Confirmatory information seeking is robust in psychologists' diagnostic reasoning.

OBJECTIVE: Across two experiments, we examined three cognitive biases (order effects, context effects, confirmatory bias) in licensed psychologists' diagnostic reasoning. HYPOTHESES: Our main prediction was that psychologist-participants would seek confirming versus disconfirming information after forming an initial diagnostic hypothesis, even given multiple opportunities to seek new information in the same case. We also expected that individual differences would affect diagnostic reasoning, such that psychologists with lower (vs. higher) cognitive reflection tendencies and larger (vs. smaller) bias blind spots would be more likely to demonstrate confirmatory bias. METHOD: In Study 1, we recruited 149 licensed psychologists (M = 18 years of experience; 44% women; 71% White) and exposed them to one of four randomly assigned vignettes that varied order effects (one set of symptoms in reversed orders) and context effects (court referral vs. employer referral). They rank ordered a list of four possible initial diagnostic hypotheses and received a piped follow-up choice of which of two pieces of information (confirmatory or disconfirmatory) they wanted to test their initial hypothesis. Study 2 (n = 131; M = 21 years of experience; 53% men; 68% White) replicated and extended Study 1, following the same procedure except offering three sequential choice opportunities. RESULTS: Both studies found robust confirmatory information seeking: 92% sought confirmatory information in Study 1, and confirmation persisted across three opportunities in Study 2 (90%, 84%, 77%), although it lowered with each opportunity (generalized logistic mixed regression model), F(2, 378) = 3.85, p = .02, ηp² = .02. CONCLUSION: These findings expand a growing body of research on bias in expert judgment. Specifically, psychologists may engage in robust confirmation bias in the process of forming diagnoses. Although further research is needed on bias and its impact on accuracy, psychologists may need to take steps to reduce confirmatory reasoning processes, such as documenting evidence for and against each decision element. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Are videoconferenced mental and behavioral health services just as good as in-person? A meta-analysis of a fast-growing practice.

The use of videoconferencing technologies (VCT) is on the rise given its potential to close the gap between mental health care need and availability. Yet, little is known about the effectiveness of these services compared to those delivered in-person. A series of meta-analyses were conducted using 57 empirical studies (43 examining intervention outcomes; 14 examining assessment reliability) published over the past two decades that included a variety of populations and clinical settings. Using conventional and HLM3 meta-analytical approaches, VCT consistently produced treatment effects that were largely equivalent to in-person delivered interventions across 281 individual outcomes and 4336 clients, with female clients and those treated in medical facilities tending to respond more favorably to VCT than in-person. Results of an HLM3 model suggested assessments conducted using VCT did not appear to lead to differential decisions compared to those conducted in-person across 83 individual outcomes and 332 clients/examinees. Although aggregate findings support the use of VCT as a viable alternative to in-person service delivery of mental healthcare, several limitations in the current literature base were revealed. Most concerning was the relatively limited number of randomized controlled trials and the inconsistent (and often incomplete) reporting of methodological features and results. Recommendations for reporting the findings of telemental health research are provided.

Diagnostic field reliability in forensic mental health evaluations.

How likely are multiple forensic evaluators to agree on defendants' diagnoses in routine forensic mental health evaluations? A total of 720 evaluation reports were examined from 240 cases in which 3 evaluators, working independently, provided diagnoses for the same defendant. Results revealed perfect agreement across 6 independent diagnostic categories in 18.3% of cases. Agreement for individual diagnostic categories was higher, with all 3 evaluators agreeing on the separate presence of psychotic, mood, or substance disorders in more than 64.7% of cases and agreeing on the presence of cognitive or developmental disorders in more than 89.7% of cases. However, evaluators agreed about the combination of psychotic and substance-related diagnoses in only 46.5% of cases. Agreement was enhanced by diagnoses with low base rates, and it was suppressed in evaluations conducted in jails. Psychiatrists and contracted evaluators were more likely to provide dissenting diagnostic categories than psychologists and state-employed evaluators. These results are among the first to document diagnostic agreement among nonpartisan practitioners in forensic evaluations conducted in the field, and they allow for practice and policy recommendations for evaluators in routine forensic practice to be made. (PsycINFO Database Record

The impact of defendant ethnicity on the psycholegal opinions of forensic mental health evaluators.

The impact of ethnicity on clinicians' decision making has received a great deal of attention and research. Several studies have documented that client ethnicity significantly influences diagnoses, testing and assessment protocols, recommendations for treatment, and expected outcomes. However, there is limited research examining the impact of a criminal defendant's ethnicity upon forensic mental health experts. To examine this issue, the authors reviewed 816 forensic reports on competency to stand trial submitted to the Hawaii judiciary between 2007 and 2008 and compared recommendation rates across categories of defendant ethnicity. Significant differences between ethnic groups were found in recommendations of competency to stand trial. Specifically, Asian misdemeanant populations were found to be incompetent to stand trial at higher rates than other ethnic groups. These findings highlight the potential impact that ethnicity may have on clinicians' decision making in certain forensic settings.