Swanson Jeffrey W, Swartz Marvin S, Elbogen Eric B, Wagner H Ryan, Burns Barbara J
Duke University Medical Center, Box 3071, Brightleaf Square Suite 23-A, Durham, NC 27710, USA.
Behav Sci Law. 2003;21(4):473-91. doi: 10.1002/bsl.548.
Recent evidence suggests that involuntary outpatient commitment (OPC), when appropriately applied, can improve adherence with psychiatric treatment, decrease hospital recidivism and arrests, and lower the risk of violent behavior in persons with severe mental illness. Presumably these are benefits that improve quality of life (QOL); however, insofar as OPC involves legal coercion, the undesirable aspects of OPC could also exert a negative effect on quality of life, thus offsetting clinical benefits. Involuntarily hospitalized subjects, awaiting discharge under outpatient commitment, were randomly assigned to be released or continue under outpatient commitment in the community after hospital discharge, and were followed for one year. Quality of life was measured at baseline and 12 months follow-up. Treatment characteristics and clinical outcomes were also measured. Subjects who underwent longer periods of outpatient commitment had significantly greater quality of life as measured at the end of the 1 year study. Multivariable analysis showed that the effect of OPC on QOL was mediated by greater treatment adherence and lower symptom scores. However, perceived coercion moderated the effect of OPC on QOL. Involuntary outpatient commitment, when sustained over time, indirectly exerts a positive effect on subjective quality of life for persons with SMI, at least in part by improving treatment adherence and lowering symptomatology.
近期证据表明，非自愿门诊治疗（OPC）若应用得当，可提高精神病治疗的依从性，减少再次住院和被捕情况，并降低重症精神疾病患者的暴力行为风险。据推测，这些都是改善生活质量（QOL）的益处；然而，鉴于OPC涉及法律强制手段，其不良方面也可能对生活质量产生负面影响，从而抵消临床益处。将非自愿住院且等待门诊治疗出院的受试者随机分为两组，一组在出院后在社区中被释放，另一组继续接受门诊治疗，并随访一年。在基线和随访12个月时测量生活质量。还测量了治疗特征和临床结果。在为期1年的研究结束时，接受门诊治疗时间较长的受试者的生活质量显著更高。多变量分析表明，OPC对生活质量的影响是通过更高的治疗依从性和更低的症状评分介导的。然而，感知到的强制手段调节了OPC对生活质量的影响。非自愿门诊治疗若长期持续，至少部分通过提高治疗依从性和减轻症状，对重症精神疾病患者的主观生活质量间接产生积极影响。
