期刊
CANADIAN JOURNAL OF PSYCHIATRY-REVUE CANADIENNE DE PSYCHIATRIE
卷 66, 期 2, 页码 147-158出版社
SAGE PUBLICATIONS INC
DOI: 10.1177/0706743720935647
关键词
electroconvulsive therapy; major depressive disorder; bipolar disorder; observational study; regression analysis
类别
资金
- ICES - Ontario Ministry of Health and Long-Term Care (MOHLTC)
- University of Toronto Department of Psychiatry Clinician Scientist Program Norris Scholar Award
- Canadian Institute for Health Research Fellowship Award
- Canadian Institutes of Health Research (CIHR)
- National Institutes of Health-US (NIH)
- Weston Brain Institute
- Brain Canada
- Temerty Family through the CAMH Foundation
- Campbell Research Institute
- Brainsway Ltd.
- Canada Research Chair in Drug Policy Research Evaluation
- Brainsway Inc
- Magventure Inc.
- National Institutes of Mental Health (NIMH)
- Temerty Family
- Grant Family
- Centre for Addiction and Mental Health (CAMH) Foundation
- Campbell Institute
- New Investigator Award from the Canadian Institutes of Health Research
- Department of Anesthesia at the University of Toronto
- Endowed Chair in Translational Anesthesiology Research at St. Michael's Hospital
- University of Toronto
- Women's College Hospital
- University of Toronto Department of Psychiatry
- Canadian Institutes for Health Research
Factors such as age, marital status, education level, neighborhood income, and illness polarity are associated with the likelihood of receiving inpatient electroconvulsive therapy (ECT) for depression. Many clinical factors regarding the receipt of inpatient ECT are in line with clinical guidelines, but nonclinical factors impacting its use should be further investigated for equitable access to ECT.
Objective: A variety of patient characteristics drive the use of electroconvulsive therapy (ECT) in depression. However, the extent to which each characteristic influences the receipt of ECT, and whether they are appropriate, is unknown. The aim of this study is to identify patient-level characteristics associated with receiving inpatient ECT for depression. Method: We identified all psychiatric inpatients with a major depressive episode admitted to hospital >= 3 days in Ontario, Canada (2009 to 2017). The association between patient-level characteristics at admission and receipt of inpatient ECT was determined using logistic regression, where a generalized estimating equations approach accounted for repeat admissions. Results: The cohort included 53,174 inpatients experiencing 75,429 admissions, with 6,899 admissions involving ECT (9.2%). Among demographic factors, age was most associated with ECT-younger adults had reduced (OR = 0.30, 95%CI, 0.24 to 0.37; 18 to 25 years) while older adults had increased (OR = 3.08, 95%CI, 2.41 to 3.93; 85+ years) odds compared to middle-aged adults (46 to 55 years). The likelihood of ECT was greater for individuals who were married/partnered, had postsecondary education, and resided in the highest neighborhood income quintile. Among clinical factors, illness polarity was most associated with receiving ECT-bipolar depression had reduced odds of receiving ECT (OR = 0.62, 95%CI, 0.57 to 0.69) The likelihood of receiving ECT was greater in psychotic depression, more depressive symptoms, and incapable to consent to treatment and was reduced with comorbid substance use disorders and several medical comorbidities. Conclusions: Nearly 1 in 10 admissions for depression in Ontario, Canada, involve ECT. Many clinical factors associated with receiving inpatient ECT were concordant with clinical guidelines; however, nonclinical factors associated with its use warrant investigation of their impact on equitable access to ECT.
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