The Impact of COVID-19 on Electroconvulsive Therapy

Kwan, Elaine; Le, Brandon; Loo, Colleen; Dong, Vanessa; Tor, Phern‐Chern; Davidson, D.; Mohan, Titus; Waite, Susan; Branjerdporn, Grace; Sarma, Shanthi; Hussain, Salam; Martin, Donel

doi:10.1097/yct.0000000000000800

Cited by 7 publications

(18 citation statements)

References 18 publications

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“…4 By the end of 2020 in Australia/Singapore, 67% of ECT services had reduced service provision, and 27% had closed completely. 5 Single-site studies report services reducing ECT service provision from 115 treatments per week to a maximum of 90 7 and 30 treatments per week to a maximum of only 8. 10 Although there have been individual region reports of lack of access to ECT, this is the first time regions could be directly compared by identified percentage of patients unable to access services.…”

Section: Discussionmentioning

confidence: 99%

“…The survey did not ask about the type/s of PPE used; however, the literature suggests that PPE practices in ECT services are variable, ranging from mandatory full PPE to risk-based PPE. 4,5 Many early guidelines from Asia and Australia recommend that, because ECT may be an aerosol-generating procedure, full PPE should be used. 8,10 However, guidelines from international peak bodies about the use of PPE when delivering ECT during the pandemic allow for local decision making.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] However, the delivery of ECT by services worldwide has been significantly disrupted by the COVID-19 pandemic. [4][5][6] Electroconvulsive therapy services are high-risk settings for COVID-19 transmission. Clinical tasks such as electrode placement and anesthesia require direct clinician-patient contact, often for extended periods.…”

mentioning

confidence: 99%

“…In some services, this necessitated that ECT treatment intervals were extended, that ECTwas delivered only to the severely ill patients, or that ECT delivery was discontinued. [4][5][6] In other services, the decision to discontinue ECT treatment was made because ECT was considered a nonessential "elective" procedure. 13 Such decisions were often driven by stigma and misunderstanding about psychiatric illness.…”

mentioning

confidence: 99%

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Impact on Electroconvulsive Therapy Services, Including Patient Relapse and Death, During the COVID-19 Pandemic

Sarma¹,

Branjerdporn

McCosker³

et al. 2023

J ECT

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Objectives: Electroconvulsive therapy (ECT) is important in the management of major, life-threatening, and treatment-resistant psychiatric illness. The COVID-19 pandemic has significantly disrupted ECT services. The need for new infection control measures, staff redeployment and shortages, and the perception that ECT is as an "elective" procedure have caused changes to, and reductions in, ECT delivery. The aim of this study was to explore the impact of COVID-19 on ECT services, staff, and patients globally.Methods: Data were collected using an electronic, mixed-methods, cross-sectional survey. The survey was open from March to November 2021. Clinical directors in ECT services, their delegates, and anesthetists were asked to participate. Quantitative findings are reported.Results: One hundred and twelve participants worldwide completed the survey. The study identified significant impacts on services, staff, and patients. Importantly, most participants (57.8%; n = 63) reported their services made at least 1 change to ECT delivery. More than three-quarters (81.0%; n = 73) reported that their service had identified at least 1 patient who could not access ECT. More than two-thirds (71.4%; n = 67) reported that their service identified patients who experienced a relapse in their psychiatric illness due to lack of ECT access. Six participants (7.6%) reported that their service had identified at least 1 patient who died, by suicide or other means, due to lack of ECT access.Conclusions: All ECT practices surveyed were impacted by COVID-19 with decreases in capacity, staffing, changes in workflow, and personal protective equipment requirements with relatively little change to ECT technique. Lack of access to ECT resulted in significant morbidity and mortality, including suicide, internationally. This is the first multisite, international survey to explore the impacts of COVID-19 on ECT services, staff, and patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Impact on Electroconvulsive Therapy Services, Including Patient Relapse and Death, During the COVID-19 Pandemic

