Patient satisfaction after electroconvulsive therapy

We sought to determine the degree of satisfaction with bifrontal and right unilateral electroconvulsive therapy (ECT) and to investigate the relation with treatment-related variables, such as memory complaints, and patient-related variables, such as self-rated depression severity and negative affectivity.

Subjects included all patients who started a course of ECT between May 2001 and December 2003, or still were receiving continuation or maintenance ECT (C/M-ECT) at the time of the study. A psychiatric nurse that was not a member of the treatment team conducted semi-structured interviews based on a battery of questionnaires (Patient Satisfaction Survey [PSS], Mini-Mental State Examination [MMSE], Squire Subjective Memory Questionnaire [SSMQ], Beck Depression Inventory [BDI], and Positive and Negative Affect Schedule [PANAS]).

Of 50 eligible subjects, 36 (72%) completed the survey. Fourteen patients refused to participate. At the time of the interview, 19 patients (52.8%) were hospitalized, and 14 (38.9%) were receiving C/M-ECT. The mean time between last treatment session and interview was 282 days. Diagnostic categories were depressive disorder (50%) and psychotic disorder (47.2%). Bifrontal electrode position was used in 25 (69.4%) of the study patients and unilateral in 4 (11.1%). Patients had a considerable degree of satisfaction (mean PSS 153.41; SD 16.29), although they had prominent cognitive complaints (mean score SSMQ -11.86; SD 21.30). In a multiple regression model, in which satisfaction was predicted on the basis of age, sex, and scores on BDI, SSMQ, PANAS, and GAF, only the GAF-score at the time of the interview was significantly related to satisfaction. All other predictors were not significant.

Patients receiving bifrontal or right unilateral ECT do have considerable memory complaints, even a long time after their treatment. However, the degree of these complaints does not seem to predict satisfaction with the treatment. Only 38% of the variance of satisfaction could be predicted on the basis of age, sex, BDI, SSMQ, Negative Affectivity subscale of the PANAS, and GAF-scores, which proves that satisfaction with ECT is based on other factors than just the relief of symptoms or the occurrence of side-effects. The factors that contribute to patients' satisfaction remain largely unknown.