Electroconvulsive Therapy Practice in Catalonia A Survey Study Comparing Data From 1993 and 2010 Erika Martínez-Amorós, MD,* Verònica Gálvez, MD,† Narcís Cardoner, PhD,‡§ Diego Palao, PhD,* Miquel Bernardo, PhD,§∥ and Mikel Urretavizcaya, PhD‡§ Objective: The aim of this study was to assess the current use of electro- convulsive therapy (ECT) in Catalonia (Spain) as compared with ECT practice 17 years ago (1993). Methods: This was a descriptive, cross-sectional study using a structured questionnaire to collect data regarding the use of ECT in Catalan psychiat- ric units in 2010. A comparative approach was used with respect to previ- ously published data. Results: Data were obtained from 25 of the 27 units (92.6%) surveyed. The ECT was used in 20 facilities (80%, as opposed to 60% in 1993), and in all cases, a brief-pulse device was used. The most commonly used anesthetic was propofol (65%), and most facilities recorded the seizure du- ration (95%). The ECT was always administered in combination with phar- macologic therapy, and the primary clinical indication was depression. Only 20% of the ECT procedures were performed in the inpatient unit. Written informed consent to administer ECT was obtained in all centers. Conclusions: The ECT practice in Catalonia has changed since the 1990s, being administered more often, in a more standardized way and across a larger number of psychiatric units. The results indicate consider- able consensus with regard to its indications and conditions of application, which comply with current clinical practice guidelines and standards. Key Words: electroconvulsive therapy, survey, questionnaire, practice (J ECT 2014;00: 00–00) T he estimated annual rates for the application of electroconvul- sive therapy (ECT) range between 0.11 and 5.10 per 10,000 inhabitants, 1 meaning that the treatment is administered to approx- imately 1 million patients a year worldwide. 2 Historically, most data regarding ECT administration have been derived from the United States, although in recent years, detailed figures have also been published for Asia, Australia, and Europe and, to a lesser, extent for South America and Africa (for a review, see the study of Leiknes et al 1 , 2012). However, despite its demonstrated efficacy and the accessibility of guidelines for its application, 3–9 ECT practice is highly heterogeneous, both within countries and worldwide. 1 Although ECT use in Spain dates back to 1940, 8 its use across the country was not examined until relatively recently: the first study was conducted in 1993 10 and focused specifically on the province of Barcelona (Catalonia), whereas the second pro- vided more general data for Spain in 2001 (data published in 2006). 11 Catalonia is one of Spain’s 17 autonomous communities and has a population of over 7 million inhabitants (7,512,000 in 2010 12 ). A total of 4433 psychiatric beds are available in the re- gion. 13 In the aforementioned Catalan study, Bernardo et al 10 reported data from 20 facilities, 12 of which (60%) used ECTwith the most common indication being depression (83%). According to more recent data published by Bertolín-Guillén et al, 11 ECT was prescribed and applied in 108 (46.4%) of the 233 Spanish psychiatric units that were surveyed, with an annual rate of 0.61 per 10,000 inhabitants (a total of 2435 patients received ECT). This study concluded that there was notable variability between different regions of Spain in the rate of application of ECT (range, 0.03–1.66), similar to the regional differences reported in other countries. 14–19 The results showed that Catalonia had the largest number of hospitals prescribing and applying ECT (67.7% of fa- cilities), where the annual rate of ECT application was 1.36 per 10,000 inhabitants. Bertolín-Guillén et al 11 also noted that 0.6% of patients were not given general anesthesia and 2.29% were not administered a muscle relaxant, both of which are not recommended practices in the current guidelines. The aim of the present study was to collect data on the profile of ECT use in Catalonia, including clinical indications and ECT application technique. The views of professionals regarding the usefulness, effectiveness, and social acceptability of the procedure were also collected. METHODS This was a cross-sectional study in which a structured ques- tionnaire (see Appendix 1) and a document containing the study objectives were e-mailed to the head of department and/or to the head of the ECT unit in Catalan hospitals that had an inpatient psychiatric unit (general and psychiatric hospitals from both the private and public sectors). The data were provided by 1 clinician per center. Psychiatric units were identified through the Catalan Service of Health (Servei Català de la Salut). The questionnaire was adapted from Bernardo et al 10 (1996) and composed of 30 questions concerning different aspects of ECT application (technical issues), its indications, and activity data for the year 2010 (number of patients and sessions). It also sought the opinion of the responding psychiatrist regarding ECT (see Appendix 1). The survey was e-mailed to 27 psychiatric units in Catalonia. Data collection lasted approximately 1 year. To in- crease response rate, the survey was e-mailed on 4 occasions, first in November 2011 and then again in January, May, and August 2012. A descriptive analysis of the data was performed using SPSS v15.0 for Windows (SPSS, Chicago). RESULTS Twenty-five (92.6%) of the 27 facilities surveyed responded to the questionnaire. The 2 nonresponders were both private From the *Psychiatry Department, Parc Taulí Health Corporation, University Insti- tute Parc Taulí Foundation, Autonomous University of Barcelona (IUFPT-UAB), Sabadell, Spain; †School of Psychiatry, University of New South Wales, Therapeutic Neurostimulation Group, Black Dog Institute, Sydney, Australia; ‡Neuroscience Group [Bellvitge Biomedical Research Institute-] IDIBELL, Mood Disorders Clin- ical and Research Unit, Psychiatry Department, Bellvitge University Hospital-ICS, L ’Hospitalet de Llobregat, University of Barcelona, Barcelona, Spain; §Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain; and ∥Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Department of Psy- chiatry and Clinical Psychobiology, Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain. Received for publication December 23, 2013; accepted April 3, 2014. Reprints: Erika Martínez Amorós, MD, Psychiatry Department, Parc Taulí Health Corporation, IUFPT-UAB, Sabadell, Spain (e‐mail: emartineza@tauli.cat). The authors have no conflicts of interest or financial disclosures to report. Copyright © 2014 by Lippincott Williams & Wilkins DOI: 10.1097/YCT.0000000000000150 ORIGINAL STUDY Journal of ECT • Volume 00, Number 00, Month 2014 www.ectjournal.com 1 Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.