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Research ArticleRegular Articles

Treatment of Depression in Voluntary Versus Mandated Physicians

R. Scott Johnson, J. Christopher Fowler, Kristi A. Sikes, Jon G. Allen and John M. Oldham
Journal of the American Academy of Psychiatry and the Law Online December 2015, 43 (4) 476-482;
R. Scott Johnson
Dr. Johnson is a forensic psychiatry fellow at Massachusetts General Hospital/Harvard Medical School in Boston, MA. Dr. Sikes is the Medical Director, Cypress Creek Hospital, Houston, TX. Dr. Allen is Professor of Psychiatry and Helen Malsin Palley Chair in Mental Health Research, Dr. Fowler is Associate Professor, and Dr. Oldham is Professor and Executive Vice Chair for Clinical Affairs and Development, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX. Dr. Fowler is also Associate Director of Clinical Research, and Dr. Oldham is also Senior Vice President and Chief of Staff, The Menninger Clinic, Houston, TX. A preliminary poster of this material was presented at the 44th annual meeting of the American Academy of Psychiatry and the Law, October 24–27, 2013, San Diego, CA.
MD, JD, LLM
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J. Christopher Fowler
Dr. Johnson is a forensic psychiatry fellow at Massachusetts General Hospital/Harvard Medical School in Boston, MA. Dr. Sikes is the Medical Director, Cypress Creek Hospital, Houston, TX. Dr. Allen is Professor of Psychiatry and Helen Malsin Palley Chair in Mental Health Research, Dr. Fowler is Associate Professor, and Dr. Oldham is Professor and Executive Vice Chair for Clinical Affairs and Development, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX. Dr. Fowler is also Associate Director of Clinical Research, and Dr. Oldham is also Senior Vice President and Chief of Staff, The Menninger Clinic, Houston, TX. A preliminary poster of this material was presented at the 44th annual meeting of the American Academy of Psychiatry and the Law, October 24–27, 2013, San Diego, CA.
PhD
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Kristi A. Sikes
Dr. Johnson is a forensic psychiatry fellow at Massachusetts General Hospital/Harvard Medical School in Boston, MA. Dr. Sikes is the Medical Director, Cypress Creek Hospital, Houston, TX. Dr. Allen is Professor of Psychiatry and Helen Malsin Palley Chair in Mental Health Research, Dr. Fowler is Associate Professor, and Dr. Oldham is Professor and Executive Vice Chair for Clinical Affairs and Development, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX. Dr. Fowler is also Associate Director of Clinical Research, and Dr. Oldham is also Senior Vice President and Chief of Staff, The Menninger Clinic, Houston, TX. A preliminary poster of this material was presented at the 44th annual meeting of the American Academy of Psychiatry and the Law, October 24–27, 2013, San Diego, CA.
MD
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Jon G. Allen
Dr. Johnson is a forensic psychiatry fellow at Massachusetts General Hospital/Harvard Medical School in Boston, MA. Dr. Sikes is the Medical Director, Cypress Creek Hospital, Houston, TX. Dr. Allen is Professor of Psychiatry and Helen Malsin Palley Chair in Mental Health Research, Dr. Fowler is Associate Professor, and Dr. Oldham is Professor and Executive Vice Chair for Clinical Affairs and Development, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX. Dr. Fowler is also Associate Director of Clinical Research, and Dr. Oldham is also Senior Vice President and Chief of Staff, The Menninger Clinic, Houston, TX. A preliminary poster of this material was presented at the 44th annual meeting of the American Academy of Psychiatry and the Law, October 24–27, 2013, San Diego, CA.
PhD
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John M. Oldham
Dr. Johnson is a forensic psychiatry fellow at Massachusetts General Hospital/Harvard Medical School in Boston, MA. Dr. Sikes is the Medical Director, Cypress Creek Hospital, Houston, TX. Dr. Allen is Professor of Psychiatry and Helen Malsin Palley Chair in Mental Health Research, Dr. Fowler is Associate Professor, and Dr. Oldham is Professor and Executive Vice Chair for Clinical Affairs and Development, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX. Dr. Fowler is also Associate Director of Clinical Research, and Dr. Oldham is also Senior Vice President and Chief of Staff, The Menninger Clinic, Houston, TX. A preliminary poster of this material was presented at the 44th annual meeting of the American Academy of Psychiatry and the Law, October 24–27, 2013, San Diego, CA.
MD, MS
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  • Figure 1.
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    Figure 1.

    Mean BDI scores for voluntary and mandated physicians (N = 51).

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    Figure 2.

    Reliable change scores by length of stay.

Tables

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    Table 1

    Descriptive Statistics

    VariableMinimumMaximumMeanSDFp
    Length of stay, days
        Mandated (n = 32)45730.316.2
        Voluntary (n = 35)112537.121.72.0.16
    Age, years
        Mandated (n = 32)266749.39.92
        Voluntary (n = 35)276848.99.43.02.89
    Outpatient treatments, n
        Mandated (n = 32)0275.44.9
        Voluntary (n = 35)0104.72.6.57.45
    Short-term hospitalizations, n
        Mandated (n = 32)07.691.42
        Voluntary (n = 35)04.46.82.67.42
    Long-term hospitalizations, n
        Mandated (n = 32)07.72.85
        Voluntary (n = 35)04.631.2.13.72
    Admission BDI
        Mandated (n = 32)14716.42.4
        Voluntary (n = 35)14922.61.94.0.05
    • N = 67.

    • View popup
    Table 2

    Change in Beck Depression Inventory-II Score

    VariableMeanSDFp
    Admission BDI
        Mandated (n = 22)16.413.9.79.38
        Voluntary (n = 29)22.611.5
    Discharge BDI
        Mandated (n = 22)4.75.1.43.52
        Voluntary (n = 29)6.18.2
    BDI reliable change index
        Mandated (n = 22)3.92.3.31.58
        Voluntary (n = 29)3.62.9
    • N = 51. BDI, Beck Depression Inventory.

    • View popup
    Table 3

    RCI Scores and Clinical Significant Change in Depression Severity, According to BDI-II

    BDI-IIBDI-II
    Improved(%)Deteriorated(%)
    Mandated (n = 22)
        RCI >1.96146400
        SD >2.0146400
        Recovered BDI <14209100
    Voluntary (n = 29)
        RCI >1.96248300
        SD >2.0248300
        Recovered BDI <14248300
    • N = 51. RCI, reliable change index, BDI-II, Beck Depression Inventory-II.

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Journal of the American Academy of Psychiatry and the Law Online: 43 (4)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 43, Issue 4
1 Dec 2015
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Treatment of Depression in Voluntary Versus Mandated Physicians
R. Scott Johnson, J. Christopher Fowler, Kristi A. Sikes, Jon G. Allen, John M. Oldham
Journal of the American Academy of Psychiatry and the Law Online Dec 2015, 43 (4) 476-482;

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Treatment of Depression in Voluntary Versus Mandated Physicians
R. Scott Johnson, J. Christopher Fowler, Kristi A. Sikes, Jon G. Allen, John M. Oldham
Journal of the American Academy of Psychiatry and the Law Online Dec 2015, 43 (4) 476-482;
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