Supervisors info:
Μιχόπουλος Ιωάννης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Δουζένης Αθανάσιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μπατιστάκη Χρυσάνθη, Αναπληρώτρια Καθηγήτρια , Ιατρική Σχολή, ΕΚΠΑ
Summary:
Aim: Depressive and phobic symptoms have been associated with decreased cognitive abilities and, consequently, impairments in capability to consent. However, the role of mental illness in informed consent is a topic that requires further research and evaluation. The present study aims to find association between depressive and / or phobic symptoms, with impairment in patient's capability to consent to anesthesia.
Methods: The participants consisted of 38 men and women, aged 21-77 years (M = 48.8 years), who are about to undergo a surgery, and therefore, anesthesia. The MMSE and a special tool for assessing the ability to consent to anesthesia, which is in a pilot stage, were used in order to examine their mental state. Psychometric tools such as HADS, PHQ-9 and Marks & Mathews Phobia Questionnaire, were used to evaluate depression and phobias.
Results: Statistically significant negative correlations among the MMSE scale and the scale of total phobia (r = -0.36, p-value = 0.028), HADS-A anxiety score (r = -0.36, p-value = 0.027), HADS- D depression score (r = -0.47, p-value = 0.003), PHQ-9 score (r = -0.35, p-value = 0.032), and age (r = -0.55, p-value = 0.001), were observed. The present sample was mildly depressed and anxious. Similar findings were noticed in the Special Assessment Tool for the Ability to Consent in Anesthesia. Indicatively, in question 10 Α΄ "The less a patient who is about to undergo a surgery knows, the better it is for his psychological wellbeing." those who answered “yes”, had a poor MMSE score (p-value = 0.009) and educational level (100% primary school graduates), yet total phobia (p-value = 0.025) and blood-injury phobia (p-value = 0.029) scores were high. Respectively, in question 19 Β΄ "Elderly patients who are about to undergo a surgery do not need to be informed in such detail about it", those who answered “yes”, scored lower on MMSE (p-value = 0.004), and higher on PHQ-9 scale (p-value = 0.002). They were also of old age (p-value = 0.003).
Conclusions: The findings of this study suggest that depressive and phobic symptoms are associated with reduced ability to consent. High rates of anxiety and depression were correlated with weakened mental function. Respectively, patients with phobic symptoms demonstrated avoidant behavior when it came to informed consent and poor judgement of the surgery risks. Finally, people who demonstrated reduced ability to consent, had higher rates of phobia and depression, as well as decreased mental function, low educational level and old age.
Keywords:
Capacity to Consent, Anesthesia, Phobias, Depression
