ECT and demography in Scotland

The Scottish ECT Accreditation Network (SEAN) published their annual report in October. During 2009, 390 patients received 483 courses of electroconvulsive therapy (ECT) in Scotland. In addition there were a few courses that didn’t find their way into the statistics. After decades of declining use, ECT in Scotland has risen by about 9 per cent. The report says that most health boards saw a slight decrease in use, which means that one or two health boards were responsible for the increase, but they don’t tell us which ones.

ECT provision is governed by clinical need and appears to make no distinction on demographic grounds“, the report says. They then give figures which contradict this claim: 69 per cent of patients were women (more women than men are, as the report says, treated for depression but not quite in these proportions); no-one under the age of 20 has received ECT since 2005.

Ten years ago the Clinical Resource and Audit group published some more detailed information on the demographics of ECT (CRAG 2000 National audit of electroconvulsive therapy in Scotland). At that time ECT was used on about 1200 people a year in Scotland, more than twice as many as in 2009. The ratio of women to men was more than two to one, while the ratio of women to men admitted to hospital with depression was 1.6 to 1. Information on the numbers of depressed patients in different age groups receiving ECT were given, and showed patients over the age of 45 more than twice as likely as those under 45 to be given ECT.

Age group    No. of ECT courses per 100 depressed inpatients

15-24           3.4

25-44           4.8

45-64         11.6

65-74         13.6

75+             12.7

Since those figures were published, the average age of ECT patients in Scotland has risen by a few years, so the differences are unlikely to have evened out.

Clinical need is only part of it: demographic factors appear to play a significant role in the use of ECT. Why are they not investigated?

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