Cross-cultural Comparison of Perceptions and Knowledge About Electroconvulsive Therapy Among Adults Who Screened Positive for Depression in the United States, India, and China

Abstract

Objective: Despite the established efficacy of electroconvulsive therapy (ECT), negative perceptions and inaccurate knowledge about ECT in the United States and other countries persist. This study examined ECT perceptions and knowledge in the 3 most populous countries in the world. Methods:We recruited participants who screened positive for depression on the Patient Health Questionnaire 9 (PHQ-9) in the United States (n = 1643), India (n = 1469), and China (n = 328) and compared responses on the ECT-Perception and Knowledge Scale.Results: Although the US sample had significantly higher PHQ-9 scores than the India and China samples, the US sample was less likely to have been offered ECT or to have ever received ECT. Moreover, the US sample scored lower on the ECT Perception and Knowledge subscales than the other samples indicating more negative perceptions and inaccurate knowledge about ECT. Across samples, there were moderate fears about ECT being painful or causing brain damage, and misconceptions about ECT being outdated and adverse effects of induced seizures. Higher PHQ-9 scores were correlated with more negative perceptions.Conclusions: Greater public education is needed about ECT, particularly in the United States. Misperceptions and lack of knowledge may hinder utilization of ECT in India, China, and the United States.

Electroconvulsive therapy knowledge and attitudes among patients and caregivers in South China: A preliminary study

“…For example, a recent study found that both older Chinese patients with severe psychiatric disorders and their caregivers mostly reported positive attitudes towards ECT (19). The possible reasons for the above inconsistent findings were mainly attributed to the fact that the use of ECT is associated with cultural, social, and legal factors (22)(23)(24).…”

“…However, another study found that more adolescents with psychiatric disorders (55.7%) reported receiving adequate information about the therapeutic effects of ECT than their caregivers (50.6%) (20). Given that ECT practice is influenced by cultural, social, and legal factors, findings from previous studies on ECT attitudes and knowledge from other countries or regions may not be applicable to samples in different regions of China (22)(23)(24).…”

The influence of prior awareness on views about psychiatric electroceutical interventions among non-clinician stakeholders

“…Some work suggests that people who lack specific knowledge of newer PEI interventions may rely on general attitudes toward more well-known PEIs (like ECT), which are largely negative 8 . In the absence of reliable information, negative attitudes toward PEIs proliferate and influence perceptions of these treatments’ efficacy, safety, and side effects 1 , 8 , 21 , 25 .…”