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Research ArticleRegular Articles

Assessing Racial Effects on Adjudicative Competence

Kelsey S. Hobart, Shilpa Krishnan, Sean D. Cleary and Philip J. Candilis
Journal of the American Academy of Psychiatry and the Law Online December 2023, 51 (4) 542-550; DOI: https://doi.org/10.29158/JAAPL.230074-23
Kelsey S. Hobart
At the time of this work, Dr. Hobart was Physician Resident (PGY-IV), Department of Psychiatry, Saint Elizabeths Hospital, Washington, DC; she is currently a fellow in forensic psychiatry at the University of Rochester Medical Center, Rochester, NY. Dr. Krishnan is Deputy Director, Forensic Services Division, DC Department of Behavioral Health, Saint Elizabeths Hospital, Washington, DC. Dr. Cleary is Associate Professor, Department of Epidemiology & Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC. Dr. Candilis is Director of Medical Affairs, Saint Elizabeths Hospital, Washington, DC, and Professor of Psychiatry, George Washington University School of Medicine and Health Sciences, Washington, DC.
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Shilpa Krishnan
At the time of this work, Dr. Hobart was Physician Resident (PGY-IV), Department of Psychiatry, Saint Elizabeths Hospital, Washington, DC; she is currently a fellow in forensic psychiatry at the University of Rochester Medical Center, Rochester, NY. Dr. Krishnan is Deputy Director, Forensic Services Division, DC Department of Behavioral Health, Saint Elizabeths Hospital, Washington, DC. Dr. Cleary is Associate Professor, Department of Epidemiology & Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC. Dr. Candilis is Director of Medical Affairs, Saint Elizabeths Hospital, Washington, DC, and Professor of Psychiatry, George Washington University School of Medicine and Health Sciences, Washington, DC.
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Sean D. Cleary
At the time of this work, Dr. Hobart was Physician Resident (PGY-IV), Department of Psychiatry, Saint Elizabeths Hospital, Washington, DC; she is currently a fellow in forensic psychiatry at the University of Rochester Medical Center, Rochester, NY. Dr. Krishnan is Deputy Director, Forensic Services Division, DC Department of Behavioral Health, Saint Elizabeths Hospital, Washington, DC. Dr. Cleary is Associate Professor, Department of Epidemiology & Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC. Dr. Candilis is Director of Medical Affairs, Saint Elizabeths Hospital, Washington, DC, and Professor of Psychiatry, George Washington University School of Medicine and Health Sciences, Washington, DC.
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Philip J. Candilis
At the time of this work, Dr. Hobart was Physician Resident (PGY-IV), Department of Psychiatry, Saint Elizabeths Hospital, Washington, DC; she is currently a fellow in forensic psychiatry at the University of Rochester Medical Center, Rochester, NY. Dr. Krishnan is Deputy Director, Forensic Services Division, DC Department of Behavioral Health, Saint Elizabeths Hospital, Washington, DC. Dr. Cleary is Associate Professor, Department of Epidemiology & Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC. Dr. Candilis is Director of Medical Affairs, Saint Elizabeths Hospital, Washington, DC, and Professor of Psychiatry, George Washington University School of Medicine and Health Sciences, Washington, DC.
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    Table 1

    Descriptive Statistics

    MeasureBlack DefendantsWhite DefendantsSignificance
    Age, mean (SD), range38.8 (14.0), 18–7441.8 (11.4), 21–65F = 1.54, P = .2159
    Sex, n (%)F: 51 (32)
    M: 109 (68)
    F: 7 (18)
    M: 33 (82)
    χ2 = 3.21 (df = 1), P = .073
    High school education or less, n (%)125 (78)18 (45)χ2 = 17.23 (df = 1), P < .0001
    Undomiciled, n (%)101 (63)29 (73)χ2 = 1.24 (df = 1), P = .266
    Unemployed, n (%)149 (93)38 (95)χ2 = 0.19 (df = 1), P = .667
    Uninsured, n (%)38 (24)16 (40)χ2 = 4.29 (df = 1), P = .038
    Government benefits, n (%)81 (51)15 (38)χ2 = 2.21 (df = 1), P = .137
    • View popup
    Table 2

