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

R. Scott Johnson, James Chris Fowler, Suni N. Jani, Hillary L. Eichelberger, John M. Oldham, Edward Poa, David P. Graham

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)39-46
Number of pages8
JournalPsychiatric Quarterly
Issue number1
StatePublished - Mar 1 2017


  • Coercion
  • Depression
  • Fitness for duty
  • PHQ-9

ASJC Scopus subject areas

  • Psychiatry and Mental health


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