Has electroconvulsive therapy use remained stable over time? A decade of electroconvulsive therapy service provision in Victoria, Australia

Abstract

Objective: Despite the long history of electroconvulsive therapy (ECT) as a psychiatric treatment modality in Australia, existing literature regarding ECT use and practices in Australia is limited. In this unique study, we report ECT provision in Victoria to adults aged 25 years and over from 1998 to 2007, based on complete data from all public and private treatment settings within the State; compare our results to previous literature in the field; and offer possible explanations for these findings as a basis for future research. Method: Analysis of statutory ECT service provision data collected by the Office of the Chief Psychiatrist of Victoria. Results: ECT use declined overall from 2001 onward, followed by a small increase in use in 2007. Eighty per cent of patients received ECT for depression and 14% for psychosis. Sixty-two per cent of ECT recipients were women. Although patients aged 65 years and over were small in number, age adjustment of data was indicative of a higher utilisation rate in this group. With increasing age, the percentage of ECT recipients treated for depression increased, whereas the percentage treated for psychosis decreased. Sixty per cent of patients were treated in the public sector. Public-private sector ECT use did not differ greatly for depression, but more patients were treated in the public sector for psychosis. The majority of patients with depression received treatment voluntarily, but the converse was true for patients with psychosis. Unilateral electrode placement predominated. Conclusions: While utilisation rates gradually declined over the decade studied, patients continued receiving ECT in significant numbers, suggesting its role in treating severe mental illness is far from superceded. The present, population-level research cannot explain the causative factors underlying the patterns observed, but raises interesting questions for further investigation. Ongoing collection of statutory ECT data in a manner making it amenable to research applications is recommended.

Is Electroconvulsive Therapy Use Among Young-Old and Old-Old Adults Comparable? A 10-Year Population-Level Analysis of Service Provision

“…Older adults with comorbid depression and medical illness are at risk of further physical compromise through food and fluid refusal and are less likely to tolerate adequate antidepressant pharmacotherapy. 3 Our aforementioned findings concurred with those of earlier population-level studies conducted in Australia. 9 Electroconvulsive therapy has been shown to reduce mortality due to all causes among older depressed individuals 10 and may therefore be a treatment of choice in these clinical situations.…”

“…The percentage of old-old ECT recipients was less than half the percentage of young-old individuals. 3 In our earlier paper, 3 we reported that most patients were treated for depression, followed by psychosis and other diagnoses in decreasing order. 3 In examining our data further according to age group in the present study, we found women to represent an increasing percentage of patients and men a decreasing percentage of patients with increasing age.…”

“…3 Figure 2 shows older men and women treated with ECT in Victoria from 1998 to 2007 per 100,000 age-specific populations. 3 Figure 2 shows older men and women treated with ECT in Victoria from 1998 to 2007 per 100,000 age-specific populations.…”

“…7 The clinical profile and associated risks of severe depression among older patients may influence old age psychiatrists' use of ECT in this population. 3 Although only 27.2% of ECT recipients were comprised of patients aged 65 years and older, age adjustment of the data showed patients in this age group to consistently receive ECT at a higher rate than younger patients. 8 Depressed older men pose a particularly high suicide risk.…”

Balance and gait in older electroconvulsive therapy recipients: a pilot study

“…ECT remains the treatment of choice for patients whose physical health is significantly compromised by food and fluid refusal, profound psychomotor retardation, psychotic symptoms or suicidality. Older adults are over-represented among ECT recipients 5,6. Reasons postulated for this finding include a higher incidence of psychomotor retardation and psychotic features among depressed older adults 7…”