Contemporary use and practice of electroconvulsive therapy worldwide

Area of Science:

• Psychiatry
• Neurology
• Global Health

Background:

• Electroconvulsive therapy (ECT) remains a vital treatment for severe mental health conditions.
• Contemporary utilization and practice patterns of ECT globally require updated understanding.

Purpose of the Study:

• To systematically review and analyze the worldwide utilization and practice of electroconvulsive therapy (ECT) from 1990 onwards.
• To identify global trends, variations, and challenges in contemporary ECT administration.

Main Methods:

• A systematic literature search was conducted across multiple databases (Medline, Embase, PsycINFO, SveMed, EBSCO/Cinahl) for studies published since 1990.
• Two independent reviewers screened titles and abstracts, then extracted data from 70 primary data-based studies/surveys on ECT utilization and practice.

Main Results:

• Significant global disparities exist in ECT administration, including the prevalence of unmodified ECT (over 90% in Asia and Africa).
• Bilateral electrode placement is preferred globally, though unilateral is used in some European and Australasian regions. Brief-pulse wave devices are mainstream, but sine-wave devices persist.
• Patient demographics vary, with older women with depression treated in Western countries versus younger men with schizophrenia in Asian countries.

Conclusions:

• Worldwide variations in ECT utilization, administration methods, and patient populations are substantial.
• Inadequate training, inconsistent guideline adherence, and sparse ECT registry data are prevalent issues.
• There is a critical need for global knowledge exchange and collaborative learning to enhance electroconvulsive therapy practices worldwide.