title: A Systematic Analysis of Treatment Effects on Depressive Symptom Severity by Level of Coercion.
abstract: Few studies examine the effect of interpersonal, regulatory or legal coercion on the treatment of depressive symptoms. This retrospective case-control study compared the recovery rates of 574 adults whose level of coercion was scored on a 0-3 scale from fully voluntary to severe coercion when admitted to the Menninger Clinic between 2009 and 2014. The change in Patient Health Questionnaire-9 (PHQ-9) scores (measuring depression severity) from admission to discharge served as the primary outcome measure. Level of coercion was not associated with a difference in rate of improvement in PHQ-9 score. Greater improvement in PHQ-9 scores was associated with (a) older age, (b) lack of a psychotic spectrum disorder diagnosis, (c) stronger working alliance with treatment team, and (d) less difficulty with emotional regulation [lower Difficulties in Emotion Regulation Scale (DERS) scores]. DERS scores were the most impactful factor. This study suggests that licensure boards can continue to mandate treatment despite concerns that coercion may decrease treatment effectiveness.
authors.affiliation: MGH Law and Psychiatry Service, Harvard Medical School, 1 Bowdoin Square, 10th Floor, Boston, MA, 02114, USA. rscottjohnson3@gmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Scott Johnson
authors.affiliation: Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.|The Menninger Clinic, Houston, TX, USA.
authors.forename: J
authors.initials: J
authors.lastname: Christopher Fowler
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Suni N
authors.initials: SN
authors.lastname: Jani
authors.affiliation: University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: Hillary L
authors.initials: HL
authors.lastname: Eichelberger
authors.affiliation: Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.|The Menninger Clinic, Houston, TX, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Oldham
authors.affiliation: Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Poa
authors.affiliation: Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.|Neurorehabilitation: Neurons to Networks Traumatic Brain Injury Center of Excellence, Michael E. DeBakey Veterans Affairs (VA) Medical Center, Houston, TX, USA.|Michael E. DeBakey Veterans Affairs (VA) Medical Center, Mental Health Care Line, Houston, TX, USA.|Department of Veterans Affairs, South Central Mental Illness, Research, Education and Clinical Center (MIRECC), Little Rock, AR, USA.
authors.forename: David P
authors.initials: DP
authors.lastname: Graham
mesh_terms: D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D003068:Coercion; D003299:Cooperative Behavior; D003863:Depression / Q000523:psychology / Q000628:therapy*; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011369:Professional-Patient Relations; D011618:Psychotic Disorders / Q000523:psychology; D012189:Retrospective Studies; D000068356:Self-Control / Q000523:psychology; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
keywords: Coercion; Depression; Fitness for duty; PHQ-9