title: Coerced hospital admission and symptom change--a prospective observational multi-centre study.
abstract: BACKGROUND
  Coerced admission to psychiatric hospitals, defined by legal status or patient's subjective experience, is common. Evidence on clinical outcomes however is limited. This study aimed to assess symptom change over a three month period following coerced admission and identify patient characteristics associated with outcomes.
  
  
  METHODS
  At study sites in 11 European countries consecutive legally involuntary patients and patients with a legally voluntary admission who however felt coerced, were recruited and assessed by independent researchers within the first week after admission. Symptoms were assessed on the Brief Psychiatric Rating Scale. Patients were re-assessed after one and three months.
  
  
  RESULTS
  The total sample consisted of 2326 legally coerced patients and 764 patients with a legally voluntary admission who felt coerced. Symptom levels significantly improved over time. In a multivariable analysis, higher baseline symptoms, being unemployed, living alone, repeated hospitalisation, being legally a voluntary patient but feeling coerced, and being initially less satisfied with treatment were all associated with less symptom improvement after one month and, other than initial treatment satisfaction, also after three months. The diagnostic group was not linked with outcomes.
  
  
  CONCLUSIONS
  On average patients show significant but limited symptom improvements after coerced hospital admission, possibly reflecting the severity of the underlying illnesses. Social factors, but not the psychiatric diagnosis, appear important predictors of outcomes. Legally voluntary patients who feel coerced may have a poorer prognosis than legally involuntary patients and deserve attention in research and clinical practice.
authors.affiliation: Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Leipzig, Germany.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Kallert
authors.forename: Christina
authors.initials: C
authors.lastname: Katsakou
authors.forename: Tomasz
authors.initials: T
authors.lastname: Adamowski
authors.forename: Algirdas
authors.initials: A
authors.lastname: Dembinskas
authors.forename: Andrea
authors.initials: A
authors.lastname: Fiorillo
authors.forename: Lars
authors.initials: L
authors.lastname: Kjellin
authors.forename: Anastasia
authors.initials: A
authors.lastname: Mastrogianni
authors.forename: Pětr
authors.initials: P
authors.lastname: Nawka
authors.forename: Georgi
authors.initials: G
authors.lastname: Onchev
authors.forename: Jiri
authors.initials: J
authors.lastname: Raboch
authors.forename: Matthias
authors.initials: M
authors.lastname: Schützwohl
authors.forename: Zahava
authors.initials: Z
authors.lastname: Solomon
authors.forename: Francisco
authors.initials: F
authors.lastname: Torres-González
authors.forename: Stephen
authors.initials: S
authors.lastname: Bremner
authors.forename: Stefan
authors.initials: S
authors.lastname: Priebe
mesh_terms: D000328:Adult; D010054:Brief Psychiatric Rating Scale / Q000706:statistics & numerical data*; D003068:Coercion; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D008297:Male; D008954:Models, Biological; D015999:Multivariate Analysis; D010343:Patient Admission / Q000706:statistics & numerical data; D018579:Patient Selection; D011446:Prospective Studies