Evolution of Electroconvulsive Therapy Practice During the COVID-19 Pandemic: A Systematic Review

Area of Science:

• Neuroscience
• Public Health
• Healthcare Management

Background:

• The COVID-19 pandemic presented unprecedented challenges to healthcare delivery worldwide.
• Electroconvulsive therapy (ECT) is a critical treatment for severe mental health conditions, necessitating continuity of care.
• Disruptions to ECT services during the pandemic risked patient well-being and treatment efficacy.

Purpose of the Study:

• To systematically review and map global electroconvulsive therapy (ECT) practices during the COVID-19 pandemic.
• To identify challenges faced by ECT services and analyze adaptations made to maintain treatment provision.
• To inform the development of strategies for ensuring ECT service continuity during future public health crises.

Main Methods:

• A systematic literature search was conducted across major databases (MEDLINE, PsycINFO, Embase) for English-language articles published during the COVID-19 pandemic.
• Articles describing ECT practice at global centers during the pandemic were critically appraised.
• Descriptive synthesis focused on ECT capacity, decision-making processes, resource availability, procedural modifications, and patient outcomes.

Main Results:

• Of 297 identified articles, 61 met inclusion criteria, with 90.7% reporting reduced ECT treatment volumes.
• ECT services prioritized inpatient treatments, facing challenges like staff shortages (39.3%) and PPE limitations (18.0%).
• Relapse rates reached 85.0% in studies reporting disruptions, with significant variation in procedural modifications and limited consensus on best practices.

Conclusions:

• The COVID-19 pandemic severely impacted global ECT service delivery, leading to reduced volumes and increased patient relapse.
• Decision-making regarding ECT services during the pandemic often lacked clinical ethicist involvement.
• Developing adaptive policies and a decision matrix for varying transmission risks and resource availability is crucial for ensuring ECT service continuity in future emergencies.