The decision to use ECT: A retrospective study

Abstract

There is a paucity of literature on electroconvulsive therapy (ECT) utilization in hospitals. No mention occurs in major psychiatric texts. 1,2 Fink 3 found only three studies. 4–6 Hedlund et al. 7 reported on the declining use of ECT in Missouri from 1971 to 1975. All these studied agree that there are low use rates in public hospitals (0.1%–1.7%) and much higher rates in private hospitals (5.2%–28.0%). ECT has been used in two different settings at Long Island Jewish-Hillside Medical Center, a private, nonprofit voluntary hospital. The Hillside Division has 202 psychiatric beds with treatment provided by salaried staff. Long Island Jewish (LIJ) has 490 beds, 20 of which are for treating psychiatric inpatients by private attending physicians. Between April 17, 1973, and July 19, 1976, 69 of 4,236 Hillside inpatients (1.16%) and 115 of 969 LIJ inpatients (12.1%) received at least one ECT treatment. The Hillside rate was indistinguishable from the public hospital rate and significantly different ( χ 2 − 247.5, df = 1, p < 0.0001) from the higher LIJ rate which was consistent with rates found in private hospitals. This retrospective study was undertaken to assess preliminarily what factors may have affected the decision to use ECT at the Medical Center, with the expectation that it might help explain the different utilization rates reported in the literature. Another purpose for the study related to the problem of predicting improvement from using ECT. Attempts at predicting improvement have met with variable success. 8–11 Mendel 12–15 has developed and validated a weighted factor index to predict improvement which appeared promising. We attempted to replicate his approach on the Hillside sample. Replication for the LIJ ECT-treated patients was not possible due to insufficient data.