Interaction of neurological disorders and medical comorbidities is associated with an increased rate of incompetency adjudications.

Abstract

Objective: This study examined if medical comorbidities predict civil competency adjudication.

Hypotheses: We hypothesize that individuals with greater comorbidities will be at an increased risk for incompetency. Second, we hypothesize that there will be an interaction of medical comorbidities with neurological conditions, such that those respondents will be more likely adjudicated incompetent than those with psychiatric conditions and/or developmental disabilities. Last, we hypothesize that medical comorbidities will interact with functional abilities to predict incompetency more strongly.

Methods: This study used data from 265 court-ordered competency evaluations conducted by one licensed psychologist in North Carolina between 2004 and 2022. Actual legal competency determinations were obtained for 232 individuals with either psychiatric, neurological, combined psychiatric and neurological, or developmentally disabled diagnoses. Medical comorbidity data was extracted from 228 cases using the Charlson Comorbidity Index.

Results: We found that individuals adjudicated incompetent tend to have more medical conditions than those deemed competent. However, the impact of medical comorbidities was not equivalent across all respondents. Instead, an interaction effect was observed for patients with neurological conditions and medical comorbidities. With no or low medical comorbidities, the odds of being adjudicated incompetent are significantly higher for those with a psychiatric diagnosis. However, this changes in the context of the high number and severity of medical comorbidities. With these circumstances, neurological patients are significantly more likely to be adjudicated incompetent than psychiatric patients with the same number of medical comorbidities.

Conclusions: Our findings suggest that medical comorbidities do not impact all clinical populations equivalently. This provides support for the importance of evaluating how medical comorbidities affect neurological patients' ability to live independently and/or manage their own affairs, over and above their primary condition.