Psychiatric Quarterly

, Volume 88, Issue 1, pp 39–46 | Cite as

A Systematic Analysis of Treatment Effects on Depressive Symptom Severity by Level of Coercion

  • R. Scott JohnsonEmail author
  • J. Christopher Fowler
  • Suni N. Jani
  • Hillary L. Eichelberger
  • John M. Oldham
  • Edward Poa
  • David P. Graham


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.


Depression PHQ-9 Coercion Fitness for duty 




Compliance with Ethical Standards

Conflict of Interest

All authors declare that they have no conflicts of interest.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • R. Scott Johnson
    • 1
    Email author
  • J. Christopher Fowler
    • 2
    • 8
  • Suni N. Jani
    • 3
  • Hillary L. Eichelberger
    • 4
  • John M. Oldham
    • 2
    • 8
  • Edward Poa
    • 2
  • David P. Graham
    • 2
    • 5
    • 6
    • 7
  1. 1.MGH Law and Psychiatry ServiceHarvard Medical SchoolBostonUSA
  2. 2.Menninger Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonUSA
  3. 3.Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  4. 4.University of Texas Medical School at HoustonHoustonUSA
  5. 5.Neurorehabilitation: Neurons to Networks Traumatic Brain Injury Center of ExcellenceMichael E. DeBakey Veterans Affairs (VA) Medical CenterHoustonUSA
  6. 6.Michael E. DeBakey Veterans Affairs (VA) Medical Center, Mental Health Care LineHoustonUSA
  7. 7.Department of Veterans AffairsSouth Central Mental Illness, Research, Education and Clinical Center (MIRECC)Little RockUSA
  8. 8.The Menninger ClinicHoustonUSA

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