Table C3.
North and Latin America, N= 12.
| Country | Reference | Study | Demographics | Other data | Rate* | Technical parameters |
|---|---|---|---|---|---|---|
| Land (L) | First autdor (reference) | Study design | Diagnoses | Side effects | TRP* | Modified/Unmodified |
| Region (R) | N | Indication | Outcome | EAR* | Anesthesia | |
| City (C) | Date | Gender | Conditions | iP* | Devices | |
| Hospital (H) | Time span | Age | Training | AvE* | Current type | |
| Ethnicity | Guidelines | Electrode placement | ||||
| Legal regulations | C-ECT** | Dosage | ||||
| Other | A-ECT** | (Monitoring) | ||||
| USA (L) | Hermann RC (Hermann et al. 1995) | Study: Survey data, American Psychiatric association (APA)'s Professional Activities Survey Date: 1988–1989 Time span: One year | Indication (main): depression Gender: No information Age: Not reported, except proportion of residents >60 years stated not significantly related to utilization rate | Other: 6% of psychiatrists administered ECT to at least one patient during the last month Large variability. ECT use higher in middle and upper classes | TPR: 0.4–81.2 TPR Nationwide: 4.9 | No information |
| USA (L) | Prudic J (Prudic et al. 2001) | Study: Postal questionnaire survey in tri-state New York City metropolitan region to all Directors of Psychiatric Services with inpatient mental health beds. N= 156 facilities N= 86 of 156 (55%) provided ECT N= 59 of 86 responded (response rate 69%). No. of patients annually receiving ECT: Range 1–288 No. of patients ECT treated per year census reported by facilities: <15 patients by 21 facilities >100 patients by nine facilities Date:1997 Time span: One year | Indication (main): >85% medication resistant depression (major depression) then mania and schizophrenia next most common Gender: No information Age, year groups: 45%, 18–60 55%, >60 (0%, <13) | Side effects: 46% post ECT cognitive impairment and cognitive evaluation usually undertaken in 80% Treatment setting: 85% inpatient 14% outpatients Outcome: 23% relapse rate of illness Guidelines: APA guidelines not entirely followed | AvE: 8 | Modified Anesthetic agents: 59% methohexital 36% sodium pentothal 31% propofol Type: 2% sine wave Placement: 79% BL 21% UL Dose: 18% dosing strategy 30% fixed (formula-based) 55% titration Monitoring: All used EKG, pulse oximetry and vital sign monitoring. 14% EEG monitoring not used. 53% cuff technique not used |
| Latin America and the Caribbean (L) | Levav I (Levav and Gonzalez 1996) | Study: Postal questionnaire survey to directors responsible for mental health programs and/or psychiatric hospitals N= 19 Latin America countries, 17 (89%) responded and two partially. N= 12 Caribbean, only four (30%) provided ECT Date: 1995 Time span: One year | No information | Comment: Haiti not included among the Caribbean territories Unknown country names of included in Latin America. Public hospitals use ECT more frequent than private Trend away from use of ECT reported in eight Latin American countries and in two most populated English-speaking Caribbean Guidelines: In four Caribbean countries, but only in 10 out of 19 Latin American Conditions: Informed consent (Latin America): 37% always 26% sometimes 26% never 11% no data | No information | Unmodified and modified: 26% Latin America unmodified One of four Caribbean used modified |
| California, USA (R) | Kramer BA (Kramer 1999) | Study: Retrospective chart review of ECT required reports by Welfare and Institutions Code, from state department of health ECT-treated patients: N= 2671 (1990) N= 2251 (1991) N= 2356 (1992) N= 2636 (1993) N= 2529 (1994) ECT facilities providing ECT: N= 81 (1990) N= 80 (1991) N= 71 (1992) N= 70 (1993) N= 69 (1994) Date: 1984–1994 Time span: 11 years | Diagnoses: No information Gender (1994): 69% women Ethnicity (1994): 91% Anglo-American 4% Hispanic 2% African-American | Adverse events: 0.2 deaths/10,000 11 cardiac arrests nine fractures Conditions: 2.4–3.4% involuntary (in period 1990–1994) Other: Mandatory report of death if within 24 h after ECT treatment Increased ECT use with age Decrease in facilities providing ECT. Less than 6% ECT treatment in public hospitals | TPR: 0.9 (1990) 0.7 (1991) 0.8 (1992) 0.8 (1993) 0.8 (1994) TPR by age in years (1994): 0.001 <18 0.1 18–24 0.5 25–44 1.2 45–65 3.8 >65 AvE: 5. | No information |
