a) & b) Questions regarding the frequency of ECT use in British Columbia (B.C.), and outcome, should be referred to the B.C. Ministry of Health.
As for national statistics, Statistics Canada keeps information on procedures in general hospitals but not in psychiatric hospitals. They have advised us that:
(1) The information requested is not available "off the shelf". A user fee would be levied by Statistics Canada for analysis of the data.
(2) It may be possible to produce figures showing the number of general hospital separations following ECT in the past 10 years, broken down by province, age group and sex.
(3) It may also be possible to determine how many of these separations were discharges of living patients and how many were deceased.
(4) Before 1992-93, the absence of personal identifier data precluded the determination of the link between the number of separations and the number of patients involved: e.g., whether the same patient was (admitted and) discharged 5 times or whether, in the other extreme, five separations involved five different individuals.
(5) The following questions cannot be answered using Statistics Canada data: (i) total number of people receiving ECT annually for the past 10 years (because data exclude psychiatric hospitals, and data prior to 1992/93 relate only to separations, not individuals, as noted above); (ii) number of patients who were given ECT and who died within 14 days or one year of treatment (all that could be obtained are the number of separations of living patients and the number of deceased, in the same year that ECT had been administered in a general hospital, but the causal link could not be established).
c) There have not been any comprehensive Canadian studies on this issue. Statistics Canada have advised that they keep data on the number of separations following the administration of ECT in general hospitals (as above) and the average cost of a day of care in hospital, but the number of hospitals days actually attributable to ECT would not be known. As well, unknown is the cost of a day in a general hospital attributable to ECT administration compared to the average cost of a day in hospital for any treatment.
The interpretation of any cost study should include an estimate of the costs, both direct and indirect, of alternatives to the use of ECT for the severe conditions for which it is administered [see response to question (e)].
d) The only federally-funded research identified by the Medical Research Council (MRC) and by Health Canada's National Health Research and Development Program (NHRDP) was a three-year study at the University of British Columbia, currently funded by MRC, entitled ECT-induced Prolactin Release, the Mechanism of Action of ECT and Clinical Outcome.
e) According to the 1992 position paper of the Canadian Psychiatric Association on ECT, the main diagnostic indications for ECT include major depression, bipolar disorder, non chronic schizophrenia (especially when affective or catatonic symptomatology is prominent), schizoaffective disorder and schizophreniform disorder.
The decision to use ECT in the treatment of an individual patient is a medical one, based on the psychiatrist's assessment of the patient's illness and an evaluation of the merits of ECT versus alternative treatments. It involves a process of informed consent. The decision is based on factors, in addition to diagnosis, such as
the patient's prior treatment response, the severity of the disorder, the relative need for rapid response to treatment (e.g., when the patient is suicidal), the risks and benefits of ECT in comparison with other appropriate treatments and the patient's preferred treatment modality).
Additional questions on this subject may be addressed to the Canadian Psychiatric Association, 200-237 Argyle Avenue, Ottawa, Ontario K2P 1B8.
Question No. 34-
