Racial Bias in ECT: Special Article in Psychiatric Services

Out on PubMed, from researchers at Yale and the Medical College of Georgia, is this special article:

Clinicians' Racial Bias Contributing to Disparities in Electroconvulsive Therapy for Patients From Racial-Ethnic Minority Groups.

Black Parker C, McCall WV, Spearman-McCarthy EV, Rosenquist P, Cortese N.Psychiatr Serv. 2021 Mar 18:appips202000142. doi: 10.1176/appi.ps.202000142. Online ahead of print.PMID: 33730880

The abstract is copied below: 

and a figure from the text:

and the Conclusions section:

 Although several theories seek to explain the persistent racial disparities in ECT treatment, racially influenced referral bias is one prominent and probable provider-level factor. Evidence has suggested that both aversive and acknowledged forms of racism among clinicians likely influence cultural diagnostic validity and accuracy, largely through clinician-level interpersonal communication and perceptual deficits, while also influencing how closely decision-making rationales adhere to evidence-based standards for ECT. Increasing use of gold-standard treatment algorithms for ECT with patients of color is contingent on clinicians’ ability and willingness to transcend aversive racism to cultivate culturally unbiased, clinically indicated diagnostic and treatment rationales. Clinicians promote equity by openly identifying and safeguarding against racial bias in clinical encounters.

This is an important and timely wake up call to clinicians and researchers in ECT service delivery. Bias in all aspects of clinical encounters and particularly in diagnosis is astutely described in this thoughtful commentary. We have long known that ECT is  under prescribed for minority populations. This article is an overdue call to understand and correct this injustice. I recommend a full read (~20minutes) for all ECT health care providers. Kudos to Dr. Black Parker and colleagues for this contribution to the ECT literature.