Perceptions and awareness of electroconvulsive therapy among patients and their families: a review of the research from developing countries.

OBJECTIVES

Although electroconvulsive therapy (ECT) is used frequently in many developing countries, investigations of patients' awareness and perceptions of the treatment are rare. This review attempted to pool the research evidence in this area from developing countries.

METHODS

Electronic searches of databases using relevant keywords were supplemented by extensive manual checking of cross-references and other sources.

RESULTS

Sixteen such reports were found suitable for inclusion. The limited data showed that patients were usually poorly informed about ECT, which was partly attributable to unsatisfactory pretreatment explanations received by approximately two thirds of the recipients. About a third also reported deficiencies in the process of consent, including a sense of coercion. Fear of ECT was reported by a significant percentage (36%-75%). Distressing adverse effects were frequent; memory impairment (25%-95%) being the most common one. Despite these problems, most studies found that most patients perceived ECT to be helpful and had positive views about it. Simultaneously, a sizeable percentage (10%-32%) was quite critical of ECT. In contrast, relatives of patients were invariably better aware, more satisfied with the experience, and had more favorable attitudes toward ECT.

CONCLUSIONS

Overall, the weight of the evidence supported the notion that patients undergoing ECT and their relatives are well disposed towards it. However, the lacunae in treatment highlighted by this review and extreme variations in practice of ECT suggest that much more needs to be done to improve the practice of ECT in developing countries, to enhance patients' and relatives' satisfaction with the treatment.