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The 5-year longitudinal diagnostic profile and health services utilization of patients treated with electroconvulsive therapy in Quebec: a population-based study

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Abstract

Purpose

Electroconvulsive therapy (ECT) is effective for treating several psychiatric disorders. However, only a minority of patients are treated with ECT. It is of primary importance to characterize their profile for epidemiological purposes and to inform clinical practice. We aimed to characterize the longitudinal profile of psychopathology and services utilization of patients first treated with ECT.

Methods

We conducted a population-based comparative study using data from a national administrative database in Quebec. Patients who received a first ECT between 2002 and 2016 were compared to controls who were hospitalized in psychiatry but did not receive ECT. We performed descriptive analyses to compare psychiatric diagnoses, domains of psychopathology (internalizing, externalizing and thought/psychotic disorders), medical services and medication use in the 5 years prior to the ECT or hospitalization.

Results

5 080 ECT patients were compared with 179 594 controls. Depressive, anxiety, bipolar and psychotic disorders were more frequent in the ECT group. 96.2% of ECT patients had been diagnosed with depression and 53.8% with a primary psychotic disorder. In the ECT group, 1.0% had been diagnosed exclusively with depression and 47.0% had disorders from that belong to all three domains of psychopathology. Having both internalizing and thought/psychotic disorders was associated with an increased likelihood of receiving ECT vs having internalizing disorders alone (unadjusted OR = 2.93; 95% CI = 2.63, 3.26). All indicators of mental health services utilization showed higher use among ECT patients.

Conclusion

Our results provide robust evidence of complex longitudinal psychopathology and extensive services utilization among ECT patients.

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Data availability

The data are not available to the public due to confidentiality requirements.

Abbreviations

ASD:

Absolute standardized difference

CI:

Confidence interval

DSM:

Diagnostic and statistical manual

ECT:

Electroconvulsive therapy

HiTOP:

Hierarchical taxonomy of psychopathology

ICD:

International classification of diseases

INSPQ:

Institut national de santé publique du Québec

OR:

Odds ratio

MDE:

Major depressive episode

QICDSS:

Québec integrated chronic disease surveillance system

TRD:

Treatment-resistant depression

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Funding

This research was funded by a grant from FRQS—Partenariat Innovation Québec—Janssen. S.L. and F.G-Z-K. received a grant from the Quebec Network on Suicide, Mood Disorders and Associated Disorders (RQSHA). C.S. is supported by Fonds de recherche du Québec – Santé (Junior 2) salary award.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Neurosciences, Université Laval, Quebec City, Qc, Canada

    Simon Lafrenière, Simon Patry & Chantal Mérette

  2. Department of Electrical Engineering and Computer Engineering, Université Laval, Quebec, Qc, Canada

    Fatemeh Gholi-Zadeh-Kharrat

  3. Institut National de Santé Publique du Québec, Quebec City, Qc, Canada

    Fatemeh Gholi-Zadeh-Kharrat, Caroline Sirois, Victoria Massamba & Louis Rochette

  4. Faculty of Pharmacy, Université Laval, Quebec, Qc, Canada

    Caroline Sirois

  5. Centre of Excellence on Aging of Quebec, VITAM Research Centre on Sustainable Health, Quebec City, Qc, Canada

    Caroline Sirois

  6. Department of Psychiatry and Addiction, Université de Montréal, Montreal, Qc, Canada

    Camille Brousseau-Paradis, Morgane Lemasson & Alain Lesage

  7. Institut Universitaire en Santé Mentale de Québec, 2601, Chemin de La Canardière, Quebec, QC, G1J 2G3, Canada

    Simon Lafrenière & Simon Patry

  8. Computer Vision and Systems Laboratory, Université Laval, Quebec, Qc, Canada

    Christian Gagné

  9. Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada

    Geneviève Gariépy

  10. Institut Universitaire en Santé Mentale de Montréal Research Centre, Montreal, Qc, Canada

    Geneviève Gariépy & Alain Lesage

  11. CERVO Research Centre, Quebec City, Canada

    Chantal Mérette

  12. Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, Qc, Canada

    Elham Rahme

Authors
  1. Simon Lafrenière
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  2. Fatemeh Gholi-Zadeh-Kharrat
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  13. Alain Lesage
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Contributions

All authors contributed to the study design. FG-Z-K, LR and SL: conducted the analyses. SL: drafted the manuscript. All authors contributed to the interpretation of the results, revised the manuscript, and approved the final version.

Corresponding author

Correspondence to Simon Lafrenière.

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Conflict of interest

The authors have no competing interests to declare.

Ethical approval

This project was approved by the Ethics committee of both the Institut universitaire en santé mentale de Montréal and of Université Laval. Access to the QICDSS was approved by government bodies, the Public Health Ethics Committee, and the Commission d'accès à l'information du Québec for chronic disease surveillance purposes [1]. Informed consent was not required in the context of register-based studies that use anonymized data. This study was performed in line with the principles of the 1964 Helsinki Declaration.

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Lafrenière, S., Gholi-Zadeh-Kharrat, F., Sirois, C. et al. The 5-year longitudinal diagnostic profile and health services utilization of patients treated with electroconvulsive therapy in Quebec: a population-based study. Soc Psychiatry Psychiatr Epidemiol 58, 629–639 (2023). https://doi.org/10.1007/s00127-022-02369-w

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  • DOI: https://doi.org/10.1007/s00127-022-02369-w

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