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Sociodemographic Characterization of ECT Utilization in Hawaii

Ona, Celia M. MD*†; Onoye, Jane M. PhD†‡; Goebert, Deborah DrPH†‡; Hishinuma, Earl PhD; Bumanglag, R. Janine BS; Takeshita, Junji MD†‡; Carlton, Barry MD†‡; Fukuda, Michael MSW

doi: 10.1097/YCT.0000000000000075
Original Studies

Objectives: Minimal research has been done on sociodemographic differences in utilization of electroconvulsive therapy (ECT) for refractory depression, especially among Asian Americans and Pacific Islanders.

Methods: This study examined sociodemographic and diagnostic variables using retrospective data from Hawaii, an island state with predominantly Asian Americans and Pacific Islanders. Retrospective data were obtained from an inpatient and outpatient database of ECT patients from 2008 to 2010 at a tertiary care community hospital on O’ahu, Hawaii.

Results: There was a significant increase in overall ECT utilization from 2008 to 2009, with utilization remaining stable from 2009 to 2010. European Americans (41%) and Japanese Americans (29%) have relatively higher rates of receiving ECT, and Filipino Americans and Native Hawaiians have relatively lower rates in comparison with their population demographics. Japanese Americans received significantly more ECT procedures than European Americans.

Conclusions: Electroconvulsive therapy is underutilized by certain sociodemographic groups that may benefit most from the treatment. There are significant differences in ECT usage based on ethnicity. Such differences may be related to help-seeking behavior, economic differences, and/or attitudes regarding mental illness. Further research is needed to elucidate the reasons for differences in utilization.

From the *Tripler Army Medical Center; †Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii at Mānoa and ‡The Queen’s Medical Center, Honolulu, HI.

Received for publication March 1, 2013; accepted August 5, 2013.

Reprints: Jane M Onoye, PhD, Department of Psychiatry, 1356 Lusitana St., 4th Floor, John A. Burns School of Medicine, University of Hawaii at Mānoa, Honolulu, HI 96813 (e-mail: onoyej@dop.hawaii.edu).

The following disclosures have been made by the authors and may be viewed as potential conflicts of interest.

This research and dissemination were supported, in part, by a grant from The Queen’s Medical Center, which also reviewed but did not edit this article. Drs. Onoye and Goebert are faculty of the University of Hawaii John A. Burns School of Medicine, as well as senior scientists at The Queen’s Medical Center. Drs. Takeshita and Carlton are also affiliated with The Queen’s Medical Center. Dr. Ona was previously affiliated with The Queen’s Medical Center. The contents of this article are solely the responsibility of the authors and do not represent the official views, policy, or position of The Queen’s Medical Center, the University of Hawaii, the Army, the Department of Defense, or the US Government. A portion of this article was presented at the American Psychiatric Association’s Annual Meeting in May 2011 in Honolulu, Hawaii.

© 2014 by Lippincott Williams & Wilkins