Table 4.
Demographic and Clinical Characteristics by ≥ 5 ECT Claims Use Among Older Adults With Major Depressive Disorder Who Used ECTa
| Characteristic | < 5 ECT Claims (n = 1,390) | ≥ 5 ECT Claims (n = 2,736) | Bivariate Odds Ratio (95% CI)b |
|---|---|---|---|
| Setting of first ECT claim | |||
| Inpatient | 1,026 (73.8) | 1,898 (69.4) | Reference |
| Outpatient | 364 (26.2) | 838 (30.6) | 1.24 (1.08–1.44)*** |
| Age | |||
| 65–74 y | 819 (58.9) | 1,615 (59.0) | Reference |
| ≥ 75 y | 571 (41.1) | 1,121 (41.0) | 1.00 (0.87–1.14) |
| Sex | |||
| Male | 478 (34.4) | 935 (34.2) | Reference |
| Female | 912 (65.6) | 1,801 (58.8) | 1.01 (0.88–1.16) |
| Race/ethnicity | |||
| Non-Hispanic white | 1,278 (91.9) | 2,565 (93.8) | Reference |
| Non-Hispanic black | 52 (3.7) | 73 (2.7) | 0.70 (0.49–1.00) |
| Other | 44 (3.2) | 80 (2.9) | 0.91 (0.62–1.32) |
| Region | |||
| Northeast | 342 (24.6) | 922 (33.7) | Reference |
| Midwest | 387 (27.8) | 634 (23.2) | 0.61 (0.51–0.73)*** |
| South | 519 (37.3) | 827 (30.2) | 0.59 (0.50–0.70)*** |
| West | 141 (10.1) | 353 (12.9) | 0.93 (0.74–1.17) |
| Median household income | |||
| < $40,000 | 195 (14.0) | 353 (12.9) | Reference |
| $40,000–$59,999 | 539 (38.8) | 971 (35.5) | 1.00 (0.81–1.22) |
| ≥ $60,000 | 639 (46.0) | 1,373 (50.2) | 1.19 (0.97–1.45) |
| Service use: psychotherapy | |||
| Any service use | 740 (53.2) | 1,742 (63.7) | 1.53 (1.35–1.75)*** |
| Individual therapy | 703 (50.6) | 1,675 (61.2) | 1.54 (1.35–1.75)*** |
| Group/family | 110 (7.9) | 279 (10.2) | 1.32 (1.05–1.66)* |
| Other | 24 (1.7) | 66 (2.4) | 1.40 (0.88–2.25) |
| Service use: no. of outpatient visits | |||
| Any, mean ± SD | 124.9 ± 88.6 | 151.8 ± 89.7 | −0.30 (−0.37 to −0.24)c |
| Medical, mean ± SD | 80.1 ± 71.8 | 78.8 ± 68.8 | −0.02 (−0.05–0.08)c |
| Psychiatric, mean ± SD | 45.0 ± 40.1 | 73.0 ± 50.0 | −0.60 (−0.66 to −0.53)c |
| Service use: emergency department visit | |||
| Any | 979 (70.4) | 1,911 (70.0) | 0.97 (0.84–1.11) |
| Medical | 804 (57.8) | 1,514 (55.3) | 0.90 (0.79–1.03) |
| Psychiatric | 480 (34.5) | 1,085 (39.7) | 1.24 (1.09–1.42)** |
| Medications prescribed | |||
| Any psychotropics | 1,067 (76.8) | 2,097 (76.6) | 0.99 (0.85–1.16) |
| Antidepressants | 1,018 (73.2) | 2,027 (74.1) | 1.33 (0.92–1.91) |
| Antipsychotics | 852 (61.3) | 1,797 (65.7) | 1.49 (1.23–1.81)*** |
| Anxiolytics, sedative/hypnotics | 865 (62.2) | 1,717 (62.8) | 1.05 (0.87–1.26) |
| Mood stabilizers | 515 (37.1) | 995 (36.4) | 0.97 (0.83–1.12) |
| Lithium | 161 (11.6) | 349 (12.8) | 1.12 (0.92–1.37) |
| Stimulants | 140 (10.1) | 294 (10.8) | 1.08 (0.87–1.34) |
| Behavioral comorbidity | |||
| ADHD and other conduct disorders | 87 (6.3) | 203 (7.4) | 1.20 (0.93–1.56) |
| Anxiety disorder | 1,122 (80.7) | 2,279 (83.3) | 1.19 (1.01–1.41)* |
| Bipolar disorder | 695 (50.0) | 1,481 (54.1) | 1.18 (1.04–1.34)* |
| Posttraumatic stress disorder | 92 (6.6) | 186 (6.8) | 1.03 (0.79–1.33) |
| Schizophrenia | 615 (44.2) | 1,366 (49.9) | 1.26 (1.10–1.43)* |
| Personality disorder | 202 (14.5) | 437 (16.0) | 1.12 (0.93–1.34) |
| Traumatic brain injury and nonpsychotic mental disorders due to brain damage | 36 (2.6) | 71 (2.6) | 1.00 (0.67–1.50) |
| Alcohol use disorder | 115 (8.3) | 235 (8.6) | 1.04 (0.83–1.32) |
| Substance use disorder | 182 (13.1) | 360 (13.2) | 1.01 (0.83–1.22) |
| Tobacco use disorder | 219 (15.8) | 349 (12.8) | 0.78 (0.65–0.94)** |
| Modified Elixhauser index score, mean ± SD | 16.3 ± 11.9 | 16.2 ± 11.5 | −0.01 (−0.06–0.07)c |
a
Values expressed as n (%) unless otherwise noted. Data are from 2014 to 2015 Medicare claims files.
b
Statistical significance:
*
< .05
**
< .01
***
< .001.
c
Indicates Cohen d.
Abbreviations: ADHD = attention-deficit/hyperactivity disorder, ECT = electroconvulsive therapy.