| Texas, USA (R) | Scarano VR (Scarano et al. 2000) | Study: Retrospective chart review. N= approximately 5971 ECT-treated patients N= 41,660 ECT administrations Date: 1993–1997 Time span: Four years | Diagnoses: 82% depression 6% schizoaffective 10% bipolar/mania 2% schizophrenia Gender: 69% women 31% male Ethnicity: 87% Anglo-American 9% Hispanic 3% African American Age, year groups*: 0.7%, 16–20 37.4%, 21–50 53.7%, 51–80 8.2%, >80 | Conditions: 98% voluntary 2% consent by legal guardian. Adverse events (within two weeks after ECT): Five unexpected apnea, one fracture, 25 deaths [two week mortality rate 14 deaths per 100,000 treatments] Outcome: 61% completed ECT treatment series Other: Report of memory impairment by physicians, no rating instruments | AvE: 7 | Placement: 76% BL 16% UL 8% mixed |
| *[Correction added after first online publication on 20 March 2012: The “Age, year groups” for Texas, USA (R) was earlier missing from the article.] | ||||||
| Texas, USA (R) | Reid WH (Reid et al. 1998) | Study: Retrospective chart review. N= 2583 mandatory reports (describing a patient treatment with an index series), approximately. N= 15,240 ECT treatments administered in 50 hospitals (Representing 33% of all psychiatric units in Texas). Date: September 1993 to April 1995 Time span: One year + seven months (19 months) | Diagnoses (approximately): 90% severe mood disorder (some manic), 10% schizoaffective, schizophrenia, or related diagnoses 2% organic affective syndrome, mood disorder due to a general medical condition, or dementia Gender: 70% women Age, year groups: 0.2%, 16–17 2%, 18–24 24%, 25–44 25%, 45–64 48%, >64 Ethnicity: 88% Caucasian 8% Hispanic 3% Black 1% Other | Conditions: 1% involuntary guardian consent Adverse events (within two weeks after ECT): Eight deaths (two possibly anesthesia related complications) Other: 6% of institutions performed ECT during the study period Legal regulations: Since 1993 mandatory ECT reporting to Department of Mental Health and Mental Retardation in Texas. ECT not allowed to persons <16 years. Funding: 57% public third party payment source (including Medicare) | AvE: 5 [excluding maintenance ECT] | Placement: 73% BL 19% UL 8% Mixed |
| USA (Medicare) (R) | Rosenbach ML (Rosenbach et al. 1997) | Study: Retrospective chart review of ECT-treated Medicare enrollees. N= 15,560 (1992) [N= 12,000 (1987)] Date: 1987–1989 and 1990–1992 Time span: Two, one-year time periods | Diagnoses (1992): 80% affective disorder 9% schizophrenia Gender (1992): 66% women Ethnicity (1992): >90% Caucasian | Treatment setting (1992): 75% inpatients 11% outpatients 14% both Other: Mean no. of ECT treatment length of stay days: 57.1 Comments: Increase in rate of ECT use 1987–1992. Increasing use among women, Caucasian, and disabled. Substantial geographic treatment variation from West to Northeast in United States, an increase in outpatient ECT use | TPR (TPR in Medicare population): 5.1 (1992) [4.2 (1987)] TPR (1992) by gender: 5.7 women 3.6 men TPR (1992) by age, year groups: 16.2, <45 6.4, 45–65 4.2, >65 TPR (1992) for disabled <65 years: 9.2 TPR (1992) by region: 6.1, Northeast 4.1, South 5.4, North Central 3.8, West TPR (1992) by location: 3.2, rural 4.8, small urban 6.0, large urban AvE: 8 AvE (in both inpatient and outpatient setting): 13 | No information |
| North Carolina, USA (R) | Creed P (Creed et al. 1995) | Study: Postal and telephone survey to all 169 hospitals in region, with 54 having psychiatric units. Structured questionnaire to those providing ECT N= 24 (14%, out of 169 hospitals and 44% out of 54 psychiatric units) Date: September 1992 to August 1993 Time span: One years | Patient demographic data: No information | Training: 55% provided on-the-job training for ECT nursing staff Other: No. of physicians at each facility administering ECT, Range 1–6 Resident physicians administering ECT in 25% of facilities | Estimated rate data: No. of combined inpatient and outpatient ECT treatments per year: Range <100 to >1,300 | Devices: Unclear, report of only use of recommended ECT machines Monitoring: 75% use combination of EEG and cuffed distal limb |
