The featured paper is a 2002 online article (pdf) by the Department of Health freely available here. The article presents data from an English survey of ECT without displaying any statistical analysis of this data. Although there are some comments, the raw data is presented and the readers are able to make their own interpretation.
On moving through the document we are first told that there were 12,800 administrations of ECT in the specified 3-month period which was a decrease of some 4000 from a similar time period 3 years previously – nearly 25%. Perhaps this might represent a move towards favouring medication, a reducing need for ECT or else a change in the ‘prescriber’ population. The gender ratio was very interesting with 1 man to every 2 women undergoing ECT which fits with other data on the ratio of men to women being treated for depression in general practice. Nearly half of the people were over the age of 65. Indeed those under the age of 16 were a rather small minority and a general trend from the data was that as age increased so too did the percentage of treated cases allocated to the different age groupings. It is tempting to speculate that this may mean that a person is more likely to receive ECT if they have had this before – although we need further data to explore this hypothesis. This may not be the case for instance if many of the people over the age of 65 were receiving it for the first time.
Another interesting finding was that nearly 1/4 of the people receiving ECT were detained under the Mental Health Act(1983) and of these nearly 60% did not consent to treatment. This is of particular interest in view of the 2007 amendments to the Mental Health Act (1983) which brings the capacity assessment into the process of treating with ECT when a person is detained.
The authors of the paper write that data was derived from the Hospital Episode Statistics (HES) and that the information wasn’t always documented as relevant ECT codes were not always appreciated nor the operation status of ECT. Additionally the HES did not incorporate day case activities. Another interesting finding from the survey was the relative stability of the number of ECT cases in private practice compared to the almost 25% reduction over the 3 year period in the NHS. There may be a number of explanations for this including a reducing proportion of cases treated with ECT combined with increasing private practice caseload, a different case mix between private and NHS work (again further data would be required in order to explore this further) or difference in practitioner’s prescribing patterns although for all of these we require further data to test each hypothesis.
Further data gives a breakdown of diagnoses and we see that a majority of people undergoing ECT had received a diagnosis of mood disorder and that of these over 2/3’s were women in keeping with the overall ratio of women to men being treated with ECT. We also see from the data that per 100,000 people, higher rates of treatment with ECT are evident in the NorthWest and the lowest rates are in London. However it is difficult to draw any conclusions about why this might be so without knowing more about the specifics of where people are treated in the different regions and other specifics about services.
This survey provides raw data that could be used for numerous purposes including comparison where appropriate and it will be interesting to see future trends in light of general changes in practice.
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