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A systematic review and meta-analysis of decision-making in offender populations with mental disorder

Jones, Katy A.; Hewson, Thomas; Sales, Christian; Khalifa, Najat

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Assistant Professor in Applied Psychology

Thomas Hewson

Christian Sales

Najat Khalifa


Decision-making has many different definitions, and is measured in varied ways using neuropsychological tasks. Offenders with mental disorder habitually make disadvantageous decisions, but no study has systematically appraised the literature. This review aimed to clarify the field by bringing together different neuropsychological measures of decision-making, and using meta-analysis and systematic review to explore the performance of offenders with mental disorders on neuropsychological tasks of decision-making. A structured search of Pubmed, Embase, PsycINFO, Medline, Cinahl was conducted with additional hand searching and grey literature consulted. Controlled studies of decision-making in offenders with evidence of any mental disorder, including a validated measure of decision-making were included. Total score on each relevant decision-making task was collated. Twenty-three studies met inclusion criteria (n=1,820), and 10 studies (with 15 experiments) were entered into the meta-analysis (n=841). All studies included in the meta-analysis used the Iowa Gambling Task (IGT) to measure decision-making. Systematic review findings from individual studies showed violent offenders made poorer decisions than matched offender groups or controls. An omnibus meta-analysis was computed to examine performance on IGT in offenders with mental disorder compared with controls. Additionally, two sub-group meta-analyses were computed for studies involving offenders with personality disorder and psychopathy, and recidivists who were convicted of Driving While Intoxicated (DWI). Individual studies not included in the meta-analysis partially supported the view that offenders make poorer decisions. However, the meta-analyses showed no significant differences in performance on IGT between the offender groups and controls. Further research is required to ascertain whether offenders with mental disorder have difficulty in making advantageous decisions. An analysis of cause and effect and various directions for future work are recommended to help understand the underpinning of these findings.


Jones, K. A., Hewson, T., Sales, C., & Khalifa, N. (2019). A systematic review and meta-analysis of decision-making in offender populations with mental disorder. Neuropsychology Review, 29(2), 244–258.

Journal Article Type Article
Acceptance Date Dec 10, 2018
Online Publication Date Feb 23, 2019
Publication Date 2019-06
Deposit Date Jan 16, 2019
Publicly Available Date Feb 24, 2020
Journal Neuropsychology Review
Print ISSN 1040-7308
Electronic ISSN 1573-6660
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 29
Issue 2
Pages 244–258
Keywords Decision-making; Offenders; Neuropsychological tasks; Iowa Gambling Task (IGT) ; Mental disorders; Personality disorder (PD); Meta-analysis
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