    Number, Percent, and Adjusted Odds Ratios (95% CI) for Clinical Variables by Race

    VariableBlack DefendantsWhite DefendantsCrude Black versus White ComparisonLogistic Regression Including Socioeconomic Factors
    Thought disorder, n (%)111 (69)23 (58)χ2 = 1.041, df = 1, P = .1531aORa = 1.872 (95% CI,b 0.847–4.137)
    IMP referral, n (%)17 (11)8 (25)χ2 = 2.57, df = 1, P = .11aOR = 0.772 (95% CI, 0.266–2.243)
    Psychological testing, n (%)44 (28)4 (10)χ2 = 5.37, df = 1, P = .0205aOR = 3.212 (95% CI, 1.036–9.961)
    Antipsychotic medication, n (%)138 (86)34 (85)χ2 = 0.0415, df = 1, P = .8385aOR = 1.584 (95% CI, 0.513–4.886)
    Restraint, mean (SD), range0.5625 (1.990), 0–180.1 (0.3038), 0–1ANOVA F = 2.14, P = .145aOR = 1.555 (95% CI, 0.462–5.227)
    Seclusion, mean (SD), range0.4438 (1.097), 0–70.575 (1.824), 0–11ANOVA F = 0.34, P = .5606OR = 0.775 (95% CI, 0.310–1.940)
    • Note. ANOVA = analysis of variance; aOR = adjusted odds ratio; CI = confidence interval; IMP = involuntary medication process.

    • ↵a aOR after controlling for age, gender, education, housing, employment, insurance, and benefits.

    • ↵b If the 95% CI includes 1.0, then the association is not statistically significant at P < .05.

    • View popup
    Table 3

    Number, Percent, and Adjusted Odds Ratios (95% CI) for Forensic Variables by Race

    VariableBlack DefendantsWhite DefendantsCrude Black versus White ComparisonLogistic Regression Including Socioeconomic Factors
    Number violent felonies, mean (SD), range0.3188 (0.796), 0–70.200 (0.823), 0–5ANOVA F = 0.70, P = .4029aORa = 2.941 (95% CI,b 0.888–9.745)
    Time to attain competency in days, mean (SD), range67.9 (62.79), 8–62062.2 (35.89), 12–176χ2 = 4.616, df = 6, P = .5939bc =8.37, SE =11.11 t = 0.75 P = .452
    IST (initial evaluation), n (%)69 (43)20 (50)χ2 = 0.67, df = 1, P = .71aOR = 1.24 (95% CI, 0.568–2.711)
    Return to jail, n (%)37 (23)6 (15)χ2 = 11.19, df = 3, P = .01aOR = 1.62 (95% CI, 0.597–4.372)
    IST (court finding), n (%)31 (19)6 (15)χ2 = 0.4062, df = 1, P = .5239aOR = 1.159 (95% CI, 0.417–3.219)
    • Note. aOR = adjusted odds ratio; CI = confidence interval; IMP = involuntary medication process; IST = incompetent to stand trial.

    • ↵a aOR after controlling for age, gender, education, housing, employment, insurance, and benefits.

    • ↵b If the 95% CI includes 1.0, then the association is not statistically significant at P < .05.

    • ↵c Adjusted linear regression coefficient indicating a mean difference of 8.37 days after controlling for demographics.

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Journal of the American Academy of Psychiatry and the Law Online: 51 (4)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 51, Issue 4
1 Dec 2023
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Assessing Racial Effects on Adjudicative Competence
Kelsey S. Hobart, Shilpa Krishnan, Sean D. Cleary, Philip J. Candilis
Journal of the American Academy of Psychiatry and the Law Online Dec 2023, 51 (4) 542-550; DOI: 10.29158/JAAPL.230074-23

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Assessing Racial Effects on Adjudicative Competence
Kelsey S. Hobart, Shilpa Krishnan, Sean D. Cleary, Philip J. Candilis
Journal of the American Academy of Psychiatry and the Law Online Dec 2023, 51 (4) 542-550; DOI: 10.29158/JAAPL.230074-23
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Keywords

  • competency to stand trial
  • forensic hospital psychiatry
  • institutional racism
  • racial determinants

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