Perceptions of outcome from electroconvulsive therapy by depressed patients and psychiatrists.
OBJECTIVE
To determine (i) patients' expectations before and attitudes after a course of electroconvulsive therapy (ECT); (ii) the concordance between the perceptions of patients and their psychiatrists; and (iii) whether patients and psychiatrists are accurate in predicting a positive outcome with ECT.


METHODS
Eighty-one inpatients (mean 67.2 years, median 70 years) with major depression were assessed before and after receiving a course of ECT. On both occasions, patients were administered the Hamilton Rating Scale for Depression (HRSD) and the Global Assessment of Functioning Scale (GAF). Patients and two research psychiatrists rated their expectancy of treatment outcome before ECT and their impression of outcome after ECT was completed.


RESULTS
Both HRSD and GAF scores improved with treatment. Before treatment, 39.7% of patients believed ECT would improve their condition. Following treatment, 68.8% of patients thought their condition had improved as a result of ECT. There was only slight agreement between patients' and psychiatrists' expectations before and ratings of efficacy after treatment. The psychiatrists', but not the patients', pretreatment expectations of ECT efficacy were significantly associated with improvement in depression as measured by the effect size change in HRSD score from pre- to post-ECT.


CONCLUSIONS
Patients were poor judges of ECT outcome and, in this sample, less positive than previous reports had suggested. Psychiatrists' expectations however, were generally accurate indicating good clinical selection.
Brodaty
Henry
H
School of Psychiatry, University of New South Wales, and Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, New South Wales 2031, Australia. h.brodaty@unsw.edu.au
Berle
David
D
Hickie
Ian
I
Mason
Cathy
C
D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003865:Major Depressive Disorder / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011570:Psychiatry; D011795:Surveys and Questionnaires; D013997:Time Factors