OBJECTIVE: The objective was to analyze nationally representative data
from the National Institute of Mental Health (NIMH) to update trends in the
use of ECT in the United States. METHOD: The data are estimates from the
NIMH Sample Survey Program for 1975, 1980, and 1986, which include
representative samples of inpatients in psychiatric facilities in the
United States. The authors' analyses use trend data from public general
hospitals, private general hospitals, private psychiatric hospitals, and
state and county mental hospitals. They report on 126,739 patients who
received ECT in 1975, 1980, and 1986, focusing on data from 1980 and 1986.
RESULTS: In 1986, 36,558 patients received ECT. This represents a decrease
from the 1975 figure (58,667 patients) but no change from 1980 (31,514
patients). ECT was used primarily in private general hospitals (64%) and
private psychiatric hospitals and much less often in public general
hospitals and state and county mental hospitals. In 1986 over 90% of ECT
recipients were white, and 84% had an affective disorder diagnosis.
Although 71% of the patients who received ECT were women, hospital type and
age were more important than gender in predicting ECT use. Individuals 65
years of age and older received ECT out of proportion to their numbers in
inpatient care. CONCLUSIONS: The declining use of ECT in the United States
ended in the 1980s. Few African Americans receive ECT, and its use is
becoming more targeted toward patients with affective disorders. The amount
of services research done on this modality is very small. Basic questions
have yet to be answered, including who refers patients for ECT and why, and
how ECT fits into the overall course of treatment.