Sinha Preeti, Sreeraj Vanteemar S, Arumugham Shyam Sundar, Thirthalli Jagadisha
Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India.
BMC Psychiatry. 2025 Jul 1;25(1):670. doi: 10.1186/s12888-025-07109-3.
The large treatment gap in mental disorders in India also includes a lack of access to electroconvulsive therapy (ECT), a potentially lifesaving treatment. With the introduction of the Mental Health Care Act (MHCA) 2017 in India, an impact was speculated on the utilisation of ECT due to the ban on unmodified ECT and the regularisation of ECTs in children.
We planned this survey to identify the current status of ECT services in India as perceived by psychiatrists and to explore the barriers to providing ECT, particularly those influenced by the enactment of the MHCA 2017 in India. The psychiatrists practising in India were invited to complete an online questionnaire distributed through social media and professional group forums. A total of 225 consenting participants completed the survey.
A majority of the participating psychiatrists (n = 160; 71.11%) were from urban areas, and 102 (45.33%) worked in private hospitals. Approximately half of the respondents (n = 118; 52.44%) could provide ECT to less than a quarter of patients for whom ECT was recommended. Furthermore, 52.4% of psychiatrists (n = 118) reported a decrease in the number of patients receiving ECT following post MHCA 2017 in India, while 44.9% (n = 101) observed no change. Additionally, 114 psychiatrists (50.67%) noted a reduction in the use of ECT for children since MHCA 2017. A substantial proportion (78.22%; n = 176) regarded patient refusal of consent as a significant factor. Access to anaesthesia services and associated costs was identified as a major barrier by 59.1% of psychiatrists (n = 133), significantly influencing their opinion on the reduction of ECT services post-MHCA 2017 (Odds ratio = 2.024, p = 0.018).
The limited availability of anaesthesia services and associated expenses are significant barriers to using ECT in developing countries such as India. This issue became more pronounced after the implementation of the MHCA 2017 and should be addressed promptly. Training psychiatrists in ECT anaesthetic skills via task-sharing and telementoring can help resolve this issue.
印度精神障碍治疗差距巨大，其中还包括无法获得电休克疗法（ECT），而这是一种可能挽救生命的治疗方法。随着2017年印度《精神卫生保健法》（MHCA）的出台，由于对未改良的ECT的禁令以及儿童ECT的规范化，人们推测这会对ECT的使用产生影响。
我们策划了这项调查，以确定印度精神科医生所认为的ECT服务现状，并探讨提供ECT的障碍，特别是那些受印度2017年《精神卫生保健法》颁布影响的障碍。邀请在印度执业的精神科医生完成一份通过社交媒体和专业团体论坛分发的在线问卷。共有225名同意参与的参与者完成了调查。
大多数参与调查的精神科医生（n = 160；71.11%）来自城市地区，102人（45.33%）在私立医院工作。大约一半的受访者（n = 118；52.44%）为不到四分之一被建议接受ECT治疗的患者提供ECT。此外，52.4%的精神科医生（n = 118）报告称，在印度2017年《精神卫生保健法》实施后，接受ECT治疗的患者数量有所减少，而44.9%（n = 101）观察到没有变化。此外，114名精神科医生（50.67%）指出，自2017年《精神卫生保健法》实施以来，儿童ECT的使用有所减少。很大一部分（78.22%；n = 176）认为患者拒绝同意是一个重要因素。59.1%的精神科医生（n = 133）认为获得麻醉服务和相关费用是一个主要障碍，这对他们关于2017年《精神卫生保健法》实施后ECT服务减少的看法有显著影响（优势比 = 2.024，p = 0.018）。
在印度等发展中国家，麻醉服务的有限供应和相关费用是使用ECT的重大障碍。在2017年《精神卫生保健法》实施后，这个问题变得更加突出，应立即加以解决。通过任务分担和远程指导对精神科医生进行ECT麻醉技能培训有助于解决这个问题。
