Relatives' Knowledge, Attitudes, and Experiences Toward Electroconvulsive Therapy: A Systematic Review

Electroconvulsive therapy (ECT) is an effective treatment for patients with severe psychiatric disorders. Stigma and lack of knowledge surrounding ECT are major obstacles for both patients and their caregivers, who play an important role as shared decision-makers. Insight in caregivers' perspectives on ECT can support the consent process and patient compliance with ECT. We aimed to review perspectives on knowledge, attitudes, and experiences of caregivers of adult and adolescent patients who received ECT. We performed a computerized search (EMBASE, MEDLINE) for articles meeting the following inclusion criteria: (1) qualitative studies, quantitative studies, or quasi-experimental studies that (2) report on caregiver perspectives of patients who received ECT. We conducted our systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. In total, 29 articles were included. Variation in knowledge about ECT was high among caregivers. Their attitudes were generally positive and most would advise for future ECT if necessary. Psychoeducational tools and ECT experience increased knowledge and attitudes in caregivers. In general, caregivers were satisfied with ECT but wanted more information on risks and side effects before ECT. Caregivers reported more positive attitudes toward and had better experiences with ECT compared with patients. Our systematic review demonstrated moderate knowledge, but overall positive attitudes and experiences on ECT in caregivers. Overall low methodological quality of included studies limits our conclusions. Future research should focus more on qualitative methods and cohort studies.