Temporal Variations in Access: Investigating Time-to-Electroconvulsive Therapy (ECT) Utilization Among Inpatients Using the National Inpatient Sample.

Abstract

Objectives: This study examined temporal trends and sociodemographic variations in time-to-electroconvulsive therapy (ECT) administration among inpatients with psychiatric conditions for which ECT is indicated.

Methods: We conducted a retrospective analysis using the National Inpatient Sample database from 2016 to 2021. Hospitalizations of adults with a primary diagnosis of major depressive disorder, bipolar disorder, schizoaffective disorder, noncatatonic schizophrenia, or catatonia who received ECT were included. Outcomes assessed included time to first ECT session, hospitalization length, discharge disposition, costs, and complications. Mixed-effects negative binomial regression was used to evaluate differences in time-to-ECT by age, biological sex, primary insurance, income quartile, and health-related social needs.

Results: From 2016 to 2021, ECT-utilizing hospitalizations declined, while the time to first ECT session increased by 24.6% from 7.3 days in 2016 to 9.1 days in 2021. Delays were longest for noncatatonic schizophrenia and catatonia. Sociodemographic variations included significantly longer wait times for Blacks and Hispanics, Medicaid beneficiaries, and those with housing insecurity or unemployment. Hospitalizations that included older patients experienced longer delays, whereas rural hospitals reported shorter wait times.

Conclusions: Significant delays in ECT administration exist, particularly for vulnerable populations and less common indications. These findings underscore the need for interventions to address systemic barriers and improve equitable access to timely ECT.