ECT and gender in Scotland

The latest issue of The Psychiatrist (the journal of the Royal College of Psychiatrists) contains an article by Fiona Martin and Tim Elworthy with the title “Scottish psychiatrists’ attitudes to electroconvulsive therapy: survey analysis”.

Psychiatrists in Scotland were sent a questionnaire in 2009 asking them to estimate how many times they had prescribed ECT over the past two years. The mean number of times psychiatrists said they had prescribed ECT over this period was twice; about a third of them had not prescribed it at all. This latter figure seems quite high, but I couldn’t work out if the survey only included those psychiatrists who might be expected to prescribe ECT, that is those of a high enough grade, so that figure might not be significant.

The total amount of ECT prescribed by the psychiatrists in the survey came to about 180 courses. In fact, over the two year period, about four times this number of courses of ECT were given in Scotland. Were psychiatrists underestimating the amount of ECT they prescribed, or was there a poor response rate to the survey – or both?

The authors found that “There was a significant correlation between doctors’ gender and estimated prescription rates”. Men were more likely to prescribe ECT than women. All the heaviest users of ECT, those who said they had prescribed it more than 5 times over a two-year period – about 18 of them, were men. Women meanwhile predominated in those who had prescribed it less than 3 times or not at all. The authors say: “If gender does indeed have an effect, with psychiatry becoming increasingly female dominated, this will have consequences for ECT prescription rates”. They note that a previous survey in the United States found that men were more likely to prescribe ECT than women.

It is women who form the majority of those who undergo ECT. In the latest figures from Scotland, according to the Scottish ECT Accreditation Network 2012 report, 71 per cent of patients undergoing ECT were women. This is explained in the report in the usual way: “The percentage of women to men undergoing ECT (71% to 29%) reflects the relative percentages of patients being treated for depressive illness”. I would query this – I think the difference between the numbers of men and women undergoing ECT might be greater than the difference in the numbers of men and women admitted to hospital for treatment of depression (although I haven’t seen any very recent figures). ECT was invented by men and, even though women form a greater proportion of psychiatrists than they used to, men still dominate as lead authors in the ECT literature. If they are more likely to prescribe ECT then it looks as if something more complicated is going on, rather than it simply being a case of women being in greater need of ECT than men.

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