Trends in the usage of electroconvulsive therapy – adapted from the American Journal of Psychiatry, November 1994 – Tips from Other Journals
Reports of the use of electroconvulsive therapy in the United States and foreign countries have varied widely. Although reports indicated an overall decline in the use of electroconvulsive therapy during the 1970s, other reports have indicated a possible increase in popularity in the 1980s as a therapy for affective disorders. Thompson and associates reviewed data from the patient Sample Survey Program of the National Institute of Mental Health to identify trends in the selective use of electroconvulsive therapy in the United States since 1975.
Data reviewed represented national estimates of 126,739 patients admitted to psychiatric inpatient care during 1975, 1980 and 1986. Data were obtained from county and private psychiatric hospitals and public and private general hospitals. Diagnoses were determined according to criteria in the Diagnostic and Statistical Manual of Mental Disorders, second and third editions (DSM-II and DSM4III). Type of treatment received during admission and the primary diagnosis were included in the data.
In 1986, 36,558 patients received electroconvulsive therapy, representing a significant decrease from 1975 but not a significant change from 1980. The percentage of patients receiving electroconvulsive therapy did not change between 1980 and 1986. State and county hospitals used electroconvulsive therapy the least each year. Private general hospitals remained the primary utilizers of electroconvulsive therapy.
No significant changes occurred between 1980 and 1986 with regard to any of the diagnostic and demographic variables such as DSM-III diagnosis, sex, race or age. The great majority of patients who underwent electroconvulsive therapy in 1986 had affective disorders (84 percent). Thirteen percent of patients with a primary diagnosis of affective disorder, including schizoaffective disorder, received electroconvulsive therapy in 1975, compared with 4.8 percent of patients with this diagnosis in 1986. About 1 percent of patients admitted with a diagnosis of schizophrenia and less than 1 percent of patients admitted with other diagnoses received electroconvulsive therapy in 1986.
More than two-thirds of patients who received electroconvulsive therapy were women. However, female sex was a poorer predictor of electroconvulsive therapy use than was a diagnosis of affective disorder or hospital type. Twenty-three percent of patients admitted were African American, but this group accounted for only 1.5 percent of electroconvulsive therapy usage. Over 34 percent of persons who received electroconvulsive therapy in 1986 were aged 65 or older, yet this group represented only 8.2 percent of hospitalized psychiatric patients. Patients with mood disorders were twice as likely to receive electroconvulsive therapy, compared with schizophrenic patients, and both groups were more likely to receive electroconvulsive therapy than were patients with other diagnoses. Most patients who received electroconvulsive therapy had been hospitalized previously and were in the private sector.
The authors conclude from this review that the decline in the use of electroconvulsive therapy in the United States ended in the 1980s. They estimate that approximately 300,000 electroconvulsive therapy treatments were given in 1986, which is comparable to the number of coronary artery bypass surgeries, tonsillectomies, inguinal hernia repairs and appendectomies performed in the same year. The authors believe that documentation and analyses of the cost-benefit ratio of electroconvulsive therapy use is increasingly important. The potential for overuse of this therapy in the elderly and for its underuse in African Americans is of concern. (American journal of Psychiatry, November 1994, vol. 151, p. 1657.)
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