Electroconvulsive therapy (ECT) and Psychiatric rehospitalization rates: a retrospective study

Electroconvulsive therapy (ECT) induces a generalized seizure under anesthesia with an electrical current for treatment-resistant patients and may be underutilized. To our knowledge, no large-scale, American, nationwide hospital system retrospective study has examined how ECT affects psychiatric rehospitalization chances.

We analyzed initial inpatient encounters for adults aged > 18 years at HCA Healthcare Behavioral Health Units from 2016 to 2021 with diagnoses of major depressive disorder with/without psychosis, bipolar disorder with/without psychosis, schizoaffective disorder, and schizophrenia. Excluding pregnancy and incarceration cases, we compared psychiatric rehospitalization rates within 365 days for patients receiving ECT versus those with the same diagnoses not receiving ECT. Subgroup analyses were conducted by diagnosis, length of stay, sex, and race. Detailed statistical analyses included bivariate analyses with Fisher's Exact Test and Wilcoxon Rank Sum Test.

We analyzed 38,109 distinct patients, 637 of which received ECT. The rehospitalization rate was 37.52% for ECT recipients versus 20.71% for non-ECT patients (p < 0.0001). ECT was associated with higher rehospitalization rates, particularly for severe diagnoses like psychosis (87.28%), schizoaffective disorder (3.77%), and schizophrenia (6.59%). ECT patients had significantly longer rehospitalization lengths of stay (mean 14.53 days vs. 6.54 days for non-ECT, p < 0.0001). White patients received ECT more frequently. Females received ECT more often, while males had higher rehospitalization rates.

ECT was associated with higher psychiatric rehospitalization rates and longer lengths of stay. This suggests ECT is more commonly used for complex, severe cases which may contribute to higher rehospitalization. Stronger social support and hospital and geographic ties among ECT patients may also play a role.