The MacArthur competence assessment tools for assessing decision-making capacity in schizophrenia: A meta-analysis
Abstract
Objective This meta-analysis aimed to examine the decisional capacity measured by the MacArthur Competence Assessment Tools (MacCAT) in schizophrenia.Method English (PubMed, PsycINFO, Embase, Cochrane Library databases and the Cochrane Controlled Trials Register) and Chinese (Wan Fang Database and Chinese National Knowledge Infrastructure) databases were systematically and independently searched from 1995 until August 1, 2016. Weighted and standardized mean differences were calculated. The random effects model was used in all cases.Results Altogether 10 studies were identified, with 7 studies using the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR) and 3 studies using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). The meta-analysis showed that there was significant impairment in decision-making capacity in schizophrenia patients compared to the healthy control group in terms of Understanding (SMD=-0.81, 95% CI: -1.06 to -0.56, P<0.001), Reasoning (SMD=-0.57, 95% CI: -0.80 to -0.34, P<0.001), Appreciation (SMD=-0.87, 95% CI: -1.20 to -0.53, P<0.001), and Expression a choice (SMD=-0.24, 95% CI: -0.43 to -0.05, P=0.01).Conclusion Compared to the control group, schizophrenia patients are more likely to have impaired decision-making capacity in clinical research and treatment as measured by the MacCAT instruments. Researchers and clinicians need to consider the impaired decisional capacity in schizophrenia patients providing informed consent.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The MacCAT-T lacks an established cut-off point to produce a binary measure of capacity.
“The MacCAT-T remains the most frequently used psychometric assessment (Wang et al., 2017), but it lacks an established cut-off point to produce a binary measure of capacity.”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Wang et al., 2017
Cites
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139 · see citing works
Evaluating non-randomised intervention studies
Deeks, J., Dinnes, J., D'Amico, R., Sowden, A., Sakarovitch, C., Song, F., Petticrew, M., & Altman, D. (2003) · Health Technology Assessment · doi:10.3310/hta7270 · Cited by 2,907 · see citing works
Assessment of Patients' Competence to Consent to Treatment
Appelbaum, P. S. (2007) · New England Journal of Medicine · doi:10.1056/nejmcp074045 · Cited by 1,427 · see citing works
Cannon, M., Caspi, A., Moffitt, T. E., Harrington, H., Taylor, A., Murray, R. M., & Poulton, R. (2002) · Archives of General Psychiatry · doi:10.1001/archpsyc.59.5.449 · Cited by 783 · see citing works
The MacCAT-T: a clinical tool to assess patients' capacities to make treatment decisions
(1997) · Psychiatric Services · doi:10.1176/ps.48.11.1415 · Cited by 704 · see citing works
Grisso, T., & Appelbaum, P. S. (1995) · Law and Human Behavior · doi:10.1007/bf01499323 · Cited by 595 · see citing works
Decisional Capacity for Informed Consent in Schizophrenia Research
Carpenter, W. T. (2000) · Archives of General Psychiatry · doi:10.1001/archpsyc.57.6.533 · Cited by 506 · see citing works
Assessing Decisional Capacity for Clinical Research or Treatment: A Review of Instruments
Dunn, L. B., Nowrangi, M. A., Palmer, B. W., Jeste, D. V., & Saks, E. R. (2006) · American Journal of Psychiatry · doi:10.1176/ajp.2006.163.8.1323 · Cited by 464 · see citing works
The MacArthur Treatment Competence Study. I: Mental illness and competence to consent to treatment.
Appelbaum, P. S., & Grisso, T. (1995) · Law and Human Behavior · doi:10.1007/bf01499321 · Cited by 424 · see citing works
Raymont, V., Bingley, W., Buchanan, A. W., David, A. S., Hayward, P., Wessely, S. C., & Hotopf, M. H. (2004) · The Lancet · doi:10.1016/s0140-6736(04)17224-3 · Cited by 390 · see citing works
Competency to Consent to Research: A Psychiatric Overview
Appelbaum, P. S. (1982) · Archives of General Psychiatry · doi:10.1001/archpsyc.1982.04290080061009 · Cited by 287 · see citing works
MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR)
Kreutzer, J. S., DeLuca, J., & Caplan, B. (2010) · Springer eBooks · doi:10.1007/978-0-387-79948-3_4894 · Cited by 271 · see citing works
Do Patients With Schizophrenia Wish to Be Involved in Decisions About Their Medical Treatment?
