Decisional capacity of severely depressed patients requiring electroconvulsive therapy.

Full Abstract

OBJECTIVE:
The decisional capacity of severely depressed people frequently comes into question. The ability to improve this decisional capacity through educational efforts alone is not known. Our study aimed to determine the decisional capacity of severely depressed people requiring electroconvulsive therapy (ECT), and whether educational interventions improve their ability to provide informed consent for ECT.

MATERIALS AND METHODS:
Forty subjects with severe depression were recruited. Using the MacArthur Competence Assessment Tool for Treatment instrument, decisional capacity was assessed at baseline and reassessed after education. All of the subjects received standard education. Additionally, half were blindly randomized to receive an experimental educational intervention.

RESULT:
SAt baseline, there was no statistical difference in the decisional capacity between the standard and experimental intervention groups. After educational interventions, all four areas of decisional capacity improved for both groups (understanding p < 0.001, reasoning p < 0.001, appreciation p = 0.031, choice p = 0.006). However, there was no measurable additional improvement in scores for those randomized to receive additional education.

CONCLUSION:
Our findings indicate that this group of severely depressed people had good decisional capacities to give informed consent. Education improved their decisional capacity. There is an endpoint beyond which additional educational intervention does not result in measurable improvement in decisional capacity.

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Author information

Author/s: Lapid, Maria I (MI); Rummans, Teresa A (TA); Poole, Kristine L (KL); Pankratz, V Shane (VS); Maurer, Megan S (MS); Rasmussen, Keith G (KG); Philbrick, Kemuel L (KL); Appelbaum, Paul S (PS);

Affiliation: Department of Psychiatry and Psychology and dagger Department of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA.

Grants: MH5548 (Agency:United States NIMH)

Journal and publication information

Publication Type: Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.

Journal: The journal of ECT (J ECT), published in United States. (Language: eng)

Reference: 2003-Jun; vol 19 (issue 2) : pp 67-72

Dates: Created 2003/06/06; Completed 2003/09/23; Revised 2007/11/15;

PMID: 12792453, status: MEDLINE (last retrieval date: 11/6/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Aged
Aged, 80 and over
Decision Making
Depressive Disorder - psychology; therapy
Electroconvulsive Therapy
Female

Humans
Informed Consent
Male
Mental Competency
Mental Status Schedule
Middle Aged
Patient Education as Topic

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