Accumulated coercion and short-term outcome of inpatient psychiatric care. 2010

Lars Kjellin, and Tuula Wallsten
School of Health and Medical Sciences, Psychiatric Research Centre, Orebro University, Orebro, Sweden. lars.kjellin@orebroll.se

BACKGROUND The 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 care METHODS 233 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 variables RESULTS Number 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 scores CONCLUSIONS The 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.

UI MeSH Term Description Entries
D007902 Length of Stay The period of confinement of a patient to a hospital or other health facility. Hospital Stay,Hospital Stays,Stay Length,Stay Lengths,Stay, Hospital,Stays, Hospital
D008297 Male Males
D010054 Brief Psychiatric Rating Scale A scale comprising 18 symptom constructs chosen to represent relatively independent dimensions of manifest psychopathology. The initial intended use was to provide more efficient assessment of treatment response in clinical psychopharmacology research; however, the scale was readily adapted to other uses. (From Hersen, M. and Bellack, A.S., Dictionary of Behavioral Assessment Techniques, p. 87) Overall and Gorham Brief Psychiatric Rating Scale,Overall-Gorham Brief Psychiatric Rating Scale,Overall Gorham Brief Psychiatric Rating Scale
D010343 Patient Admission The process of accepting patients. The concept includes patients accepted for medical and nursing care in a hospital or other health care institution. Voluntary Admission,Admission, Patient,Admission, Voluntary,Admissions, Patient,Admissions, Voluntary,Patient Admissions,Voluntary Admissions
D010351 Patient Discharge The administrative process of discharging the patient, alive or dead, from hospitals or other health facilities. Discharge Planning,Discharge Plannings,Discharge, Patient,Discharges, Patient,Patient Discharges,Planning, Discharge,Plannings, Discharge
D011569 Psychiatric Status Rating Scales Standardized procedures utilizing rating scales or interview schedules carried out by health personnel for evaluating the degree of mental illness. Factor Construct Rating Scales (FCRS),Katz Adjustment Scales,Lorr's Inpatient Multidimensional Psychiatric Rating Scale,Wittenborn Scales,Edinburgh Postnatal Depression Scale,Mini International Neuropsychiatric Interview
D003068 Coercion The use of force or intimidation to obtain compliance.
D003134 Commitment of Mentally Ill Legal process required for the institutionalization of a patient with severe mental problems. Outpatient Commitment,Commitment, Outpatient,Mentally Ill Commitments
D005260 Female Females
D005555 Forensic Psychiatry Psychiatry in its legal aspects. This includes criminology, penology, commitment of mentally ill, the psychiatrist's role in compensation cases, the problems of releasing information to the court, and of expert testimony. Jurisprudence, Psychiatric,Psychiatric Jurisprudence,Psychiatry, Forensic

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