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Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis

Published online by Cambridge University Press:  04 March 2024

Silvia Marcó-García Open the ORCID record for Silvia Marcó-García [Opens in a new window] ,
Kevin Ariyo ,
Gareth S. Owen  and
Anthony S. David
Silvia Marcó-García*
Affiliation:
Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain Etiopathogenesis and treatment of severe mental disorders (MERITT), Sant Joan de Déu Research Institute, Sant Joan de Déu Foundation, Barcelona, Spain Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, University of Barcelona, 08035 Barcelona, Spain
Kevin Ariyo
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Gareth S. Owen
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Anthony S. David
Affiliation:
Division of Psychiatry, UCL Institute of Mental Health, University College London, London, UK
*
Corresponding author: Silvia Marcó-García; Email: silvia.marco@sjd.es
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Abstract

Decision-making capacity (DMC) among psychiatric inpatients is a pivotal clinical concern. A review by Okai et al. (2007) suggested that most psychiatric inpatients have DMC for treatment, and its assessment is reliable. Nevertheless, the high heterogeneity and mixed results from other studies mean there is considerable uncertainty around this topic. This study aimed to update Okai's research by conducting a systematic review with meta-analysis to address heterogeneity. We performed a systematic search across four databases, yielding 5351 results. We extracted data from 20 eligible studies on adult psychiatric inpatients, covering DMC assessments from 2006 to May 2022. A meta-analysis was conducted on 11 papers, and a quality assessment was performed. The study protocol was registered on PROSPERO (ID: CRD42022330074). The proportion of patients with DMC for treatment varied widely based on treatment setting, the specific decision and assessment methods. Reliable capacity assessment was feasible. The Mini-Mental State Examination (MMSE), Global Assessment of Function (GAF), and Brief Psychiatric Rating Scale (BPRS) predicted clinical judgments of capacity. Schizophrenia and bipolar mania were linked to the highest incapacity rates, while depression and anxiety symptoms were associated with better capacity and insight. Unemployment was the only sociodemographic factor correlated with incapacity. Assessing mental capacity is replicable, with most psychiatric inpatients able to make treatment decisions. However, this capacity varies with admission stage, formal status (involuntary or voluntary), and information provided. The severity of psychopathology is linked to mental capacity, though detailed psychopathological data are limited.

Keywords

assessmentmental capacitymetaanalysispsychiatric inpatientssevere mental disordertreatment
Type
Review Article
Information
Psychological Medicine , Volume 54 , Issue 6 , April 2024 , pp. 1074 - 1083
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Copyright
Copyright © The Author(s), 2024. Published by Cambridge University Press

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