Malingering in Awaiting Trial Defendants in South Africa: Prevalence, Patterns and Associative Factors

Abstract Background: There is a lack of research on malingering, especially in South Africa. In forensic psychiatry, the accurate detection of malingering is vital, as failure to do so has significant ethical and legal implications. Aims: To estimate the prevalence of malingering in the forensic observation setting in South Africa, establish the most common presentations of malingering, and identify possible individual characteristics that may be associated with malingering. Methods: The study was a quantitative retrospective analysis with a cross-sectional chart review conducted at Sterkfontein Psychiatric Hospital in Gauteng, South Africa. Results: The prevalence of malingering in this study population was 66 of 478 (13,8%) observandi (those persons charged with a crime deemed to require psychiatric observation). Most of the observandi were accused of serious offences and had a history of substance use. A personality disorder or trait was noted for 26 of the observandi. The most common clinical presentations of malingering were cognitive impairment, psychotic symptoms, physical symptoms, and mood symptoms, in that order. Findings from 23 psychological assessments that were conducted highlight the question of how accurate the diagnosis of malingering is when based on clinical factors alone. Conclusions: The prevalence of malingering in this setting is comparable to that reported in other countries. Based on this study's findings, more specific and detailed note-keeping is needed to establish precise patterns of malingering. In cases where malingering of cognitive symptoms is suspected clinically, observandi should be referred to psychological services for a battery of tests. Further research on malingering is needed to build on the findings and conclusions of this study.