title: Delays in accessing electroconvulsive therapy: a comparison between two urban and two rural populations in Australia.
abstract: OBJECTIVE
  A comparison of the timing, rates and characteristics of electroconvulsive therapy use between urban and rural populations.
  
  
  METHODS
  The medical records of patients who received an acute course of electroconvulsive therapy at two rural and two urban psychiatric hospitals in New South Wales (NSW), Australia, in 2010 were reviewed retrospectively. Main outcome measures were the time from symptom onset, diagnosis and admission to commencing electroconvulsive therapy. Rates of use of electroconvulsive therapy were also compared between rural and urban hospitals using NSW statewide data.
  
  
  RESULTS
  There was a significant delay in the time it took for rural patients to receive electroconvulsive therapy compared with urban patients when measured both from the time of symptom onset and from when they received a diagnosis. There were corresponding delays in the time taken for rural patients to be admitted to hospital compared with urban patients. There was no difference in the time it took to commence electroconvulsive therapy once a patient was admitted to hospital. NSW statewide urban-rural comparisons showed rates of electroconvulsive therapy treatment were significantly higher in urban hospitals.
  
  
  CONCLUSIONS
  Patients in rural areas receive electroconvulsive therapy later in their acute illness due to delays in being admitted to hospital. The rate of use of electroconvulsive therapy also differs geographically.
authors.affiliation: Consultant Psychiatrist, Hunter New England Local Health District, Tamworth, NSW, Australia drnataliejohnston@gmail.com.
authors.forename: Natalie E
authors.initials: NE
authors.lastname: Johnston
mesh_terms: D001315:Australia; D004565:Electroconvulsive Therapy / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D012424:Rural Population / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: Electroconvulsive therapy; health disparities; rural mental health; service delivery