Table 1.
Demographic and Clinical Characteristics by ECT Use Among Older Medicare Beneficiaries With Depressiona
| Characteristic | ECT User (n = 7,817) | Non–ECT User (n = 473,426) | Bivariate Odds Ratio or Cohen d (95% CI) |
|---|---|---|---|
| Age | |||
| 65–74 y | 4,382 (56.1) | 231,974 (49.0) | Reference |
| ≥ 75 y | 3,435 (43.9) | 241,452 (51.0) | 0.75 (0.72–0.79) |
| Sex | |||
| Male | 2,603 (33.3) | 138,578 (29.3) | Reference |
| Female | 5,214 (66.7) | 334,848 (70.7) | 0.83 (0.79–0.87) |
| Race/ethnicity | |||
| Non-Hispanic white | 7,271 (93.0) | 423,963 (89.6) | Reference |
| Non-Hispanic black | 247 (3.2) | 26,637 (5.6) | 0.54 (0.48–0.61) |
| Other | 235 (3.0) | 19,972 (4.2) | 0.69 (0.60–0.78) |
| Region | |||
| Northeast | 2,479 (31.7) | 94,737 (20.1) | Reference |
| Midwest | 1,956 (25.0) | 106,855 (22.6) | 0.70 (0.66–0.74) |
| South | 2,468 (31.5) | 190,095 (40.2) | 0.50 (0.47–0.52) |
| West | 909 (11.6) | 80,470 (17.0) | 0.43 (0.40–0.47) |
| Median household income | |||
| < $40,000 | 1,064 (13.6) | 99,065 (20.9) | Reference |
| $40,000–$59,999 | 2,909 (37.2) | 197,344 (41.7) | 1.37 (1.28–1.47) |
| ≥ $60,000 | 3,739 (47.8) | 168,683 (35.6) | 2.06 (1.93–2.21) |
| Service use: psychotherapy | |||
| Any service use | 4,373 (55.9) | 99,802 (21.1) | 4.73 (4.52–4.95) |
| Individual therapy | 4,189 (53.6) | 98,400 (20.8) | 4.38 (4.18–4.58) |
| Group/family | 701 (9.0) | 6,535 (1.4) | 7.01 (6.46–7.60) |
| Other | 138 (1.8) | 769 (0.2) | 10.99 (9.16–13.20) |
| Service use: no. of outpatient visits | |||
| Any, mean ± SD | 143.6 ± 96.6 | 92.0 ± 89.5 | 0.57 (0.55–0.60) |
| Medical, mean ± SD | 77.5 ± 72.1 | 82.7 ± 83.5 | −0.06 (−0.08 to −0.04) |
| Psychiatric, mean ± SD | 66.2 ± 55.3 | 9.8 ± 21.1 | 2.55 (2.53–2.58) |
| Service use: emergency department visit | |||
| Any | 5,139 (65.7) | 236,847 (50.0) | 1.90 (1.81–1.99) |
| Medical | 4,164 (53.3) | 229,296 (48.4) | 1.20 (1.15–1.26) |
| Psychiatric | 2,642 (33.8) | 28,696 (6.1) | 7.87 (7.50–8.26) |
| Medications prescribed | |||
| Any psychotropics | 6,014 (76.9) | 345,742 (73.0) | 1.23 (1.17–1.30) |
| Antidepressants | 5,699 (72.9) | 323,392 (68.3) | 1.55 (1.38–1.73) |
| Antipsychotics | 4,935 (63.1) | 89,918 (19.0) | 13.20 (12.35–14.10) |
| Anxiolytics, sedative/hypnotics | 4,692 (60.0) | 206,764 (43.7) | 2.47 (2.33–2.63) |
| Mood stabilizers | 2,733 (35.0) | 112,611 (23.8) | 1.76 (1.68–1.86) |
| Lithium | 902 (11.5) | 2,824 (0.6) | 21.77 (20.10–23.58) |
| Stimulants | 731 (9.4) | 8,597 (1.8) | 5.52 (5.09–5.98) |
| Behavioral comorbidity | |||
| ADHD and other conduct disorders | 543 (7.0) | 11,879 (2.5) | 2.90 (2.65–3.17) |
| Anxiety disorder | 6,287 (80.4) | 245,402 (51.8) | 3.82 (3.61–4.04) |
| Bipolar disorder | 4,309 (55.1) | 47,724 (10.1) | 10.96 (10.47–11.47) |
| Posttraumatic stress disorder | 495 (6.3) | 11,586 (2.5) | 2.69 (2.46–2.96) |
| Schizophrenia | 3,751 (48.0) | 68,498 (14.5) | 5.45 (5.21–5.71) |
| Personality disorder | 1,254 (16.0) | 13,544 (2.9) | 6.49 (6.09–6.91) |
| Traumatic brain injury and nonpsychotic mental disorders due to brain damage | 193 (2.5) | 8,359 (1.8) | 1.41 (1.22–1.63) |
| Alcohol use disorder | 619 (7.9) | 22,354 (4.7) | 1.74 (1.60–1.89) |
| Substance use disorder | 971 (12.4) | 29,781 (6.3) | 2.11 (1.97–2.26) |
| Tobacco use disorder | 1,025 (13.1) | 57,602 (12.2) | 1.09 (1.02–1.16) |
| Modified Elixhauser index score, mean ± SD | 16.0 ± 11.7 | 14.8 ± 12.9 | 0.09 (0.07–0.12) |
a
Values expressed as n (%) unless otherwise noted. Data were from 2014 to 2015 Medicare claims files.
Abbreviations: ADHD = attention-deficit/hyperactivity disorder, ECT = electroconvulsive therapy.