King's College London, London, UK.
BMC Med Ethics. 2013 Dec 13;14:54. doi: 10.1186/1472-6939-14-54.
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.
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.
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.
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.
精神障碍可能会对决策能力（DMC）评估造成问题。当精神病理学被视为包括正常状态在内的维度的极端时，尤其如此。抑郁症就是这样一种精神障碍。在评估精神病学中的 DMC 时，通常会评估四项能力（理解、理解、推理和表达选择的能力），并且存在关于抑郁症在多大程度上影响治疗或研究参与决策能力的不确定性。
对有关抑郁症和 DMC 的医学伦理和经验文献进行了系统回顾。在 Medline、EMBASE 和 PsycInfo 数据库中搜索了关于抑郁症和同意以及 DMC 的研究。提取并分析了经验研究和包含伦理分析的论文。
确定了 17 篇出版物。临床伦理研究强调了对信息的理解是抑郁症可能受损的能力，这表明情绪因素会影响 DMC。报告决策能力评分的实证研究也强调了理解的损害，但没有证据表明影响很大。然而，存在测量问题的可能性。根据疾病的严重程度以及判断是否结构化或非结构化，判断患有抑郁症的人缺乏 DMC 的临床判断频率差异很大。
抑郁症会损害 DMC，尤其是在严重的情况下。大多数证据表明，抑郁症主要损害了理解能力。在抑郁症中理解和衡量理解能力仍然是一个需要进一步研究的问题。
