The clinical and economic effects of cancelled or delayed ECT treatment during the COVID-19 pandemic: A scoping review

Introduction Electroconvulsive therapy (ECT) is a highly effective and essential treatment for patients suffering from severe mental illness, including treatment-resistant depression and catatonia. Delaying ECT treatment leads to worsening symptoms, which require more repeat ECT treatments for patients to recover, and increases wait times for others. During the COVID-19 pandemic, many ECT facilities significantly reduced or cancelled their ECT services. The overall clinical and economic effects of these delayed and cancelled ECT treatments are unknown. Methods We conducted a scoping review of studies assessing the clinical and economic effects of missed or cancelled ECT treatment during the COVID-19 pandemic among patients ≥ 18 years. We searched MEDLINE, Embase, and PsycINFO (inception to March 2024). Three independent reviewers performed screening and extracted data. Results were summarized narratively. Results Of 365 articles screened, a total of 11 articles met eligibility criteria for inclusion in this review. There was consistent evidence across all included studies to suggest that cancelling and reducing ECT treatment was associated with patient relapse, hospitalization, and need for new treatment. Only one of the included studies reported economic outcomes, with the findings suggesting that cancelled and reduced ECT led to significantly increased healthcare costs. Conclusion Our findings highlight that delaying access to critical services, such as ECT, can result in negative clinical outcomes and greater healthcare spending. ECT facilities should prioritize maintaining access to treatment, both presently and during future emergencies, especially for patients with the greatest need, such as those with treatment-resistant disorders or who require more frequent ECT treatments.