admission / Q000331:legislation & jurisprudence; D010351:Patient Discharge; D017060:Patient Satisfaction; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D013548:Sweden; D016896:Treatment Outcome