Hamann, J., Cohen, R., Leucht, S., Busch, R. M., & Kissling, W. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.12.2382 · Cited by 254 · see citing works
Grisso, T., Appelbaum, P. S., Mulvey, E. P., & Fletcher, K. E. (1995) · Law and Human Behavior · doi:10.1007/bf01499322 · Cited by 253 · see citing works
Janofsky, J. S., McCarthy, R. J., & Foistein, M. F. (1992) · Psychiatric Services · doi:10.1176/ps.43.2.132 · Cited by 213 · see citing works
Decision-Making Impairments in the Context of Intact Reward Sensitivity in Schizophrenia
Heerey, E. A., Bell-Warren, K. R., & Gold, J. M. (2008) · Biological Psychiatry · doi:10.1016/j.biopsych.2008.02.015 · Cited by 197 · see citing works
The capacity to consent to treatment and research: A review of standardized assessment tools
Sturman, E. D. (2005) · Clinical Psychology Review · doi:10.1016/j.cpr.2005.04.010 · Cited by 195 · see citing works
Prevalence and predictors of mental incapacity in psychiatric in-patients
Cairns, R., Maddock, C., Buchanan, A. W., David, A. S., Hayward, P., Richardson, G., SZMUKLER, G. I., & Hotopf, M. H. (2005) · The British Journal of Psychiatry · doi:10.1192/bjp.187.4.379 · Cited by 165 · see citing works
Jeste, D. V. (2005) · Schizophrenia Bulletin · doi:10.1093/schbul/sbj001 · Cited by 150 · see citing works
Palmer, B. W., Dunn, L. B., Appelbaum, P. S., & Jeste, D. V. (2004) · Archives of General Psychiatry · doi:10.1001/archpsyc.61.3.230 · Cited by 141 · see citing works
Determining when impairment constitutes incapacity for informed consent in schizophrenia research
Kim, S. Y. H., Appelbaum, P. S., Swan, J., Stroup, T. S., McEvoy, J. P., Goff, D. C., Jeste, D. V., Lamberti, J. S., Leibovici, A., & Caine, E. D. (2007) · British Journal of Psychiatry · doi:10.1192/bjp.bp.106.033324 · Cited by 84 · see citing works
Decision making deficits in patients with first-episode and chronic schizophrenia
Hutton, S. B., Murphy, F. C., Joyce, E. M., Rogers, R. D., Cuthbert, I., Barnes, T. R. E., McKenna, P. J., Sahakian, B. J., & Robbins, T. W. (2002) · Schizophrenia Research · doi:10.1016/s0920-9964(01)00216-x · Cited by 83 · see citing works
Jeste, D. V., Palmer, B. W., Golshan, S., Eyler, L. T., Dunn, L. B., Meeks, T. W., Glorioso, D., Fellows, I. E., KRAEMER, H. C., & Appelbaum, P. S. (2008) · Schizophrenia Bulletin · doi:10.1093/schbul/sbm148 · Cited by 82 · see citing works
Instruments to assess decision-making capacity: an overview
Vellinga, A., Smit, J. H., van Leeuwen, E., van Tilburg, W., & Jonker, C. (2004) · International Psychogeriatrics · doi:10.1017/s1041610204000808 · Cited by 81 · see citing works
Assessing patient capacity to consent to treatment: an integrative review of instruments and tools
Lamont, S., Jeon, Y., & Chiarella, M. (2013) · Journal of Clinical Nursing · doi:10.1111/jocn.12215 · Cited by 78 · see citing works
Factor structure of the expanded Brief Psychiatric Rating Scale
Burger, G. K., Calsyn, R. J., Morse, G. A., Klinkenberg, W. D., & Trusty, M. L. (1997) · Journal of Clinical Psychology · doi:10.1002/(sici)1097-4679(199708)53:5 · Cited by 78 · see citing works
Assessment of Mental Competency in Community-Dwelling Elderly
Schmand, B. A., Gouwenberg, B. M., Smit, J. H., & Jonker, C. (1999) · Alzheimer Disease & Associated Disorders · doi:10.1097/00002093-199904000-00004 · Cited by 77 · see citing works
Candilis, P. J., Fletcher, K. E., GEPPERT, C. M. A., Lidz, C. W., & Appelbaum, P. S. (2008) · Schizophrenia Research · doi:10.1016/j.schres.2007.11.022 · Cited by 74 · see citing works
Using a Brief Intervention to Improve Decisional Capacity in Schizophrenia Research
Moser, D. J. (2005) · Schizophrenia Bulletin · doi:10.1093/schbul/sbi066 · Cited by 58 · see citing works
(2004) · PubMed · Cited by 56 · see citing works
Willingness of Subjects With Thought Disorder to Participate in Research
Candilis, P. J. (2005) · Schizophrenia Bulletin · doi:10.1093/schbul/sbj016 · Cited by 48 · see citing works
Do Clinicians Follow a Risk-Sensitive Model of Capacity-Determination? An Experimental Video Survey
Kim, S. Y. H., Caine, E. D., Swan, J. G., & Appelbaum, P. S. (2006) · Psychosomatics · doi:10.1176/appi.psy.47.4.325 · Cited by 44 · see citing works
Decision-making capacity for informed consent in the older population.
