title: Decisional capacity of severely depressed patients requiring electroconvulsive therapy.
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.
  
  
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychiatry and Psychology and dagger Department of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Maria I
authors.initials: MI
authors.lastname: Lapid
authors.forename: Teresa A
authors.initials: TA
authors.lastname: Rummans
authors.forename: Kristine L
authors.initials: KL
authors.lastname: Poole
authors.forename: V Shane
authors.initials: VS
authors.lastname: Pankratz
authors.forename: Megan S
authors.initials: MS
authors.lastname: Maurer
authors.forename: Keith G
authors.initials: KG
authors.lastname: Rasmussen
authors.forename: Kemuel L
authors.initials: KL
authors.lastname: Philbrick
authors.forename: Paul S
authors.initials: PS
authors.lastname: Appelbaum
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D003866:Depressive Disorder / Q000523:psychology* / Q000628:therapy*; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D007258:Informed Consent; D008297:Male; D016743:Mental Competency; D008609:Mental Status Schedule; D008875:Middle Aged; D010353:Patient Education as Topic