Advertisement

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
Article

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.

Keywords

Depression PHQ-9 Coercion Fitness for duty 

Notes

Funding

None.

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.

References

  1. 1.
    Begun AL, Murphy CM, Bolt D, Weinstein B, Strodhoff T, Short L, Shelley G. Characteristics of the safe at home instrument for assessing readiness to change intimate partner violence. Res Social Work Prac. 2003;13:80-107.CrossRefGoogle Scholar
  2. 2.
    Chamberlain P, Patterson G, Reid J, Kavanagh K, Forgatch M. Observation of client resistance. Behav Therapy. 1984;15:144-55.CrossRefGoogle Scholar
  3. 3.
    Lehmer M. Court-ordered therapy: making it work. Am J Foren Psychol. 1986;4(2):16-24.Google Scholar
  4. 4.
    Orlinsky DE, Howard KI. Process and outcome in psychotherapy. In: Garfield SL, Bergin AE, editors. Handbook of psychotherapy and behavior change, third edition. New York: Wiley; 1986. pp. 311-81.Google Scholar
  5. 5.
    Schottenfeld RS. Involuntary treatment of substance abuse disorders—impediments to success. Psychiatry. 1989;52:164-76.CrossRefGoogle Scholar
  6. 6.
    Rosenfeld BD. Court-ordered treatment of spouse abuse. Clin Psychol Rev. 1992;12:205-26.CrossRefGoogle Scholar
  7. 7.
    Simpson DD, Joe GW, Rowan-Szal GA. Drug abuse treatment retention and process effects on follow-up outcomes. Drug Alcohol Depen.1997; 47:227-35.CrossRefPubMedGoogle Scholar
  8. 8.
    Nolan J, Thompson AP. Psychological change in voluntary and legally coerced clients of a residential drug and alcohol treatment programme. Psychiat Psychol Law. 2009;16(3):458-472.CrossRefGoogle Scholar
  9. 9.
    Anglin MD, Brecht ML, Maddahian E. Pretreatment characteristics and treatment performance of legally coerced versus voluntary methadone maintenance admissions. Criminology. 1989;27:537-57.CrossRefGoogle Scholar
  10. 10.
    Brecht ML, Anglin MD, Wang JC. Treatment effectiveness for legally coerced versus voluntary methadone maintenance clients. J Drug Alcohol Abuse. 1993;19(1):89-99.CrossRefGoogle Scholar
  11. 11.
    De Leon G. Legal pressure in therapeutic communities. J Drug Issues. 1988;18:625-40.CrossRefGoogle Scholar
  12. 12.
    Burke AC, Gregoire TK. Substance Abuse Treatment Outcomes for Coerced and Noncoerced Clients. Health Soc Work. 2007;32(1):7-15.CrossRefPubMedGoogle Scholar
  13. 13.
    Johnson RS, Fowler JC, Sikes KA, Allen JG, Oldham JM. Fitness for duty: a systematic analysis of treatment effects on depression severity for mandated versus voluntary physicians. J Am Acad Psychiatry Law. 2015;43:476-482.PubMedGoogle Scholar
  14. 14.
    Allen JG, Frueh BC, Ellis TE, Latini DM, Mahoney JS, Oldham JM, Sharp C, Wallin L. Integrating outcomes assessment and research into clinical care in inpatient adult psychiatric treatment. Bull Menninger Clin. 2009;73:259-295.CrossRefPubMedGoogle Scholar
  15. 15.
    Allen JG, O’Malley F, Freeman C, Bateman AW. Promoting mentalizing in brief treatment. In: Fonagy P, Bateman AW, editors. Handbook of mentalizing in mental health practice. Washington, DC: American Psychiatric Publishing; 2012. pp. 159-196.Google Scholar
  16. 16.
    Groat M, Allen JG. Promoting mentalizing in experiential psychoeducational groups: from agency and authority to authorship. Bull Menninger Clin. 2011;75:315-343.CrossRefPubMedGoogle Scholar
  17. 17.
    Linehan MM. Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford; 1993.Google Scholar
  18. 18.
    Fowler JC, Allen JG, Oldham JM, Frueh BC. Exposure to interpersonal trauma, attachment insecurity, and depression severity. J Affect Disorders. 2013;149:313-318.CrossRefPubMedGoogle Scholar
  19. 19.
    Kroenke K, Spitzer RL, Williams JBW. The PHQ-9 — validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Kroenke K, Spitzer RL, Williams J BW, Lowe B. The patient health questionnaire somatic, anxiety and depressive symptom scales: a systematic review. Gen Hosp Psychiatry. 2010;32(4):345-359.CrossRefPubMedGoogle Scholar
  21. 21.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Publishing; 1994.Google Scholar
  22. 22.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fourth edition, text revision. Washington, DC: American Psychiatric Publishing; 2000.CrossRefGoogle Scholar
  23. 23.
    Pilkonis PA, Heape CL, Proietti JM, Clark SW, McDavid JD, Pitts TE. The reliability and validity of two structured diagnostic interviews for personality disorders. Arch Gen Psychiatry. 1995;52:1025–1033.CrossRefPubMedGoogle Scholar

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

Personalised recommendations