Abstract
Aims and methodElectroconvulsive therapy (ECT) prescription rates in Scotland are decreasing. This study aims to look for possible causes, in particular psychiatrists' attitudes. Ninety-one Scottish psychiatrists completed a survey in 2009 relating to demographics, training, current practice, National Institute for Health and Care Excellence (NICE) guidelines and attitudes.ResultsThe mean number of times the psychiatrists had prescribed ECT in the past 2 years was twice. About 43% felt that their prescribing rates had decreased. Reasons for this included more effective medication, public and patient perception, and NICE guidelines. There was a significant correlation between doctors' gender and estimated prescription rates (P= 0.004), however, not with other prescription data. Almost all surveyed psychiatrists (97%) agreed that ECT has a place in current psychiatric practice.Clinical implicationsDespite generally positive attitudes to ECT shown by psychiatrists in this study, prescription rates were low and decreasing. With more effective medication the role of ECT in therapy appears to be changing.
Highlights
As in many other Western European countries, Electroconvulsive therapy (ECT) prescription rates in The Netherlands are significantly lower than even the UK, yet the majority of psychiatrists surveyed felt that ECT was effective (92.1%), safe (90%) and acceptable to patients (91.2%)
The National Institute for Health and Care Excellence (NICE) guidance relating to ECT in depression was updated in 2009.24 This new guidance stated that ECT should be considered in patients with moderate depression in whom multiple-drug and psychological therapies have been unsuccessful as well as in those with severe, life-threatening depression
Psychiatrists’ estimations of the number of times they had prescribed ECT over the past 2 years were generally low, the mean being just twice (Fig. 1), and a significant proportion (43%) felt their prescription rate had decreased over recent years
Summary
Of the psychiatrists who work in Scotland, 91 completed the survey. The majority were male (60%), consultants (61%), and had graduated in the UK (88%). The number of times psychiatrists estimated they had prescribed ECT in the past 2 years is shown in Fig. 1; the mean was twice and 34% had not prescribed it at all. The majority of psychiatrists felt that their prescription rates had either remained constant (51%) or decreased (43%) over the past 5 years. The impact of the psychiatrists’ gender on ECT prescription was investigated (Fig. 3). Estimated prescription rates in male doctors were significantly higher than. Those in female doctors (P = 0.004). The impact of years worked in psychiatry and time since graduation was investigated; neither was found to be significant. A minority (4%) felt that ECT is overprescribed, whereas 40% thought that it is underprescribed
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