| Louisiana, USA (Medicare) (C) | Westphal JR (Westphal et al. 1997) | Study: Retrospective chart review of elderly (≥65 years) ECT treated in Louisiana Medicare population. N= 218 ECT administrations in ≥65 years Medicare population Date: 1993 and 1994 Time span: Two years | Age, age groups ≥65 years: 54%, 65–74 37%, 75–84 8%, ≥85 Gender: 79% women Ethnicity: 89% Caucasian 7% Black 4% Other | Comment: Within Louisiana variability in rates between urban parishes, TPR 2.8 versus rural TPR 1.9 was nonsignificant—but significant nonrandom variation found when comparing treatment for major depression and inpatient ECT | TPR (Medicare population ≥65 years): 2.38 [TPR rural parishes: 1.9 TPR urban parishes: 2.8] | No information |
| North Carolina, USA (H) | McCall WV (McCall et al. 1992) | Study: State hospital survey of all patients referred for ECT N= 82 ECT-treated patients Date: 1989 to 1991 Time span: Two years | Diagnoses: 73% of depressed patients receiving ECT were women, constituted 52% of all patients with severe depression Gender: Percent women among ECT patients by diagnoses: 73% major depression 58% bipolar, manic 68% schizoaffective 16% schizophrenia Percent men among ECT patients by diagnoses: 27% major depression 42% bipolar, manic 32% schizoaffective 84% schizophrenia Age mean (SD) years: 44.3 (15) Range 19–75 50.9 (15.1) for depression 38.4 (13.2) for mania, schizophrenia, and schizoaffective | Conditions: 29% treatment by guardian consent Other: ECT given to patients with schizophrenia, mania, or schizoaffective disorder younger than those with depression | iP: 1.3% C-ECT: 5% (Given to four patients: three women, one man) | Modified Device: MECTA SR1 constant current device. Placement: No information |
| South West Pennsylvania, State Hospital, USA (H) | Sylvester AP (Sylvester et al. 2000) | Study: Retrospective chart review of all receiving ECT, in one state hospital giving psychiatric services to South West Pennsylvania. N= 21 ECT-treated patients in 10 year period (charts available for 17 patients) Date: 1986–1995 Time span: 10 years | Diagnoses: 47% major depression 25% bipolar 29% schizoaffective, schizophrenia Indications: Suicidal ideation or passive death wish Refusal of oral food intake Weight loss, daily life disability, and poor hygiene. Disorganized psychotic, aggressive behavior Gender: 71% women Age, 59% >60 years Range: 28–78 years Ethnicity: 94% Caucasian | Conditions: All on civil commitment and nine (53%) patients judged incompetent of consent Other: 59% of ECT treated >60 years and only 46% of all admitted patients female. Ten (58%) patients had documented previous ECT | iP: 0.4% AvE: 12 | Devices: Until 1991, MECTA-D After 1991 MECTA-SRI Type and dosage: Brief pulse, square wave, and constant current stimuli dose |
| Rio de Janeiro, Brazil (H) | Pastore DL (Pastore et al. 2008) | Study: Medical record survey of ECT-treated patients at federal psychiatric university hospital. N= 69 ECT-treated patients Date: June 2005 to June 2007 Time span: Two years | Diagnoses: 49% schizophrenia 29% bipolar/mania 16% depression 6% other Indication: Violence, suicidal attempts, self injury Gender: 71% women Age, mean 41.3 years | Side effects: Most common (reported as mild and transient): Anterograde amnesia, disorientation, headache. Rare: Myalgia, nausea, fatigue. No deaths. Other: Clonidine given to hypertensive patients | AvE: 8 | Modified Anesthesia: Alfentanil or propofol and succinylcholine muscle relaxant Device: EMAI trademark Placement: BL |
*
TPR: treated person rate = persons ECT treated per 10,000 resident population per year.
*
EAR: ECT administration rate = no. of ECTs administered per 10,000 resident population.
*
iP: inpatient prevalence = proportion (percent,%) ECT treated among inpatient population.
*
AvE: average number of ECTs administered per patient (in a session or course).
**
C-ECT: continuation-ECT.
**
A-ECT: ambulatory-ECT.