(061) Mapping Access to Electroconvulsive Therapy (ECT) in Inpatient Psychiatric Settings: Addressing Treatment Disparities and Geographic Gaps

Background/Significance:
Electroconvulsive Therapy (ECT) induces a generalized cerebral seizure using an electric current, typically administered under intravenous sedation or general anesthesia. Originally ECT was developed for severe depression, but its use has been expanded to include conditions such as schizophrenia, schizoaffective disorder, catatonia, neuroleptic malignant syndrome, and bipolar disorder [1]. Despite its efficacy, ECT has long been associated with stigma, partly due to misinformation about its procedural methodology [2]. Furthermore, trends indicate that despite the increase in major depression in the US in recent years ECT utilization remains low [3]. Trends also indicate concerning access to healthcare in that the demographics utilizing this treatment skew towards Caucasian non-Hispanic [4].   

Objective:
The objective of this research project is to identify and map the inpatient psychiatric units that have ECT available across different geographic regions. This project aims to provide insights into the distribution of ECT facilities, assess geographic disparities in access to ECT, and establish a foundation for improving access to this life-saving treatment.

Methods:
Developed a survey/questionnaire about the presence and characteristics of ECT services within inpatient-psychiatric units. Collaborating with professional psychiatric organizations, hospital networks, and psychiatric associations, we recruited a diverse sample of inpatient-psychiatric units across different geographic regions to participate. Using REDCap we administered the survey. In cases of non-response, follow-up communication was initiated to encourage participation and ensure data completeness. Upon collection of survey responses, compiled and centralized the data into a structured database for analysis. Utilizing statistical methods, analyzed the data to identify trends in ECT availability, including the geographic distribution of facilities, frequency of ECT sessions, and types of psychiatric conditions treated. Additionally, employed geographic information systems (GIS) mapping software to visually represent the distribution of ECT facilities across different regions. To validate survey findings, we cross-referenced data with existing databases or registries of ECT facilities. Throughout the research process, ethical considerations were prioritized, including compliance with institutional review board (IRB) guidelines, protection of participant confidentiality, and privacy.

Results:
Analysis revealed disparities in the distribution of ECT treatment facilities, with certain geographic regions experiencing limited access. Nationally, trends in ECT utilization highlighted variations in treatment frequency across different regions. Survey responses provided insights into resource availability and underscored the need for streamlined referral systems.

Discussion:
The findings underscore the critical need for addressing barriers to ECT accessibility. Geographic disparities in facility distribution highlight potential gaps in psychiatric care, necessitating targeted interventions to ensure equitable access. The variation in ECT utilization trends suggests potential disparities in clinical practice or patient demographics, warranting further investigation. Streamlining referral processes and establishing centralized databases could enhance access to life-saving ECT treatments.
Conclusion/Implications:
This study illuminates the challenges surrounding ECT accessibility in inpatient psychiatric settings. By quantifying facility distribution and identifying geographic gaps, it provides valuable insights for policymakers, healthcare providers, and stakeholders. Addressing these barriers requires collaborative efforts to improve referral systems, enhance reimbursement mechanisms, and promote equitable access to ECT treatments.

References:
1.Salik.I,Marwaha.R.ElectroconvulsiveTherapy.[Updated 2022.Sep.19].In:StatPearls [Internet].Treasure.Island(FL):StatPearlsPublishing;2024Jan-.Availablefrom:https://www.ncbi.nlm.nih.gov/books/NBK538266/
2.deAntaL,Alvarez-MonMA,Donat-VargasC,Lara-AbelandaFJ,Pereira-SanchezV,GonzalezRodriguezC,Mora F,OrtegaMA,QuinteroJ,Alvarez-MonM.Assessmentof beliefsandattitudesaboutelectroconvulsivetherapypostedonTwitter:Anobservationalstudy.Eur Psychiatry.2023Jan9;66(1):e11.doi:10.1192/j.eurpsy.2022.2359.PMID: 36620994;PMCID:PMC9970148.
3.WilkinsonST,AgbeseE,LeslieDL,RosenheckRA.IdentifyingRecipientsofElectroconvulsive Therapy:DataFromPrivatelyInsured Americans.PsychiatrServ.2018May1;69(5):542-548. doi:10.1176/appi.ps.201700364.Epub2018Feb1.PMID: 29385954;PMCID:PMC6248332.
4.GoodwinRD,DierkerLC,WuM,GaleaS,HovenCW,WeinbergerAH.TrendsinU.S.DepressionPrevalenceFrom2015to2020:TheWideningTreatmentGap.AmJPrevMed.2022Nov;63(5):726-733.doi:10.1016/j.amepre.2022.05.014.Epub2022Sep19.PMID:36272761;PMCID: PMC9483000.



Presentation Eligibility: Not previously published or presented

Diversity, Equity, and Inclusion: This research project contributes to diversity, equity, and inclusion by shedding light on disparities in access to Electroconvulsive Therapy (ECT) across different demographic groups. Despite the efficacy of ECT in treating various psychiatric conditions, stigma and misinformation have disproportionately affected its utilization, particularly among historically marginalized communities. By identifying geographic disparities in ECT availability and highlighting potential inequities in access to this life-saving treatment, this study provides a foundation for addressing systemic barriers and promoting equitable healthcare access. The emphasis on collaboration with diverse inpatient psychiatric units and prioritization of ethical considerations further advance inclusivity in research practices.