Factors related to bias in forensic psychiatric assessments in criminal matters: A systematic review.

Abstract

OBJECTIVE\nIdentify factors related to bias in forensic psychiatric assessments in criminal matters.\n\n\nMETHOD\nBased on the PRISMA guidelines, we searched the following keywords with Boolean operators: (criminal responsibility OR legal responsibility OR neurolaw OR insanity defense) AND (forensic psychiatry OR assessment OR evaluation OR bias OR decision-making OR capacity OR psychometric). The search included publications from January 1998 to December 2019 in the English language, published in PubMed, Web of Science, Taylor & Francis, and Scopus databases.\n\n\nRESULTS\nThe final sample consisted of 30 articles separated into three groups: (1) legal elements and the wording of expert reports, (2) psychometric tools applied to criminal inquiries, and (3) expert forensic technique and inter-examiner agreement.\n\n\nDISCUSSION\nMultiple factors for biases were identified: difficulties in equivalence between legal and psychiatric terminologies, elements of countertransference between the expert and the examinee, absence of standardization of expert evaluations, low quality of expert reports, differences in the training of professionals involved in the evaluations, use of psychometric tools, number of professionals working on the same case, and the methodology adopted. Psychometric tools developed specifically for forensic psychiatric evaluations allowed the introduction of objective parameters in expert evaluations. Special attention was found in psychometric tools structured as vignettes that allowed the detailed evaluation of legal capacities, present in the legal texts. Psychometric tools in checklist format appeared to be more susceptible to interviewer biases.\n\n\nCONCLUSION\nThe control of inherent biases in forensic psychiatry assessments on criminal matters remains a current challenge, difficult to control in forensic practice. The identification, control and avoidance of them may improve the quality the forensic psychiatric expertise in criminal matters.