Social Psychiatry and Psychiatric Epidemiology

, Volume 53, Issue 2, pp 161–169 | Cite as

Decisional conflict in mental health care: a cross-sectional study

  • Margot J. MetzEmail author
  • Marjolein A. Veerbeek
  • Christina M. van der Feltz-Cornelis
  • Edwin de Beurs
  • Aartjan T. F. Beekman
Original Paper



Decisional conflict refers to the degree to which patients are engaged in and feel comfortable about important clinical decisions. Until now, the concept has received little attention in mental health care. We investigate the level of decisional conflict in mental health care and whether this is influenced by socio-demographics, treatment setting, diagnoses, and locus of control.


Cross-sectional study among 186 patients in Dutch specialist mental health care using the Decisional Conflict Scale, which measures five dimensions of decisional conflict: information, support, clarification of values, certainty, and decisional quality. Descriptive statistics and forward stepwise linear regression analyses were used.


Patients report relatively high levels of decisional conflict, especially those with more external locus of control. Having a personality disorder and higher education also increases decisional conflict on the dimensions support and clarification of values, respectively. Less decisional conflict was experienced by patients with psychotic disorders on the dimension certainty and by women on the information domain.


Decisional conflict is common among patients in specialist mental health care and is very useful for assessing the quality of clinical decision making. Measuring decisional conflict and knowledge about influencing factors can be used to improve patients’ participation in clinical decision making, adherence to treatment and clinical outcomes.


Decisional conflict Decisional Conflict Scale Shared decision making Cross-sectional study Mental health care 



The authors would like to thank the colleagues of the department of data management and research of GGZ inGeest for their support in the data collection. We also thank the participating patients and organisations for their contribution to the study.

Compliance with ethical standards


This study was supported by the National Network for Quality Development in mental health care (Grant number PV140003).

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  1. 1.GGz BreburgTilburgThe Netherlands
  2. 2.Trimbos InstituteUtrechtThe Netherlands
  3. 3.VU UniversityAmsterdamThe Netherlands
  4. 4.Tilburg UniversityTilburgThe Netherlands
  5. 5.Foundation for Benchmarking Mental Health CareBilthovenThe Netherlands
  6. 6.University of LeidenLeidenThe Netherlands
  7. 7.GGZ inGeestAmsterdamThe Netherlands
  8. 8.VU University Medical Centre AmsterdamAmsterdamThe Netherlands

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