Knowledge, Experience, and Attitudes Toward Electroconvulsive Therapy Among Psychiatrists in Uzbekistan

BACKGROUND: Electroconvulsive therapy (ECT) is among the most effective treatments for severe and treatment-resistant psychiatric disorders but remains underused in many low- and middle-income countries because of limited training and negative attitudes. To our knowledge, no previous study has examined psychiatrists' knowledge of, experience with, and attitudes toward ECT in Central Asia. METHODS: We conducted a cross-sectional anonymous survey of psychiatrists in Uzbekistan. A 33-item questionnaire assessed knowledge, clinical exposure, and attitudes toward ECT across age groups and psychiatric diagnoses. Group comparisons were performed using Kruskal-Wallis and χ2 tests. Multivariable logistic and linear regression analyses identified independent predictors of favorable attitudes and ECT knowledge. RESULTS: Of 212 respondents (response rate 37.6%), 44.3% reported no previous ECT exposure. Misconceptions were common: 19.8% believed ECT is administered without anesthesia, 39.6% believed psychiatric medications should be discontinued before treatment, and 65.1% considered pregnancy a contraindication. Restrictive attitudes toward ECT in children and older adults were also common. Direct clinical and indirect ECT exposure were independently associated with greater knowledge and more favorable attitudes. Rural practice location and exclusive child and adolescent practice independently predicted lower knowledge, whereas female psychiatrists were less likely to recommend ECT as a treatment option for a friend or relative. CONCLUSIONS: Psychiatrists in Uzbekistan reported limited ECT training and experience, substantial knowledge gaps, and restrictive attitudes toward ECT. Clinical exposure was the strongest independent predictor of greater knowledge and more favorable attitudes, supporting the importance of expanding supervised ECT training and educational opportunities.