USE OF ECT FOR THE INPATIENT TREATMENT OF RECURRENT MAJOR DEPRESSION

Objective: The authors' goals were to determine the frequency and dist ribution of ECT for general hospital inpatients with recurrent major d epression and to estimate the effects of prompt ECT on the length and cost of inpatient care. Method: Data from the 1993 Healthcare Cost and Utilization Project were analyzed to determine the rate of ECT rue fo r adult inpatients with a principal discharge diagnosis of major depre ssion, recurrent. Associations between prompt initial use of ECT (in t he first 5 hospital clays) and length and cost of inpatient care were examined before and after control for sociodemographic, diagnostic, an d hospital organizational characteristics. Results: An estimated 9.4% of general hospital adult inpatients with a principal diagnosis of rec urrent major depression received ECT in the survey year. A majority (5 9.2%) of these received their initial ECT session within the first 5 d ays after hospital admission. In univariate analyses, the likelihood o f receiving ECT was greater for older patients, whites, privately insu red individuals, and patients who lived in more affluent areas. Patien ts who received ECT tended to have relatively long and costly admissio ns. After control for several demographic, diagnostic, and hospital or ganizational characteristics, prompt ECT (as compared with delayed ECT or none) was associated with significantly shorter and less costly in patient care. Conclusions: The longer stays and higher treatment costs associated with ECT may be a consequence of patient selection. When p atient selection is taken into account, prompt administration of ECT i s associated with shorter and less costly, hospital stays. Nonetheless , economically disadvantaged patients are relatively unlikely, to rece ive this treatment.