title: The Prevalence of Electroconvulsive Therapy Use Since 1973: A Meta-analysis.
abstract: OBJECTIVE
  A formal meta-analysis of the use of electroconvulsive therapy (ECT) has never been conducted before in literature reviews or syntheses. Such a study would be hampered by heterogeneity and potential reporting biases. However, it would provide a single comparable measure to allow an analysis of statistical key dimensions such as trends across time and psychiatric resources available. It would also help planners and decision makers to set standards and benchmarks for national and regional guidelines for quality assurance and research in health services.
  
  
  METHODS
  We surveyed different databases for relevant studies, limited from 1973 to October 2013. Data were extracted independently by 4 reviewers. The articles retrieved were peerreviewed studies (data-based studies or surveys) presenting ECT population rates (annual patient rates calculated from the general population) or number of patients receiving ECT during or after 1973 and attending a psychiatric establishment (either hospitals or approved ECT delivery centers for inpatients and outpatients in well-defined geographic areas).
  
  
  RESULTS
  This meta-analysis includes a total of 18 studies from 12 countries. A composite event rate of 16.9/100,000 inhabitants emerged, characterized by high heterogeneity. Across the countries assessed, the prevalence of ECT was higher in older studies.
  
  
  CONCLUSIONS
  By its prevalence, ECT remains rare to exceptional as a specialist treatment for mental disorders. Heterogeneity across regions or countries could best be explained by insufficient standardization of ECT procedures and practices. Linked health databases and audits could help strengthen the effectiveness of ECT in relation to primary outcomes such as suicide and help determine the gap in ECT provision, if any.
authors.affiliation: From the *Department of Psychiatry, University of Montreal, Montreal; †Institut Universitaire en Santé Mentale de Montréal; ‡Centre d'Excellence en Électroconvulsivothérapie du Québec, Canada.
authors.forename: Alain
authors.initials: A
authors.lastname: Lesage
authors.forename: Morgane
authors.initials: M
authors.lastname: Lemasson
authors.forename: Karen
authors.initials: K
authors.lastname: Medina
authors.forename: Jackson
authors.initials: J
authors.lastname: Tsopmo
authors.forename: Nedjma
authors.initials: N
authors.lastname: Sebti
authors.forename: Stephane
authors.initials: S
authors.lastname: Potvin
authors.forename: Simon
authors.initials: S
authors.lastname: Patry
mesh_terms: D004565:Electroconvulsive Therapy / Q000009:adverse effects / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy; D015995:Prevalence; D011795:Surveys and Questionnaires