Declining use of electroconvulsive therapy in United States general hospitals.
BACKGROUND
Falling duration of psychiatric inpatient stays over the past 2 decades and recent recommendations to tighten federal regulation of electroconvulsive therapy (ECT) devices have focused attention on trends in ECT use, but current national data have been unavailable.


METHODS
We calculated the annual number of inpatient stays involving ECT and proportion of general hospitals conducting the procedure at least once in the calendar year with a national sample of discharges from 1993 to 2009. We estimated adjusted probabilities that inpatients with severe recurrent major depression (n = 465,646) were treated in a hospital that conducts ECT and, if so, received the procedure.


RESULTS
The annual number of stays involving ECT fell from 12.6 to 7.2/100,000 adult US residents, driven by dramatic declines among elderly persons, whereas the percentage of hospitals conducting ECT decreased from 14.8% to 10.6%. The percentage of stays for severe recurrent major depression in hospitals that conducted ECT fell from 70.5% to 44.7%, whereas receipt of ECT where conducted declined from 12.9% to 10.5%. For depressed inpatients, the adjusted probability that the treating hospital conducts ECT fell 34%, whereas probability of receiving ECT was unchanged for patients treated in facilities that conducted the procedure. Adjusted declines were greatest for elderly persons. Throughout the period inpatients from poorer neighborhoods or who were publicly insured or uninsured were less likely to receive care from hospitals conducting ECT.


CONCLUSIONS
Electroconvulsive therapy use for severely depressed inpatients has fallen markedly, driven exclusively by a decline in the probability that their hospital conducts ECT.
Emma Pendleton Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, USA. brady_case@brown.edu
Brady G
BG
Case
David N
DN
Bertollo
Eugene M
EM
Laska
Lawrence H
LH
Price
Carole E
CE
Siegel
Mark
M
Olfson
Steven C
SC
Marcus
D000293:Adolescent; D000328:Adult; D000368:Aged; D003865:Major Depressive Disorder / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000639:trends; D006769:Hospitals, General / Q000639:trends*; D006801:Humans; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D012008:Recurrence; D014481:United States