Racial differences in the availability and use of electroconvulsive therapy for recurrent major depression

Health Services Research Program, Emma Pendleton Bradley Hospital, East Providence, RI 02915, United States.
Journal of Affective Disorders (Impact Factor: 3.38). 12/2011; 136(3):359-65. DOI: 10.1016/j.jad.2011.11.026
Source: PubMed


Black Americans with depression were less likely to receive electroconvulsive therapy (ECT) than whites during the 1970s and 80s. This pattern was commonly attributed to treatment of blacks in lower quality hospitals where ECT was unavailable. We investigated whether a racial difference in receiving ECT persists, and, if so, whether it arises from lesser ECT availability or from lesser ECT use within hospitals conducting the procedure.
Black or white inpatient stays for recurrent major depression from 1993 to 2007 (N=419,686) were drawn from an annual sample of US community hospital discharges. The marginal disparity ratio estimated adjusted racial differences in the probabilities of (1) admission to a hospital capable of conducting ECT (availability), and (2) ECT utilization if treated where ECT is conducted (use).
Across all hospitals, the probability of receiving ECT for depressed white inpatients (7.0%) greatly exceeded that for blacks (2.0%). Probability of ECT availability was slightly greater for whites than blacks (62.0% versus 57.8%), while probability of use was markedly greater (11.8% versus 3.9%). The white versus black marginal disparity ratio for ECT availability was 1.07 (95% confidence interval 1.06-1.07) and stable over the period, while the ratio for use fell from 3.2 (3.1-3.4) to 2.5 (2.4-2.7).
Depressed persons treated in outpatient settings or receive no care are excluded from analyses.
Depressed black inpatients continue to be far less likely than whites to receive ECT. The difference arises almost entirely from lesser use of ECT within hospitals where it is available.

Download full-text


Available from: Eugene M Laska, Oct 04, 2015
18 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Depression is highly prevalent and debilitating in late life. It affected 3.8 million older Americans in 2005, and its prevalence is expected to increase to 6.6 million in 2025. Despite its prevalence and associated negative health outcomes, depression is not diagnosed and treated equally among older Americans. An under-recognition and under-treatment of depression in minority elders exists, which has lead to significant disparities between Whites and non-Whites. These disparities challenge our principles of equality, equity and adequacy and, in their most extreme form, become human rights issues. As a result, eliminating health disparities has become a priority of the US Federal government. Practitioners must address differences in the diagnosis and treatment of depression among clients served. Increased levels of cultural competency and educating clients will help reconcile differences between clinicians and their patients and lead to increased understanding of client needs, while decreasing disparities in depression care and diagnosis.
    03/2013; 2(1). DOI:10.1007/s13670-012-0036-z
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Depression is a common, disabling, and costly condition encountered in older patients. Effective strategies for detection and treatment of late-life depression are summarized based on a case of a 69-year-old woman who struggled with prolonged depression. Clinicians should screen older patients for depression using a standard rating scale, initiate treatment such as antidepressant medications or evidence-based psychotherapy, and monitor depression symptoms. Patients who are not improving should be considered for psychiatric consultation and treatment changes including electroconvulsive therapy. Several changes in treatment approaches are usually needed before patients achieve complete remission. Maintenance treatment and relapse-prevention planning (summarization of early warning signs for depression, maintenance treatments such as medications, and other strategies to reduce the risk of relapse [eg, regular physical activity or pleasant activities]) can reduce the risk of relapse. Collaborative programs, in which primary care clinicians work closely with mental health specialists following a measurement-based treatment-to-target approach, are significantly more effective than typical primary care treatment.
    JAMA The Journal of the American Medical Association 09/2012; 308(9):909-18. DOI:10.1001/2012.jama.10690 · 35.29 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Minimal research has been done on sociodemographic differences in utilization of electroconvulsive therapy (ECT) for refractory depression, especially among Asian Americans and Pacific Islanders. This study examined sociodemographic and diagnostic variables using retrospective data from Hawaii, an island state with predominantly Asian Americans and Pacific Islanders. Retrospective data were obtained from an inpatient and outpatient database of ECT patients from 2008 to 2010 at a tertiary care community hospital on O'ahu, Hawaii. There was a significant increase in overall ECT utilization from 2008 to 2009, with utilization remaining stable from 2009 to 2010. European Americans (41%) and Japanese Americans (29%) have relatively higher rates of receiving ECT, and Filipino Americans and Native Hawaiians have relatively lower rates in comparison with their population demographics. Japanese Americans received significantly more ECT procedures than European Americans. Electroconvulsive therapy is underutilized by certain sociodemographic groups that may benefit most from the treatment. There are significant differences in ECT usage based on ethnicity. Such differences may be related to help-seeking behavior, economic differences, and/or attitudes regarding mental illness. Further research is needed to elucidate the reasons for differences in utilization.
    The journal of ECT 09/2013; 30(1). DOI:10.1097/YCT.0000000000000075 · 1.39 Impact Factor
Show more