Christensen, K., Haroun, A. M., Schneiderman, L. J., & Jeste, D. V. (1995) · PubMed · Cited by 44 · see citing works
Harmell, A. L., Palmer, B. W., & Jeste, D. V. (2012) · Schizophrenia Research · doi:10.1016/j.schres.2012.08.001 · Cited by 27 · see citing works
Marco, M. C. D., Sani, G., Manfredi, G., Pacchiarotti, I., Savoja, V., Balbi, A., Mazzarini, L., Borriello, A., Kotzalidis, G. D., Tatarelli, R., et al. (2010) · Journal of Forensic Sciences · doi:10.1111/j.1556-4029.2010.01364.x · Cited by 5 · see citing works
Wang, X., Yu, X., Tang, H., et al. (2015) · Chin J Psychiatry · doi:10.3760/cma.j.issn.1006-7884.2015.01.005 · Cited by 3 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Calcedo-Barba, A., Fructuoso, A., Martinez-Raga, J., Paz, S., Sánchez de Carmona, M., & Vicens, E. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02756-0 · Cited by 89 · see citing works
Mental Capacity, Decision-Making and Emotion Dysregulation in Severe Enduring Anorexia Nervosa
van Elburg, A., Danner, U. N., Sternheim, L. C., Lammers, M., & Elzakkers, I. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.545317 · Cited by 55 · see citing works
Spencer, B. W. J., Shields, G., Gergel, T., Hotopf, M., & Owen, G. S. (2017) · Psychological Medicine · doi:10.1017/s0033291717000502 · Cited by 43 · see citing works
Elzakkers, I. F. F. M., Danner, U. N., Grisso, T., Hoek, H. W., & van Elburg, A. A. (2018) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2018.02.001 · Cited by 30 · see citing works
Marcó-García, S., Ariyo, K., Owen, G. S., & David, A. S. (2024) · Psychological Medicine · doi:10.1017/s0033291724000242 · Cited by 18 · see citing works
- Authors
- Wang, S.-B., Wang, Y.-Y., Ungvari, G. S., Ng, C. H., Wu, R.-R., Wang, J., & Xiang, Y.-T.
- Affiliations
- University of Macau (MO)
- The University of Western Australia (AU)
- The University of Melbourne (AU)
- Central South University (CN)
- Shanghai Jiao Tong University (CN)
- Corresponding author
- Xiang, Yu-Tao
- Venue
- Schizophrenia Research
- Publisher
- Elsevier BV
- Published
- 2017-05
- Volume
- 183
- Pages
- 56-63
- ISSN
- 0920-9964 (ISSN-L)
- OpenAlex
- W2556999017
- Cited by
- 38
- References
- 36
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 8 · 2023: 2 · 2022: 5 · 2021: 4 · 2020: 2 · 2019: 2 · 2018: 4 · 2017: 3
- FWCI
- 0.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Schizophrenia Research (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- schizophrenia, decision-making capacity
- MeSH terms
- Cognition Disorders, Decision Making, Neuropsychological Tests, Schizophrenia, Schizophrenic Psychology, Databases, Bibliographic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
