The assessment of decision‐making competence in patients with depression using the MacArthur competence assessment tools: A systematic review

PURPOSE This is a systematic review of the usefulness of the MacArthur Competence Assessment Tools (MacCAT) in assessing the decision-making competence in patients with depression. DESIGN AND METHODS A systematic literature search was performed. FINDINGS Eleven studies met the search criteria. The decision-making capacity was impaired in 9-31% of the patients with depression. There was inconsistency regarding the differences of MacCAT scores between patients with depression and controls, while relatively large effect sizes were found on the Appreciation and Reasoning MacCAT subscales. PRACTICE IMPLICATIONS The MacCAT appears to be a useful tool for measuring decision-making capacity in patients with depression, but the association between depression and competence is not consistent. The mechanisms mediating such association are likely to be complex and multifactorial.

[1]  T. Si,et al.  Longitudinal informed consent competency in stable community patients with schizophrenia: A one-week training and one-year follow-up study , 2016, Schizophrenia Research.

[2]  M. Mars,et al.  Pitfalls in computer housekeeping by doctors and nurses in KwaZulu-Natal: No malicious intent , 2013, BMC medical ethics.

[3]  M. Hotopf,et al.  Depression and decision-making capacity for treatment or research: a systematic review , 2013, BMC medical ethics.

[4]  Y. Jeon,et al.  Assessing patient capacity to consent to treatment: an integrative review of instruments and tools. , 2013, Journal of clinical nursing.

[5]  H. Mayberg,et al.  The ethics of research on deep brain stimulation for depression: decisional capacity and therapeutic misconception , 2012, Annals of the New York Academy of Sciences.

[6]  Mary Davoren,et al.  Effects of group metacognitive training (MCT) on mental capacity and functioning in patients with psychosis in a secure forensic psychiatric hospital: a prospective-cohort waiting list controlled study , 2012, BMC Research Notes.

[7]  G. Meynen.  Depression, possibilities, and competence: A phenomenological perspective , 2011, Theoretical medicine and bioethics.

[8]  M. Hotopf,et al.  Regaining mental capacity for treatment decisions following psychiatric admission: a clinico-ethical study , 2010, Psychological Medicine.

[9]  G. Livingston,et al.  Mental capacity to consent to treatment and admission decisions in older adult psychiatric inpatients , 2009, International journal of geriatric psychiatry.

[10]  M. Hotopf,et al.  Mental capacity, diagnosis and insight in psychiatric in-patients: a cross-sectional study , 2008, Psychological Medicine.

[11]  M. Hotopf,et al.  Mental capacity to make decisions on treatment in people admitted to psychiatric hospitals: cross sectional study , 2008, British medical journal.

[12]  D. Jeste,et al.  Assessing decisional capacity for clinical research or treatment: a review of instruments. , 2006, The American journal of psychiatry.

[13]  P. Appelbaum,et al.  Willingness of subjects with thought disorder to participate in research. , 2005, Schizophrenia bulletin.

[14]  P. Appelbaum,et al.  Impact of Decisional Capacity on the Use of Leverage to Encourage Treatment Adherence , 2006, Community Mental Health Journal.

[15]  E. Sturman,et al.  The capacity to consent to treatment and research: a review of standardized assessment tools. , 2005, Clinical psychology review.

[16]  M. Hotopf,et al.  Prevalence and predictors of mental incapacity in psychiatric in-patients. , 2005, The British journal of psychiatry : the journal of mental science.

[17]  D. Jeste,et al.  Assessment of capacity to consent to research among older persons with schizophrenia, Alzheimer disease, or diabetes mellitus: comparison of a 3-item questionnaire with a comprehensive standardized capacity instrument. , 2005, Archives of general psychiatry.

[18]  J. Smit,et al.  Instruments to assess decision-making capacity: an overview , 2004, International Psychogeriatrics.

[19]  M. Hotopf,et al.  Prevalence of mental incapacity in medical inpatients and associated risk factors: cross-sectional study , 2004, The Lancet.

[20]  R. Pinkerton,et al.  Willingness and competence of depressed and schizophrenic inpatients to consent to research. , 2004, The journal of the American Academy of Psychiatry and the Law.

[21]  T. Rummans,et al.  Decisional Capacity of Depressed Elderly to Consent to Electroconvulsive Therapy , 2004, Journal of geriatric psychiatry and neurology.

[22]  H. Danker-Hopfe,et al.  Competence of mentally ill patients: a comparative empirical study , 2003, Psychological Medicine.

[23]  T. Rummans,et al.  Decisional Capacity of Severely Depressed Patients Requiring Electroconvulsive Therapy , 2003, The journal of ECT.

[24]  J. Monahan,et al.  Development of the MacArthur Competence Assessment Tool-Criminal Adjudication (The MacCAT-CA) , 2002 .

[25]  D J Kupfer,et al.  Competence of depressed patients for consent to research. , 1999, The American journal of psychiatry.

[26]  Thomas Grisso,et al.  Assessing Competence to Consent to Treatment: A Guide for Physicians and Other Health Professionals , 1998 .

[27]  P. Appelbaum,et al.  The MacCAT-T: a clinical tool to assess patients' capacities to make treatment decisions. , 1997, Psychiatric services.

[28]  R. E. Redding,et al.  Depression in jailed women defendants and its relationship to their adjudicative competence. , 1997, The journal of the American Academy of Psychiatry and the Law.

[29]  P. Appelbaum,et al.  The MacArthur Treatment Competence Study. I , 1995, Law and human behavior.

[30]  Thomas Grisso,et al.  Mental Illness and Competence to Consent to Treatment , 1995 .

[31]  P. Appelbaum,et al.  Competency to consent to research: a psychiatric overview. , 1982, Archives of general psychiatry.