Electroconvulsive Therapy at a Veterans Health Administration Medical Center

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Abstract

Objectives

Little epidemiologic research has examined the practice of electroconvulsive therapy (ECT). We investigated sociodemographic and clinical characteristics, service use, and psychotropic medication prescription patterns associated with ECT use at a Veterans Health Administration Medical Center.

Methods

Among veterans receiving specialty mental health services, we compared those who received ECT with those who did not using bivariate χ2 and t tests and multivariate logistic regression.

Results

In fiscal year 2012, 11,117 veterans received specialty mental health services, of whom 50 received ECT (0.45%) in FY2012 or FY2013. Those who received ECT were more likely to be diagnosed with major depressive or bipolar disorders and had substantially higher levels of mental health service usage (Cohen d > 0.75) and psychotropic prescription fills, including antidepressants (Cohen d = 2.66), antipsychotics (Cohen d = 2.15), lithium (Cohen d = 1.34), mood stabilizers (Cohen d = 1.30), and anxiolytic/sedative/hypnotics (Cohen d = 1.34).

Conclusions

Our findings suggest that ECT is used as a treatment of last resort, although available evidence and guidelines recommend wider use.

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