Abstract
BackgroundThe 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 careMethods233 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 variablesResultsNumber 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 scoresConclusionThe 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.
Highlights
The knowledge of the impact of coercion on psychiatric treatment outcome is limited
The worldwide use of coercion in mental health services is based on the assumption that coercion in specific situations will lead to a better outcome, in terms of prevention of danger to self or others and health improvement, than if the patients were not coerced into treatment
Coercion at admission was measured on the one hand as formal legal status, and on the other as perceived coercion according to the MacArthur Perceived Coercion Scale, MPCS [4] and to the Coercion Ladder, CL [5,6]
Summary
The knowledge of the impact of coercion on psychiatric treatment outcome is limited. Multiple measures of coercion have been recommended. Katsakou & Priebe [2] found in a review of 18 outcome studies that most involuntarily admitted patients show substantial clinical improvement, and that retrospectively between 33 and 81% found the admission as justified and/or the treatment as beneficial. They conclude that it is not possible to determine whether the differences in results reflect true differences or different methodologies, and that data on predictors of outcomes is limited. Coercion at admission and the occurrence of coercive treatment or coercive measures during care, were not associated neither to subjective, nor to assessed, short-term outcome of inpatient psychiatric care. Coercion during care was measured according to patients' selfreports, only
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