Geographic Variation in Receipt of Electroconvulsive Therapy Among US Department of Veterans Affairs Patients

The aim of the study is to characterize geographic variation in electroconvulsive therapy (ECT) receipt across the United States (US) Veterans Administration (VA) healthcare system and explore potential explanatory variables.

ECT is a highly effective and rapidly acting treatment for multiple mental disorders. However, there may be geographic disparities in access to ECT across the US.

We conducted a retrospective, cross-sectional study of all VA patients from 2003 to 2019 to describe rates of ECT within previously defined mental health referral regions (MHRRs). We investigated differences between the population that received ECT and other patients with a mental health condition severe enough to warrant inpatient hospitalization. We analyzed crude as well as age, sex, race, and ethnicity-adjusted ECT rates and explored potential explanatory variables. We compared MHRRs in the highest and lowest tertiles of ECT receipt.

The rate of ECT receipt among VA patients was 1.7 individuals per 10,000 (SD = 1.6) annually. Among 115 MHRRs, the rate ranged from a minimum of 0 (effectively no utilization in some areas) to a maximum of 8.9. Regression analysis revealed few significant explanatory variables.

There is significant geographic variation in ECT receipt among VA patients that is not well explained by population characteristics and may be indicative of suboptimal treatment for several mental health conditions.