Sociodemographic Patterns of Electroconvulsive Therapy Referral and Utilization in a Tertiary Health Care Facility

Despite electroconvulsive therapy's (ECT) proven effectiveness in various psychiatric conditions, ECT referral and utilization remains suboptimal. This study sought to examine the pattern of ECT referral and utilization at a tertiary care center and to assess factors contributing to the underutilization of ECT.

This retrospective study examined patients referred to ECT at this facility from 2022-2023 (N = 76, ≥18 y/o) with demographic data obtained from the electronic medical record.

Seventy-six patients were referred for ECT, with 35 receiving treatments. The treated group had a slightly younger mean age (45.5 vs 46.2 years). Gender distribution varied, with more males receiving ECT (54.3%) and more females declining (70.7%). Whites were the majority in both groups, but Blacks were less likely to receive ECT (14 not treated vs 4 treated), while Hispanics were more likely to be treated (2 not treated vs 7 treated). Declining ECT was more frequent among Whites (61.9%) and Blacks (33.3%), while transportation and logistical issues affected various racial groups with the highest impact on Blacks (42.9%). Major depressive disorder was the primary diagnosis, evenly distributed between treated and nontreated patients. In comparison to state data, Blacks and Asians showed a higher representation among the treatment group with those treated with ECT, 11.4% versus 6.7% and 5.7% versus 3.5%, respectively.

ECT remains underutilized among minority racial/ethnic groups. Factors contributing to this pattern include referral, patient preference, and/or other specific situations that need to be addressed to reduce disparities.