Sociodemographic Patterns of Electroconvulsive Therapy Referral and Utilization in a Tertiary Health Care Facility.

Objective: Despite electroconvulsive therapy's (ECT) proven effectiveness in various psychiatric conditions, ECT referral and utilization remains suboptimal. This study sought to examine the pattern of ECT referral and utilization at a tertiary care center and to assess factors contributing to the underutilization of ECT.

Methods: This retrospective study examined patients referred to ECT at this facility from 2022-2023 (N = 76, ≥18 y/o) with demographic data obtained from the electronic medical record.

Results: Seventy-six patients were referred for ECT, with 35 receiving treatments. The treated group had a slightly younger mean age (45.5 vs 46.2 years). Gender distribution varied, with more males receiving ECT (54.3%) and more females declining (70.7%). Whites were the majority in both groups, but Blacks were less likely to receive ECT (14 not treated vs 4 treated), while Hispanics were more likely to be treated (2 not treated vs 7 treated). Declining ECT was more frequent among Whites (61.9%) and Blacks (33.3%), while transportation and logistical issues affected various racial groups with the highest impact on Blacks (42.9%). Major depressive disorder was the primary diagnosis, evenly distributed between treated and nontreated patients. In comparison to state data, Blacks and Asians showed a higher representation among the treatment group with those treated with ECT, 11.4% versus 6.7% and 5.7% versus 3.5%, respectively.

Conclusions: ECT remains underutilized among minority racial/ethnic groups. Factors contributing to this pattern include referral, patient preference, and/or other specific situations that need to be addressed to reduce disparities.