Patient satisfaction after electroconvulsive therapy.

Objective: We sought to determine the degree of satisfaction with bifrontal and right unilateral electroconvulsive therapy (ECT) and to investigate the relation with treatment-related variables, such as memory complaints, and patient-related variables, such as self-rated depression severity and negative affectivity.

Methods: Subjects included all patients who started a course of ECT between May 2001 and December 2003, or still were receiving continuation or maintenance ECT (C/M-ECT) at the time of the study. A psychiatric nurse that was not a member of the treatment team conducted semi-structured interviews based on a battery of questionnaires (Patient Satisfaction Survey [PSS], Mini-Mental State Examination [MMSE], Squire Subjective Memory Questionnaire [SSMQ], Beck Depression Inventory [BDI], and Positive and Negative Affect Schedule [PANAS]).

Results: Of 50 eligible subjects, 36 (72%) completed the survey. Fourteen patients refused to participate. At the time of the interview, 19 patients (52.8%) were hospitalized, and 14 (38.9%) were receiving C/M-ECT. The mean time between last treatment session and interview was 282 days. Diagnostic categories were depressive disorder (50%) and psychotic disorder (47.2%). Bifrontal electrode position was used in 25 (69.4%) of the study patients and unilateral in 4 (11.1%). Patients had a considerable degree of satisfaction (mean PSS 153.41; SD 16.29), although they had prominent cognitive complaints (mean score SSMQ -11.86; SD 21.30). In a multiple regression model, in which satisfaction was predicted on the basis of age, sex, and scores on BDI, SSMQ, PANAS, and GAF, only the GAF-score at the time of the interview was significantly related to satisfaction. All other predictors were not significant.

Conclusion: Patients receiving bifrontal or right unilateral ECT do have considerable memory complaints, even a long time after their treatment. However, the degree of these complaints does not seem to predict satisfaction with the treatment. Only 38% of the variance of satisfaction could be predicted on the basis of age, sex, BDI, SSMQ, Negative Affectivity subscale of the PANAS, and GAF-scores, which proves that satisfaction with ECT is based on other factors than just the relief of symptoms or the occurrence of side-effects. The factors that contribute to patients' satisfaction remain largely unknown.