Sarma¹,

Branjerdporn

McCosker³

et al. 2023

J ECT

Self Cite

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“…A number of studies surveying ECT centres have been performed worldwide to evaluate national response to the pandemic, including the United Kingdom and Ireland [ 27 ], Japan [ 28 ], India [ 29 ], Hungary [ 30 ], Germany, Austria, and Switzerland [ 31 ], Singapore, Australia, and New Zealand [ 32 – 34 ], France [ 35 ], Qatar [ 36 ], Turkey [ 37 ], and the United States [ 17 , 38 ]. In line with these studies, our team has previously published findings from a “what happened” survey on the effects of COVID-19 on ECT services across Canada [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 on electroconvulsive therapy practice across Canadian provinces during the first wave of the pandemic

et al. 2023

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Background Electroconvulsive therapy (ECT) is a procedural treatment that is potentially life-saving for some patients with severe psychiatric illness. At the start of the global coronavirus disease 2019 (COVID-19) pandemic, ECT practice was remarkably disrupted, putting vulnerable individuals at increased risk of symptom exacerbation and death by suicide. This study aimed to capture the self-reported experiences of psychiatrists based at healthcare facilities across Canadian provinces who were delivering ECT treatments during the first phase of the COVID-19 pandemic (i.e., from mid-March 2020 to mid-May 2020). Methods A multidisciplinary team of experts developed a survey focusing on five domains: ECT unit operations, decision-making, hospital resources, ECT procedure, and mitigating patient impact. Responses were collected from psychiatrists providing ECT at 67 ECT centres in Canada, grouped by four geographical regions (Ontario, Quebec, Atlantic Canada, and Western Canada). Results Clinical operations of ECT programs were disrupted across all four regions – however, centres in Atlantic Canada were able to best preserve outpatient and maintenance care, while centres in Western Canada were able to best preserve inpatient and acute care. Similarly, Atlantic and Western Canada demonstrated the best decision-making practices of involving the ECT team and clinical ethicists in the development of pandemic-related guidelines. Across all four regions, ECT practice was affected by the redeployment of professionals, the shortage of personal protective equipment, and the need to enforce social distancing. Attempts to introduce modifications to the ECT delivery room and minimize bag-valve-mask ventilation were consistently reported. All four regions developed a new patient prioritization framework, and Western Canada, notably, aimed to provide ECT to only the most severe cases. Conclusions The results suggest that ECT provision was disproportionately affected across different parts of Canada. Possible factors that could explain these interregional differences include population, distribution of urban vs. rural areas, pre-pandemic barriers in access to ECT, number of cases, ability to control the spread of infection, and the general reduction in physicians’ activities across different areas of health care. Studying these factors in the future will inform how medical centres should respond to public health emergencies and pandemic-related circumstances in the context of procedural treatments.

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Changes in Inpatient Electroconvulsive Therapy Utilization Between 2019 and 2020

Luccarelli¹,

Henry²,

Smith³

et al. 2023

J ECT

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Objectives: Electroconvulsive therapy (ECT) is an essential procedure for a range of psychiatric conditions. Multiple single-center studies have documented reduction in ECT administration in 2020 because of the coronavirus disease 2019 pandemic, but there have been little nationally representative data from the United States. The aim of this study was to examine the demographics of patients receiving ECT in 2019 and 2020 and to characterize temporal and regional variations in ECT utilization. Methods:The 2019 and 2020 National Inpatient Sample, an administrative database of inpatient hospitalizations in the United States, was queried for hospitalizations involving the delivery of ECT based on procedural codes. Overall number of ECT procedures was calculated based on the overall number of ECT procedural claims.

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The Impact of COVID-19 on Electroconvulsive Therapy

Cited by 7 publications

References 18 publications

Impact on Electroconvulsive Therapy Services, Including Patient Relapse and Death, During the COVID-19 Pandemic

Impact on Electroconvulsive Therapy Services, Including Patient Relapse and Death, During the COVID-19 Pandemic

Impact of COVID-19 on electroconvulsive therapy practice across Canadian provinces during the first wave of the pandemic

Changes in Inpatient Electroconvulsive Therapy Utilization Between 2019 and 2020

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