ECT in the Republic of Ireland: women, men, and misquoted statistics

In my last post I discussed the latest statistics on electroconvulsive (ECT) use in the Republic of Ireland, which can be found in a report by the Mental Health Commission. The report showed that two-thirds of those give ECT in the Republic of Ireland are women. There is nothing unusual, for most Western countries, about this statistic. But why? Why are women in these countries twice as likely to be given ECT than men are? It is not a question that bothers psychiatrists who use ECT; they tend to shrug it off with something about women being more likely to be depressed than men. For example, the annual reports on ECT use in Scotland say: “This reflects the relative higher prevalence of depressive illness in women compared with men”.

In the Irish report (in the summary and key findings) the authors say: “More females than males received treatment approximately two-third to one-third reflective of the relative incidence of depressive illness in women compared to men”. Unusually, the authors elaborate (in a footnote on page 17): “The percentage of females is reflective of a greater proportion of women (68%) admitted to approved centres with a primary diagnosis of depressive disorders in 2014 (HRB, 2015) and as highlighted in section 1.4 of this report, Depressive disorders are the most common diagnosis of those who are administered ECT.” (Most ECT patients are being treated for depression: 82% in 2014 and 73% in 2015. But a minority are being treated for other diagnoses, for example schizophrenia, where admissions for men outnumber those for women. The ECT report however did not include statistics on gender and diagnosis.) Let’s turn then to section 1.4:

“The Health Research Board reported that in 2014, depressive disorders were the most common diagnoses recorded, accounting for 27% of all admissions and the highest rates of all admissions (105.3). Schizophrenia accounted for 20% of all admissions and had the second-highest rate of all admissions (77.2). There was an equal proportion of male and female admissions, with rates being almost equal, at 388.7 per 100,000 for males and 387.1 for females. Females had a higher rate of admission for depressive disorders than males, at 9.1 per 100,000 for females and 6.3 for males (Daly and Walsh, 2015).”

Now, I can’t immediately see how these rates of admission for depressive disorders for men and women (6.3 and 9.1 per 100,000) become the 68 per cent women claimed by the report. (I make it nearer 59% women.) But at least the report tells us where the figures come from – Daly A, Walsh D (2015), HRB Statistics Series 26 Activities of Irish Psychiatric Units and Hospitals 2014. Health Research Board (Dublin).
So let’s turn to the original statistics.

Looking at the Daly and Walsh statistics, it becomes apparent what the authors of the ECT report have done. The earlier part of the above-quoted paragraph is correctly taken from Daly and Walsh’s statistics for admissions to psychiatric hospitals in Ireland in 2014. But the final sentence, referring to comparative rates of admission of men and women for depression is taken from a different section of Daly and Walsh’s report and refers to the inpatient census, that is, only to people in hospital on 31 December 2014. What they should have quoted is the total number of admissions for depression in 2014. That can be found in table 2.6a and shows that the rates, per 100,000 population, are 96 for men and 115 for women. There were, according to the same table, 2,176 admissions for men and 2,656 admissions for women. Women, therefore, accounted for about 55% of admissions for depression. Where then does the 68% claimed by the authors of the Mental Health Commission ECT report come from?

I searched the Daly and Walsh document for 68% and found (on pages 27 and 199) this sentence: “Females accounted for 68% of all admissions with a primary diagnosis of depressive disorders…”. But it is in the section of “Child and adolescent admissions” and refers only to patients aged under 18 and is therefore not relevant to ECT.

So, by misquoting statistics, the authors of the ECT report have tried to make it look as if ECT is not being given disproportionately to women. In fact, the figures show that, in Ireland, a woman who is admitted to hospital with a diagnosis of depression is more likely to be given ECT than a man. Psychiatrists should be asking themselves why.

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