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Cited by 178Healthcare Decision-Making and RestraintsEthics in Clinical ResearchEthics and bioethics in healthcare

Depression and decision-making capacity for treatment or research: a systematic review

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Hindmarch, Thomas, Hotopf, Matthew, Owen, Gareth S·2013·BMC Medical Ethics
DOI 10.1186/1472-6939-14-54PMC PMC4029430
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Abstract

Background: Psychiatric disorders can pose problems in the assessment of decision-making capacity (DMC). This is so particularly where psychopathology is seen as the extreme end of a dimension that includes normality. Depression is an example of such a psychiatric disorder. Four abilities ( understanding , appreciating , reasoning and ability to express a choice ) are commonly assessed when determining DMC in psychiatry and uncertainty exists about the extent to which depression impacts capacity to make treatment or research participation decisions. Methods: A systematic review of the medical ethical and empirical literature concerning depression and DMC was conducted. Medline, EMBASE and PsycInfo databases were searched for studies of depression and consent and DMC. Empirical studies and papers containing ethical analysis were extracted and analysed. Results: 17 publications were identified. The clinical ethics studies highlighted appreciation of information as the ability that can be impaired in depression, indicating that emotional factors can impact on DMC. The empirical studies reporting decision-making ability scores also highlighted impairment of appreciation but without evidence of strong impact. Measurement problems, however, looked likely. The frequency of clinical judgements of lack of DMC in people with depression varied greatly according to acuity of illness and whether judgements are structured or unstructured. Conclusions: Depression can impair DMC especially if severe. Most evidence indicates appreciation as the ability primarily impaired by depressive illness. Understanding and measuring the appreciation ability in depression remains a problem in need of further research.

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  • Assessing mental capacity in a life-or-death decision is never straightforward, but it is particularly complex in patients with psychiatric illnesses, which can impair decision making capacity.

    “Assessing mental capacity in a life-or-death decision is never straightforward, but it is particularly complex in patients with psychiatric illnesses, which can impair decision making capacity (27, 40).”

    From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [40]

  • Decision-making and learning impairments are core characteristics of a wide range of psychiatric disorders, including MDD, OCD, and schizophrenia, and are linked to their specific symptoms.

    “Decision-making and learning impairments are core characteristics of a wide range of psychiatric disorders — such as major depressive disorder (MDD), obsessive–compulsive disorder (OCD), and schizophrenia — and are linked to their specific symptoms.1–9”

    From Investigating disorder-specific and transdiagnostic alterations in model-based and model-free decision-making (2024) · cites this paper as [5]

  • A diagnosis of even a severe mental illness such as schizophrenia does not preclude a patient from being competent.

    “The authors of the MacArthur Treatment Competence Study, for instance, conclude that being diagnosed with even a severe mental illness like schizophrenia does not preclude a patient from being competent [8].”

    From Is the exclusion of psychiatric patients from access to physician-assisted suicide discriminatory? (2019) · cites this paper as [8]

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  1. Mental Capacity Act Chapter 9 2005 London: The Stationary Office

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Authors
Hindmarch, T., Hotopf, M., & Owen, G. S.
Affiliations
King's College London (GB)
Corresponding author
Owen, Gareth S
ORCID
Venue
BMC Medical Ethics
Publisher
Springer Science and Business Media LLC
Published
2013-12
Volume
14
Issue
1
Pages
54-54
ISSN
1472-6939 (ISSN-L)
DOI
10.1186/1472-6939-14-54
PMC
PMC4029430
OpenAlex
W2092850387
Cited by
178
References
36
Citations by year
2026: 6 · 2025: 16 · 2024: 20 · 2023: 13 · 2022: 15 · 2021: 12 · 2020: 30 · 2019: 14 · 2018: 14 · 2017: 15 · 2016: 12 · 2015: 9 · 2014: 1 · 2013: 1
FWCI
1.12
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Medical Ethics (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (publishedVersion, other-oa)
Funders
Wellcome Trust (097683)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics in Clinical Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Keywords
depression, decision-making capacity, informed consent, understanding, reasoning, research participation, treatment decision-making, clinical ethics, severe depression
MeSH terms
Decision Making, Depression, Depressive Disorder, Humans, Informed Consent, Judgment, Patient Participation, Mental Competency, Comprehension, Uncertainty

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