Impacts on electroconvulsive therapy (ECT) services, including patient relapse and death, during the COVID-19 pandemic: Mixed methods results from a multi-national survey

ABSTRACT

Objectives: Electroconvulsive therapy (ECT) is important in the management of major, life-threating, and treatment-resistant psychiatric illness. The COVID-19 pandemic has significantly disrupted ECT services. The need for new infection control measures, staff/resource redeployment and shortages, and the perception that ECT is as an 'elective' procedure have caused changes to, and reductions in, ECT delivery. The aim of this study was to explore the impacts of COVID-19 on ECT services, staff, and patients globally. Method(s) Data were collected using an electronic, mixed-methods, cross-sectional survey. The survey was open March to November 2021. Clinical directors in ECT services, their delegates, and anaesthetists were asked to participate. Quantitative findings are reported. Result(s) One hundred and twelve participants worldwide completed the survey. The study identified significant impacts on services, staff, and patients. Based on quantitative results, most participants (57.8%, n=63) reported their services made at least one change to ECT delivery. More than three-quarters (81.0%, n=73) reported their service had identified at least one patient who could not access ECT. More than two-thirds (71.4%, n=67) reported their service identified at patients who experienced a relapse in their psychiatric illness due to lack of ECT access. Six participants (7.6%) reported their service had identified at least one patient who died, by suicide or other means, due to lack of ECT access. Participants' qualitative responses were detailed, averaging 43 words. Three qualitative themes were identified (1) Service provision, about the importance of ECT services continuing during the pandemic, (2) Preparedness, through guidelines and environmental design, and (3) Personal protection, about strategies to increase staff safety. Conclusion(s) This is the first multi-site, international survey to explore the impacts of COVID-19 on ECT services, staff, and patients. Its findings can be used to inform evidence-based ECT practice. This supports the ongoing safe, effective operation of ECT services. Research Category and Technology and Methods Clinical Research 2. Electroconvulsive Therapy (ECT) Keywords Survey, Mixed Methods, COVID, Service changes;Copyright © 2023