Diversity or disarray? A systematic review of decision-making capacity for treatment and research in schizophrenia and other non-affective psychoses
Open accessAbstract
BACKGROUND: Valid consent for treatment or research participation requires that an individual has decision-making capacity (DMC), which is the ability to make a specific decision. There is evidence that the psychopathology of schizophrenia can compromise DMC. The objective of this review was to examine the presence or absence of DMC in schizophrenia and the socio-demographic/psychopathological factors associated. METHODS: We searched three databases Embase, Ovid MEDLINE(R), and PsycINFO for studies reporting data on the proportion of DMC for treatment and research (DMC-T and DMC-R), and/or socio-demographic/psychopathological associations with ability to make such decisions, in people with schizophrenia and related illnesses. RESULTS: A total of 40 studies were identified. While high levels of heterogeneity limited direct comparison, meta-analysis of inpatient data showed that DMC-T was present in 48% of people. Insight was strongly associated with DMC-T. Neurocognitive deficits were strongly associated with lack of DMC-R and to a lesser extent DMC-T. With the exception of years of education, there was no evidence for an association with socio-demographic factors. CONCLUSIONS: Insight and neurocognitive deficits are most closely associated with DMC in schizophrenia. The lack of an association with socio-demographic factors dispels common misperceptions regarding DMC and characteristics such as age. Although our results reveal a wide spectrum of DMC-T and DMC-R in schizophrenia, this could be partly due to the complexity of the DMC construct and the heterogeneity of existing studies. To facilitate systematic review research, there is a need for improvement within research study design and increased consistency of concepts and tools.
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A recent meta-analysis by Spencer et al. (2017) focused on patients with schizophrenia and only reported proportions of people with capacity for treatment decisions.
“A recent meta-analysis of four studies (Spencer et al., 2017) focused on patients with schizophrenia, and only reported on the proportions of people with capacity for treatment decisions.”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Spencer et al., 2017
The Statistical analysis and DMC-T v. DMC-R in schizophrenia sections support the description of a meta-analysis pooling proportions with capacity for treatment decisions among schizophrenia inpatients. But “only reported” overstates the scope of the paper: the Diversity or disarray 1909 section also reports proportions with capacity for research decisions, and the Associations with DMC-R section reports other findings. The indexed passages do not explicitly establish the claimed four-study count. (LLM, conf=0.88)
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Raffard, S., Bayard, S., Tattard, P., Laraki, Y., & Capdevielle, D. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1308666
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"The Case Against Legalizing Assisted Death for Psychiatric Disorders"Preprint
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- Authors
- Spencer, B. W. J., Shields, G., Gergel, T., Hotopf, M., & Owen, G. S.
- Affiliations
- King's College London (GB)
- South London and Maudsley NHS Foundation Trust (GB)
- Corresponding author
- Spencer, B. W. J.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2017-04-26
- Volume
- 47
- Issue
- 11
- Pages
- 1906-1922
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2594904649
- Cited by
- 43
- References
- 63
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 2 · 2023: 9 · 2022: 6 · 2021: 10 · 2020: 6 · 2019: 1 · 2018: 2
- FWCI
- 0.38
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Psychological Medicine (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Funders
- National Institute for Health and Care Research (NF-SI-0515-10102, DRF-2014-07-035)
- 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
- decision-making capacity, schizophrenia, informed consent, research participation, treatment decision-making, insight, neurocognitive impairment, sociodemographic factors, hospitalized patients, conceptual heterogeneity
- MeSH terms
- Decision Making, Humans, Psychotic Disorders, Schizophrenia, Mental Competency
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