Regional and Seasonal Analysis of Electroconvulsive Therapy Utilization in Japan: A Nationwide Population-Based...

Regional disparities in electroconvulsive therapy (ECT) utilization remain insufficiently investigated in Japan, where large-scale analyses are limited. This study examined ECT utilization trends across Japan's 47 prefectures, focusing on regional disparities, demographic patterns, and seasonal variations.

Using data from Japan's National Database of Health Insurance Claims and Specific Health Checkups (2014-2022), we analyzed ECT utilization stratified by age, sex, and prefecture. ECT modalities were classified by management type (outpatient or inpatient) and anesthesia method [general anesthesia (GA) or non-GA]. Interprefectural regional disparities were assessed using the Gini coefficient. Month-stratified data (April 2019 to March 2023) were analyzed to evaluate seasonal variations, with differences tested using unpaired t tests and Bonferroni correction.

In 2022, 85% of ECT sessions were conducted under inpatient GA, reflecting a strong preference for controlled hospital environments. Age-stratified analysis showed higher utilization among adolescents and middle-aged males, with a sessions-to-patients ratio >14. The Gini coefficient for inpatient ECT (GA) sessions exceeded 0.4, indicating substantial regional inequality, despite the relatively uniform distribution of board-certified psychiatrists by the Japanese Society of Psychiatry and Neurology. No significant seasonal variation was observed.

This study reveals pronounced regional disparities in ECT access across Japan, underscoring the need for targeted policies to enhance equity in mental health care. Further investigation is needed to identify factors driving these disparities and to improve ECT availability, particularly in underserved areas.