Association of Electroconvulsive Therapy With Psychiatric Readmissions in US Hospitals

Abstract

Electroconvulsive therapy may be associated with reduced short-term psychiatric inpatient readmissions among psychiatric inpatients with severe affective disorders. This potential population health effect may be overlooked in US hospitals' current decision making regarding the availability of ECT.

Identifying Recipients of Electroconvulsive Therapy: Data From Privately Insured Americans

“…This trend is consistent with conclusions from a previous study of inpatient ECT, which reported a marked decline from 1993 to 2009 (10). These contrasts are heightened by the fact that the MarketScan database is composed of individuals with private insurance, a group associated with higher rates of ECT compared with patients with public insurance (6,10). …”

“…Such a decline and limited use are problematic, given the considerable evidence that ECT is the most effective therapy for treatment-resistant depression (5), can rapidly reduce suicidal ideation (29), and may be associated with a lower rate of 30-day psychiatric hospital readmission (6). Given the marked improvements in the cognitive side-effect profile of ECT in recent decades (right unilateral site and shorter pulse width) (8,30,31), there is much room for improvement in making this effective treatment more widely available to a broad range of appropriate patients.…”

“…Whereas standard antidepressant therapies achieve response with 16%–17% of patients with treatment-resistant depression (4), ECT achieves response rates of 50%–70% with such patients (5). Recent data show that among psychiatric inpatients, ECT is associated with a 46% lower risk of 30-day readmission compared with a matched group of patients with severe depression who did not receive ECT (6). …”

“…Despite evidence that it is more effective than other treatments (5,9) for the most common psychiatric disorder (2), recent data suggest that only approximately one in 10 hospitals that provide inpatient psychiatric care even have the capacity to provide ECT (6,7). The underutilization of ECT is thought to reflect a combination of factors, including stigma, risk of cognitive side effects, and restricted access because of limited availability.…”

Association of electroconvulsive therapy with psychiatric readmissions in Singapore tertiary mood disorder unit

“…Electroconvulsive therapy (ECT) may reduce psychiatric readmissions . No similar data are available in Asia; hence, we investigated the association between ECT and 30‐day psychiatric readmission in a tertiary mood disorder unit (MDU) in Singapore.…”