Competence of mentally ill patients: a comparative empirical study
Abstract
BACKGROUND: This study investigates the competence of patients with dementia, depression and schizophrenia to make treatment decisions. The outcome of an objective test instrument is presented and compared with clinical assessment of competence by the attending physician. METHOD: The MacArthur Competence Assessment Tool-Treatment (MacCAT-T), a test instrument to assess abilities in different standards of competence, was administered to patients with diagnoses of dementia (N = 31), depression (N = 35) and schizophrenia (N = 43). Statistical significance of group differences in the MacCAT-T results were tested with the chi-square test. The concordance of the test and clinical assessment of competence by the attending physician were evaluated by Cohen's kappa coefficient. RESULTS: Patients with dementia, as a group, showed significantly more often impaired performance than those with schizophrenia who were still more impaired than depressed patients. Patients were classified as impaired or not depending on the standards used. By combination of all standards substantially more patients were classified as impaired than by clinical assessment (67.7 v. 48.4% of patients with dementia, 20.0 v. 2.9% of patients with depression, 53.5 v. 18.4% of patients with schizophrenia). CONCLUSIONS: Using different standards of competence the study showed substantial differences among patients with dementia, depression and schizophrenia. The high proportion of patients identified as incompetent raises several ethical questions, in particular, those referring to the selection of standards or the definition of cut-offs for incompetence. The discrepancy between clinical and formal evaluations points out the influence of the used procedure on competence judgements.
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Clinician assessments may not catch subtly diminished capacity in individuals with complex psychiatric conditions.
“clinician assessments may not catch subtly diminished capacity in individuals with complex psychiatric conditions (42, 43).”
From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [43]
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- Authors
- VOLLMANN, J., BAUER, A., DANKER-HOPFE, H., & HELMCHEN, H.
- Affiliations
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- ORCID
- VOLLMANN, J.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2003-10-30
- Volume
- 33
- Issue
- 8
- Pages
- 1463-1471
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2013365168
- Cited by
- 159
- References
- 16
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 7 · 2023: 5 · 2022: 3 · 2021: 5 · 2020: 6 · 2019: 4 · 2018: 4 · 2017: 7 · 2016: 9 · 2015: 12 · 2014: 10 · 2013: 15 · 2012: 11
- FWCI
- 7.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Max Planck Digital Library (submittedVersion)
- MPG.PuRe (Max Planck Society) (submittedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
- Keywords
- decision-making capacity, treatment decision-making, dementia, depression, schizophrenia, clinical competence assessment, cut-off criteria, mental illness
- MeSH terms
- Adult, Aged, Awareness, Dementia, Major Depressive Disorder, Ethics, Medical, Female, Humans, Male, Middle Aged, Patient Participation, Schizophrenia, Schizophrenic Psychology, Sick Role, Mental Competency, Treatment Outcome, Personal Autonomy, Empirical Research
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