Little is known about the ability of persons with severe mental disorders to give consent to sexual activity. A possible reason for this shortcoming is the absence of specific criteria and tools to measure sexual consent in psychiatric clinical settings. We developed a clinician oriented semi-structured interview, the Sexual Consent Assessment Scale (SCAS), and investigated sexual consent capacity in a sample of hospitalized patients with bipolar disorder (n = 54, M (age) = 38.1 years, 48% males) and schizophrenic spectrum disorders (n = 31, M (age) = 38.4 years, 29% males). The SCAS items were derived from the criteria proposed by Kennedy and Niederbuhl (Am J Ment Retard, 106:503-510, 2001). The full scale and a shorter scale comprising 10 items (SCAS-10) achieved good initial validity. Patients with schizophrenic spectrum disorders had worse sexual consent capacity than patients with bipolar disorder. This difference was unexpectedly independent from patients' symptomatology, as measured by the Brief Psychiatric Rating Scale. Conversely, poor cognitive functioning measured by the Raven's Standard Progressive matrices was associated with reduced capacity to give sexual consent in both groups. Subjects in the schizophrenic spectrum disorders group were more frequently judged incapable in basic knowledge of birth control methods and in domains underlying metacognitive abilities. Principal component analysis revealed two SCAS-10 interpretable factors: "appropriateness-recognition" and "consequences-metacognition." Our study suggests that patients with severe psychiatric disorders, especially those with cognitive dysfunction, might be at risk of incapacity to give valid sexual consent.

Objectives: To develop a clinician-oriented semi-structured interview for the assessment of sexual consent: the Sexual Consent Competency Assessment Scale (SCAS). To assess sexual consent competence in a sample of hospitalized patients, affected by bipolar disorder (BD) and schizophrenic spectrum disorders (SSD, schizophrenia or schizoaffective disorder). Methods: Patients were recruited at the Psychiatric ward of S. Spirito Hospital, Rome and diagnosed according to DSM-IV-TR criteria. The SCAS items were derived and adapted from Kennedy et al. (Am J Ment Retard 2001;106:503-510). The scale items were directly rated by 2 independent clinicians, on a 3point Likert Scale corresponding to 3 possible outcomes: capable, marginally capable or incapable. Internal consistency, test-retest and inter rater-reliability were good. Principal component factor analysis (PCA) with varimax rotation was applied. Results: Fifty-four BD patients (51.9% females) and 31 SSD patients (71.0% females) were recruited (mean age, years: 38.1±13.4; 38.4±9.7 respectively; p=0.91). BD patients had better sexual consent competence compared to SSD, there were no gender differences. Cognitive functioning as measured by the Raven Progressive Matrices appeared to moderate the relationship between diagnostic group and sexual consent decisional capacity, with better scores corresponding to higher competence. PCA revealed two interpretable factors 1) cognitive-emotional and 2) consequences-prevention. There were no significant group differences between BP and SSD in the second factor. Conclusion: The SCAS proved good psychometric validity and reliability. Patients with bipolar disorder showed better sexual consent competence compared to schizophrenic spectrum disorders.

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