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Depression and decision-making capacity for treatment or research: a systematic review
Open accessAbstract
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 (27, 40).”
From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [40]
In the citing paper
“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]
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“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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Metadata
- Authors
- Hindmarch, T., Hotopf, M., & Owen, G. S.
- Affiliations
- King's College London (GB)
- Corresponding author
- Owen, Gareth S
- Venue
- BMC Medical Ethics
- Published
- 2013-12
- Volume
- 14
- Issue
- 1
- Pages
- 54-54
- ISSN
- 1472-6939 (ISSN-L)
- 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
- gold
- doi.org
- 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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