The capacity to consent to treatment is altered in suicidal patients
Résumé
Background: Many patients with depression refuse treatment.
Moreover, suicide attempters often display low perceived need of
treatment and impaired decision-making. These observations raise
questions about the capacity to treatment consent in depressed suicide
attempters (SA).
Methods: In patients with current depressive episode (N = 33 SAs and N =
27 non-SAs), consent capacity was evaluated with the MacArthur
Competence Assessment Tool for Treatment (MacCAT-T), insight with the
Beck Cognitive Insight Scale, and depression severity with the Beck
Depression Inventory (BDI).
Results: The median BDI score in the whole sample (N = 60) was 21
[10;36], and was higher in SAs than non-SAs (27 [11;36] vs. 15 [10:33], p
< 0.001). Consent capacity was impaired in 30% (appreciation), 53%
(reasoning) and 60% (understanding) of all patients. MacCAT-T sub-scores
were lower in SAs than non-SAs (understanding: 4.4 [2.35;5.8] vs. 5.3
[3.13;6]); appreciation: 3 [1;4] vs. 4 [2;4]); reasoning (4 [1;7] vs. 7
[3;8]), and ability to express a choice: 1 [0;2] vs. 2 [0;2]; all p <
0.001). In multivariate analyses, suicide attempt history and
depression severity (but not insight) were negatively associated with
MacCAT-T sub-scores.
Conclusion: More research is needed on the capacity to consent to
treatment of patients with depression, particularly suicidal
individuals, to make informed choices about their treatment. Trial
registration The Montpellier University Hospital Institutional Review
Board approved the study (No. 202100714).
Emilie Olié, Thomas Catanzaro, Manon Malestroit, Julio Guija, Lucas
Giner, et al.. The capacity to consent to treatment is altered in
suicidal patients. Annals of General Psychiatry, 2023, 22 (1), pp.35. ⟨10.1186/s12991-023-00459-w⟩. ⟨hal-04206736⟩
https://hal.science/hal-04206736
