ECT Reduces Hospitalizations Along with Depression

Patients with severe affective disorder are less likely to require psychiatric inpatient readmission within 30 days of discharge if they have received electroconvulsive therapy (ECT), according to an analysis of inpatient databases across 9 states in the United States.

Readmission within 30 days of discharge is a key metric of mental healthcare, with implications for accreditation and payments of psychiatric inpatient facilities. The finding that ECT reduces the probability of those readmissions not only adds to the evidence of its efficacy for treatment-resistant depression, the investigators suggest, but should serve as an incentive for more institutions to offer the treatment.

“The limited and regionally variable availability of ECT in US hospitals is a curious phenomenon in view of ECT’s unique clinical benefits,” observed Eric Slade, PhD, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, and colleagues. “Electroconvulsive therapy is considered the most efficacious treatment available for individuals were severe affective disorders, yet ECT is not used during inpatient care in nearly 9 of 10 US hospitals, and its use in these settings has declined over the past 2 decades.”

Slade and his colleagues examined the most recent available State Inpatient Databases (SID) data from the 9 states that had sufficient personal and hospital identification to track the course of patients from the index admission. In assessing the effect of ECT on readmission, their analysis accounted for such possible factors as patient age (if 65 years or older), sex, race/ethnicity, and diagnosis group.

“A unique aspect of our study design compared with prior observational studies of ECT’s effects is that we used a quasi-experimental approach,” Slade and colleagues explained, “based on geographic, hospital, and insurance variation in access to inpatient treatment with ECT to minimize confounding from unmeasured patient-level characteristics that may affect both the likelihood of ECT treatment and study outcomes.”

A sample of 162,691 patients, with 2486 receiving ECT, were identified with a principal diagnosis of severe affective disorder (major depressive disorder, bipolar disorder, and schizoaffective). The treatment was infrequently used, but was also more common in private than public institutions, with private or Medicare insurance coverage, in white, non-Hispanic individuals, and in more affluent areas.

The risk for 30-day readmission for patients receiving ECT for severe affective disorder was approximately half that for patients who did not receive the treatment, with estimated rates of 6.6% and 12.3%, respectively. Although patients with major depressive disorder were more likely to receive ECT than those with bipolar or schizoaffective disorder, the latter 2 diagnostic groups had a greater reduction in risk of readmission. The effect of ECT was more prominent in men than women, but was not altered by age or race/ethnicity.

In an accompanying editorial, Harold Sackeim, PhD, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, pointed out that in addition to supporting the efficacy of ECT, the study is notable for highlighting the infrequent and inconsistent use of the procedure.

“Perhaps the most important contribution of this study is documentation of the extraordinarily low rate of ECT use and the demographic characteristics of those who receive it,” Sackeim commented. “Contrary to its portrayal as a treatment inflicted on the poor or destitute, ECT is disproportionately administered to those more well-off.”

The study was published online June 28 in JAMA Psychiatry.

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