ECT in Poland: New Survey Shows Low Rate of Use

Out on PubMed,, from colleagues in Poland and Hungary, is this paper:

Changes in the Practice of Electroconvulsive Therapy in Poland: A Nationwide Survey Comparing Data Between 2005 and 2020.

Antosik-Wójcińska AZ, Dominiak M, Mierzejewski P, Jażdżyk P, Gazdag G, Takacs R, Wichniak A.Neuropsychiatr Dis Treat. 2021 Feb 22;17:605-612. doi: 10.2147/NDT.S296210. eCollection 2021.PMID: 33654402

The abstract is copied below:

Background: The use and the characteristics of the practice of electroconvulsive therapy (ECT) in Poland have not been evaluated since 2005, when a nationwide survey revealed its rare utilization (0.11 patients/10,000 inhabitants/year). The aims of this study were to determine the current use of ECT and to compare the findings with those of the previous survey.

Methods: Two questionnaires were sent to all 48 inpatient psychiatric centers in Poland. The first one - to units providing ECT to explore its practice, and the second - to units not performing ECT to explore the reasons for not using this treatment.

Results: Nineteen (39.6%) of all psychiatric inpatient centers confirmed the use of ECT. The utilization rate was 0.13 patients/10,000 inhabitants. Similar to the findings from 2005, the main indications were affective disorders, and bitemporal electrode placement was the dominant method used for the delivery of ECT. Age-based and titration-based methods were applied exclusively in 50% and 25% of the centers, respectively (compared with 15% and 35% in 2005, respectively), while both methods were used in the remaining 25%. Improvements in safety were reflected by the use of comprehensive pre-ECT evaluation and treatment monitoring. None of the centers used sine-wave devices; this contrasts with their use by 29% of the centers in 2005. The main reasons for not using ECT were insufficient funding and a lack of experienced staff.

Conclusion: The frequency of ECT use in Poland remains very low. In view of the improvement in the quality of health services in the past decade, such a markedly rare use of an effective treatment was unexpected. There is an urgent need of education to create more positive attitude towards ECT among health professionals and among public, and to increase the training of mental health professionals in ECT.

Keywords: ECT in Poland; ECT in central and eastern Europe; ECT utilization rate; electroconvulsive therapy; survey.

The pdf is here.

and a table:

This excellent paper presents survey results from psychiatric hospitals in Poland. Despite improvements in the healthcare system in general, ECT use has remained woefully low.

Poor medical education and lack of nationwide recommendations/standards are said to be the main culprits. In a nation of 38 million people, there are 4274 psychiatrists and only about 50  psychiatrists who perform ECT. While maintenance ECT is practiced, the paper implies that all treatments are inpatient. The authors note that "an unknown percentage of Polish patients may not have access to an effective (and often life-saving) treatment."

Despite the unsatisfactory current situation, the attitude expressed by the authors is definitely optimistic, with suggestions for improvement in ECT education/training and hope for national guidelines soon.

For those of us interested in relative aspects of ECT practice around the world, this paper makes compelling reading, ~15 minutes.