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Use of ECT in California, revisited: 1984-1994
1Department of Psychiatry and the Behavioral Sciences, University of Southern California School of Medicine, Los Angeles, USA.
The Journal of ECT
|December 30, 1999
Summary
Electroconvulsive therapy (ECT) use in California declined between 1984-1994, with limited geographic and socioeconomic access. Complex legal regulations contributed to this decline, despite ECT
Area of Science:
- Neuroscience
- Psychiatry
- Public Health Policy
Background:
- Electroconvulsive therapy (ECT) is a medical treatment most often given to those who have severe depression or other serious mental illnesses that have not responded to other treatments.
- Previous studies have examined ECT utilization in California.
- Understanding current trends in ECT use and accessibility is crucial for mental healthcare planning.
Purpose of the Study:
- To examine trends in the utilization of electroconvulsive therapy (ECT) in California from 1984 to 1994.
- To compare current ECT use rates with historical data from 1977 to 1983.
- To assess the geographical and socioeconomic accessibility of ECT services.
Main Methods:
- Analysis of legally required state reports for all ECT procedures performed in California between 1984 and 1994.
- Comparison of data with a prior study covering the period 1977-1983.
- Calculation of patient rates per 10,000 population, facility and county availability, and demographic characteristics of recipients.
Main Results:
- A total of 28,437 patients received 160,847 ECT treatments during 1984-1994.
- The overall ECT patient rate showed a decline from 1.15/10,000 in 1984 to 0.74/10,000 in 1991.
- Geographic availability fluctuated, and access remained limited, particularly for public patients; 2.89% of patients received ECT after court review due to incapacity to consent, similar to the previous study.
- White patients constituted 91.5% of recipients, and three deaths were reported (0.19 deaths/10,000 treatments).
Conclusions:
- Despite demonstrated safety and efficacy, ECT availability in California is geographically and socioeconomically restricted.
- The declining rate of ECT use may be attributed to new antidepressant medications, managed care expansion, and significant legal regulatory complexities.
- Addressing barriers to access, particularly for underserved populations, is essential for equitable mental healthcare delivery.
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