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Temporal Variations in Access: Investigating Time-to-Electroconvulsive Therapy (ECT) Utilization Among Inpatients
Anisha Kohli1, Haley Schuster2, Ryan W Walters3
1School of Medicine, Creighton University.
The Journal of ECT
|September 15, 2025
Summary
Electroconvulsive therapy (ECT) wait times increased significantly from 2016 to 2021, with longer delays for Black and Hispanic patients, those with Medicaid, and individuals facing unemployment or housing insecurity. This highlights disparities in accessing timely psychiatric care.
Area of Science:
- Psychiatry
- Health Services Research
- Public Health
Background:
- Electroconvulsive therapy (ECT) is a crucial treatment for severe psychiatric conditions.
- Understanding temporal trends and sociodemographic disparities in ECT administration is vital for equitable care.
Purpose of the Study:
- To examine changes in the time to first ECT administration over time.
- To identify sociodemographic factors associated with delays in ECT access.
Main Methods:
- Retrospective analysis of the National Inpatient Sample (NIS) database (2016-2021).
- Inclusion of adult inpatients with major depressive disorder, bipolar disorder, schizoaffective disorder, noncatatonic schizophrenia, or catatonia receiving ECT.
- Statistical analysis using mixed-effects negative binomial regression to assess time-to-ECT variations.
Main Results:
- A 24.6% increase in the average time to first ECT session, from 7.3 days (2016) to 9.1 days (2021).
- Longer delays observed for noncatatonic schizophrenia and catatonia diagnoses.
- Significant delays disproportionately affected Black and Hispanic patients, Medicaid beneficiaries, and those experiencing housing insecurity or unemployment.
Conclusions:
- Substantial delays in ECT administration are prevalent, particularly for vulnerable populations and less common indications.
- Systemic barriers impede equitable access to timely ECT, necessitating targeted interventions.
