Racial Disparities in Electroconvulsive Therapy: A Study From Singapore

Electroconvulsive therapy (ECT) has been a key treatment for various psychiatric disorders. Prior research has indicated racial disparities in ECT utilization, particularly in Western populations. This study examines racial differences in ECT use and outcomes in Singapore, a multiracial Asian context, focusing on Chinese, Malay, and Indian patients.

A retrospective analysis of medical records from the Singapore Institute of Mental Health (IMH) was conducted for patients who underwent ECT between 2017 and 2023. Data on sociodemographic profiles, clinical characteristics, pre-ECT clinical data, and post-ECT outcomes were collected.

The final sample consisted of 1091 participants: 79.6% Chinese, 10.3% Malay, and 5.8% Indian. Chinese participants were older and more likely to be female. There were no differences between races in terms of primary psychiatric diagnosis, number of failed medications, or previous ECT use. There were no significant racial differences in ECT response rates, which were 48.3% for Chinese, 40.4% for Indian, and 42.7% for Malay participants. Cognitive outcomes also did not differ significantly by race. However, results showed that being Chinese was a significant predictor of better post-ECT utility scores.

These findings align with literature suggesting that ECT's efficacy is generally unaffected by race. Chinese participants were found to have higher post-ECT quality of life measure scores, which may reflect potential differences in the subjective experiences and perceived utility of ECT between races. The results provide valuable insights into ECT practices in a non-Western context and suggest that ECT is equally effective and safe across different racial groups in Singapore.