Rates and Patient Characteristics of Electroconvulsive Therapy in China and Comparisons With the United States.

OBJECTIVE: Recent studies have expressed concern about the infrequent and declining use of electroconvulsive therapy (ECT) in the United States. However, it is not known whether the US experience reflects changing global practice or one that varies between countries. This observational study examined use of ECT in the largest psychiatric hospital in China's third largest city over a 4-year period, 2014 to 2017.

METHODS: Unduplicated electronic medical records concerning all inpatients with psychiatric diagnoses were examined. Electroconvulsive therapy utilization rates, correlates of ECT use, and its association with readmission within the 6 months following discharge were evaluated using bivariate and multivariate logistic regression analyses.

RESULTS: Of 13,831 hospitalized patients, 2460 (17.8%) received ECT. Logistic regression analysis showed ECT utilization was independently associated with being female, younger age, being employed, nonlocal residence, involuntary admission, having no health insurance, longer length of stay, and the diagnoses of bipolar disorder and major depressive disorder. Use of ECT has increased since 2014 but was not significantly related to readmission 6 months after discharge.

CONCLUSIONS: Electroconvulsive therapy use appears to be substantially higher in China than in the United States and is associated with indicators of higher rather than lower functioning as reflected by independent associations with youth, employment, and fewer past hospitalizations, but also with behavioral noncompliance as reflected by involuntary admission, and has increased in recent years. Understanding United States-China discrepancies may further international understanding of the diverse roles of ECT in psychiatric practice.