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.