Trends in electroconvulsive therapy use in France from 2017 to 2023: no decline despite new therapeutics

Objective Underutilization of electroconvulsive therapy (ECT) may have negative consequences for patients' mental health. Public healthcare policies lack longitudinal data on the dynamics of ECT use, which is necessary to inform the development of appropriate strategies. This study aimed to provide a comprehensive overview of ECT use in France over an extended period. Method We analyzed exhaustive ECT data from the French national database. We conducted statistical analyses of ECT utilization from 2017 to 2023, focusing on variations in age, sex, diagnosis, and geographical use. Results The French national standardized ECT utilization rate increased from 0.33 patients per 10,000 inhabitants in 2017 to 0.50 in 2023. The significant pre-pandemic trend, indicating a +1.4% increase in ECT use rate per month, remained unaffected by the pandemic, despite a significant drop during COVID-19 period. Notably, the increase in ECT use over this period was more pronounced among younger (≤29 years) and older (≥70 years) individuals. Two-thirds of ECT recipients were aged 50 years or older, predominantly female and had a mood disorder diagnosis. A key finding was that the increase in ECT use was mainly driven by the private-for-profit hospitals. ECT use and its evolution were geographically heterogeneous in France. Conclusion Despite the availability of new therapeutics and ongoing stigma, ECT use increased in France, particularly among younger and older populations, from 2017 to 2023, indicating a change in practice. However, uneven access to ECT services across the country and the expansion of private care to the detriment of the public system, represent a major public health concern that must be addressed.