Declining use of electroconvulsive therapy in United States general hospitals

Abstract

Background: Falling duration of psychiatric inpatient stays over the past 2 decades and recent recommendations to tighten federal regulation of electroconvulsive therapy (ECT) devices have focused attention on trends in ECT use, but current national data have been unavailable.

Methods: We calculated the annual number of inpatient stays involving ECT and proportion of general hospitals conducting the procedure at least once in the calendar year with a national sample of discharges from 1993 to 2009. We estimated adjusted probabilities that inpatients with severe recurrent major depression (n = 465,646) were treated in a hospital that conducts ECT and, if so, received the procedure.

Results: The annual number of stays involving ECT fell from 12.6 to 7.2/100,000 adult US residents, driven by dramatic declines among elderly persons, whereas the percentage of hospitals conducting ECT decreased from 14.8% to 10.6%. The percentage of stays for severe recurrent major depression in hospitals that conducted ECT fell from 70.5% to 44.7%, whereas receipt of ECT where conducted declined from 12.9% to 10.5%. For depressed inpatients, the adjusted probability that the treating hospital conducts ECT fell 34%, whereas probability of receiving ECT was unchanged for patients treated in facilities that conducted the procedure. Adjusted declines were greatest for elderly persons. Throughout the period inpatients from poorer neighborhoods or who were publicly insured or uninsured were less likely to receive care from hospitals conducting ECT.

Conclusions: Electroconvulsive therapy use for severely depressed inpatients has fallen markedly, driven exclusively by a decline in the probability that their hospital conducts ECT.

Figure 1

Annual number of inpatient stays in US general hospitals involving ECT administration per 100,000 US residents, by age group, with 95% confidence intervals, 1993–2009 See text for sample description.

Figure 2

Annual percentage and number of US general hospitals which conducted ECT, with 95% confidence intervals, 1993–2009 See text for sample description.

Figure 3

The annual percentages of inpatients treated in hospitals which conduct ECT and of inpatients who received ECT where the procedure is conducted, with 95% confidence intervals, among stays for recurrent major depression in US general hospitals, 1993–2009 See text for sample description.