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ECT may reduce psychiatric readmission risk

Electroconvulsive therapy was associated with decreased risk for psychiatric readmission among individuals with major depressive disorder, bipolar disorder or schizoaffective disorder receiving inpatient treatment.

“The limited and regionally variable availability of electroconvulsive therapy (ECT) in U.S. hospitals is a curious phenomenon in view of ECT’s unique clinical benefits,” Eric P. Slade, PhD, of University of Maryland School of Medicine, Baltimore, and colleagues wrote. “Electroconvulsive therapy is considered the most efficacious treatment available for individuals with severe affective disorders, yet ECT is not used during inpatient care in nearly nine of 10 U.S. hospitals, and its use in these settings has declined over the past 2 decades.”

To determine if inpatient treatment with ECT is associated with decreased risk for 30-day psychiatric readmission, researchers conducted a quasi-experimental instrumental variables probit model analysis using observational, longitudinal data for 162,691 individuals diagnosed with major depressive disorder (MDD), bipolar disorder or schizoaffective disorder. Study participants were receiving inpatient psychiatric care.

Overall, 1.5% of the cohort underwent ECT during index admission.

Participants who received ECT were older (56.8 years vs. 45.9 years; P < .001) and more likely to be female (65% vs. 54.2%; P < .001), white non-Hispanic (85.3% vs. 62.1%; P < .001), have MDD diagnosis (63.8% vs. 32%; P < .001), a comorbid medical condition (31.3% vs. 26.6%; P < .001), private insurance (39.4% vs. 21.7%; P < .001), or Medicare (49.2% vs. 39.4%; P < .001), and receive care in small urban hospitals (31.2% vs. 22.3%; P < .001) or nonurban hospitals (9% vs. 7.6%; P = .02), compared with other inpatients.

ECT was associated with a decreased risk for 30-day readmission among participants with severe affective disorders (6.6% vs. 12.3%; RR = 0.54; 95% CI, 0.28-0.81), compared with those who did not receive ECT.

Associations between ECT and reduced risk for readmission were significantly larger among men (RR = 0.44; 95% CI, 0.2-0.69) and participants with bipolar disorder (RR = 0.42; 95% CI, 0.17-0.69) or schizoaffective disorder (RR = 0.44; 95% CI, 0.11-0.79).

“As Slade et al note, there are likely a variety of factors that contribute to the low and uneven rate of ECT use,” Harold A. Sackeim, PhD, of Columbia University, New York, wrote in an accompanying editorial. “Perhaps the most important considerations are the stigma associated with receiving the treatment on the part of patients and in recommending or administering the treatment on the part of professionals. Nonclinical economic, cultural and political factors greatly affect the availability and use of this intervention. Were we able to overcome these barriers, it is likely that untold numbers of patients would experience better outcomes by receiving an intervention that is often life altering and, for some, lifesaving.” – by Amanda Oldt

Disclosure: Slade reports no relevant financial disclosures. Sackeim reports serving as a consultant for LivaNova (vagus nerve stimulation), MECTA Corporation (electroconvulsive therapy), and Neuronetics (transcranial magnetic stimulation); consulting with or receiving research support from brain stimulation companies Brainsway, Cyberonics, Cervel Neurotech/NeoStim, Magstim, NeoSync, and NeuroPace and from pharmaceutical companies Cambridge Neuroscience, Eli Lilly and Company, Forest Laboratories, Hoffman-La Roche, Interneuron Pharmaceuticals, Novartis International, Pfizer, Warner-Lambert, and Wyeth-Ayerst; originating magnetic seizure therapy and inventing a nonremunerative patent for focal electrically administered seizure therapy; and inventing a nonremunerative pending patent on titration in the current domain as a method for seizure threshold determination in ECT.