What predicts patients' expressed likelihood of choosing electroconvulsive therapy as a future treatment option?

To examine the relationship between stated intention to choose electroconvulsive therapy (ECT) as a future treatment option and measures of function and quality of life, mood, and cognition in the month after this therapy. Understanding the factors influencing patient choice of ECT is a source of insight into the interplay between measures of response and perceived value of this treatment to patients, lending perspective to patient-centered quality improvement efforts.

In a prospective sample of 77 depressed patients given ECT, we surveyed recipients at 1 month about their expressed likelihood of choosing ECT given a future episode and examined predictors of their responses.

Thirty-four subjects were classified as "likely" to choose a course of ECT, whereas 33 patients were "unlikely." A model including Hamilton baseline and change scores as well as baseline scores in instrumental activities of daily living significantly predicted likeliness after controlling for age and sex (R = 0.34, P < 0.0001). Other quality-of-life variables and measures of change in cognition were not significant in the model.

In our sample, choosing ECT as a future treatment option was more likely for those who were more depressed before treatment, had more impaired instrumental activities at the outset of treatment, and experienced a more robust improvement in depressive symptoms. This variance was not explained by treatment-associated improvements in quality of life, function, or deficits in cognitive status.