Electroconvulsive therapy in Sweden: greater equality between the sexes

In some countries it has long been the custom to find women over-represented in electroconvulsive therapy (ECT) statistics. Such countries include the United States, Canada, Australia, New Zealand, the United Kingdom. Here are a few examples of statistics from these countries:

  • In Ontario, Canada, between 1992 and 2004, the ratio of women to men amongst ECT patients fluctuated between 1.6:1 and 2.1:1 [that is, between 62 and 68 per cent of ECT patients were women] (MJ Rapoport, M Mamdani, and N Herrman 2006 Electroconvulsive therapy in older adults: 13-year trends. Canadian Journal of Psychiatry, 51: 616-19)
  • In Texas in the United States in 2010-2011, 69 per cent of ECT patients were women (statistics published on the website of the Texas Department of State Health Services)
  • In Victoria, Australia, in 2009-10, 68 per of ECT patients were women (statistics from the Chief Psychiatrist’s annual report)
  • In Scotland, in 2010, 68 per cent of ECT patients were women (statistics from the Scottish ECT Accreditation Network annual report)

Psychiatrists generally show little curiosity regarding this gender imbalance. Typical comments are: “This reflects the relative proportions of women and men being treated for depressive illness” (Scottish ECT Accreditation Network’s annual report – with no statistics to support this assertion); and “This finding remains consistent with previous years and international findings on ECT usage patterns by gender” (Ruth Vine, in the Victoria Chief Psychiatrist’s annual report – presumably meaning findings in other Western countries, as in the rest of the world a different picture emerges with the sexes more evenly balanced or men outnumbering women amongst those undergoing ECT).

So it was interesting to see statistics from Sweden with a smaller difference between the numbers of women and men receiving ECT. A study by Axel Nordenskjöld and colleagues (Predictors of time to relapse/recurrence after electroconvulsive therapy in patients with major depressive disorder: a population-based cohort study. Depression Research and Treatment, 2011) looked at people treated for depression with ECT in seven hospitals in central Sweden and found that 56.5 per cent of them were women – a lower percentage than usual in Western countries.  The mean age of patients was 55 years. Another interesting difference with other Western countries was the percentage patients treated with unilateral ECT. Only 12 per cent of courses of ECT involved bilateral electrode placement, whereas in many countries bilateral electrode placement is still used in the majority of courses. In Scotland for example in 2010, 94 per cent involved bilateral treatment. The authors also gave the average mean dose at the last unilateral treatment: it was 429 millicoulombs, with an average current of 833 milliamps and duration of 7.5 seconds.

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8 Responses to Electroconvulsive therapy in Sweden: greater equality between the sexes

  1. markps2 says:

    I believe more women are diagnosed with depression than men. http://www.medscape.com/viewarticle/471577, so this does explain the statistically higher number of women “receiving” E.C.T..
    I am more interested in how many die from E.C.T. . Is it 1 in 200 , or 1 in 1000?
    When over the age of 60, I read there is a 1 in 200 chance.
    Quebec, Canada reportedly has more than 6, 000 E.C.T. performed a year. Using the 6,000 number, a minimum of (6) six people , were killed by their doctors (paid by medicare tax dollars), rather than dying from their own suicidal hand.

    • ectstatistics says:

      I am not registered with medscape so I can’t see what the article is. Can you give us a summary? I agree that women are more likely to be diagnosed with depression than men, and more likely to be admitted to hospital for treatment of depression. What I would query though, is whether the difference in hospital admissions is enough to entirely account for the ECT differences. If, for example, you have a women/men 55/45 ratio in hospital admissions and a 70/30 ECT ratio then that means that a woman admitted to hospital with a diagnosis of depression is more likely to be given ECT than a man admitted to hospital with a diagnosis of depression, and then you have a problem. Well, not necessarily a problem, but at least something that needs investigating.
      Thanks for the link to the Canadian magazine. Those Quebec statistics – that must be 6,000 individual treatments (rather than people)?

  2. Mark p.s.2 says:

    For the over 6000 figure in Quebec , Canada look at page 12 of http://www.actionautonomie.qc.ca/pdf/vol18n1i.pdf

  3. ectstatistics says:

    I think 6,000 treatments would probably equate to between 600 and 1,000 people but that is only a guess. As for deaths I think it is impossible to say. Texas is one of the few places where psychiatrists are required to report deaths. You can see from the article abstract here
    http://www.ncbi.nlm.nih.gov/pubmed/11474057 the numbers of people who died within 2 weeks of ECT and the numbers of people where the authors of the article thought there might be a link with ECT.

    • markps2 says:

      Hello again.
      I found two other articles saying E.C.T. is risky.
      “not a low-risk procedure” 51 out of 75 patient had trouble

      If I put a second html link, I think my comment will be blocked
      2010 Oct-Dec;19(4):333-47.
      The effectiveness of electroconvulsive therapy: a literature review.
      Read J, Bentall R.
      Department of Psychology, University of Auckland, New Zeland
      “the cost-benefit analysis for ECT is so poor that its use cannot be scientifically justified.”

      Do you have an email I can write to? Otherwise I will put a link to a page to the statistics in Quebec Canada for the years 2003, 2006, 2010. in a day or two.

      The number of women given E.C.T. are double that of males.
      It has age groups, and exact numbers. But deaths and complications are not listed.

  4. markps2 says:

    I have a copy of the statistics from Quebec, Canada for the years 2003, 2006 and 2010.

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