ELECTROCONVULSIVE THERAPY UTILIZATION IN JAPAN: EPIDEMIOLOGY USING DATA FROM THE NATIONAL DATABASE
Authors: Watanabe *Anri , Kido Masamitsu , Nakamae Takashi 
Published: February 2025

Abstract

Background
Electroconvulsive therapy (ECT) is indicated in major depression, mania, and schizophrenia in a Task Force Report of the American Psychiatric Association, and the Royal Australian and New Zealand College of Psychiatrists professional practice guidelines, and the revised recommendations for ECT compiled by the Japanese Neuropsychiatric Society and the Japanese Society of General Hospital Psychiatry. Even though each organization provides similar guidelines, it has been reported that there is a large global variation in ECT utilization. Although there are some reports on the actual status of ECT in Japan based on questionnaire surveys, surveys using the National Database are scarce, so a comprehensive survey is needed.

Aims & Objectives
This study aims to determine the number of ECT treatments by gender and age group and by prefecture using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB).

Method
The annual number of ECT treatments under general anesthesia during hospitalization from 2014 to 2020 by age group, gender, and prefecture was extracted from the NDB Open Data Japan. We calculated the average treatment number per 100,000 residents per year and performed a peak analysis of age-group data for males and females. We analyzed the Gini coefficient to examine regional differences between prefectures. Ethical approval was not required as we used public data.

Results
The rate of ECT was 68.7 treatments per 100,000 residents per year; the maximum peak was observed in males aged 50-54 years (102.2 treatments) and in females aged 70-74 years (140.8 treatments). The Gini coefficient was 0.50-0.55, which means extreme inequality.

Discussion & Conclusion
Considering that the number of ECT treatments per course is 6-12, the average number of individuals receiving ECT is estimated to be 5.7-11.5 per 100,000 residents per year. Previous studies reported ECT utilization rates per 100,000 residents as follows: 41 individuals from the national quality register in Sweden, 5.56 individuals from the commercial insurance claims database in the United States, and 10.9 individuals from the national database in Singapore. Results showed a peak at ages 50- 54 for males and 70-74 for females. Although the target psychiatric disorder is unknown in the data we used, a systematic review showed that female incidence was mostly higher than male in late-life depression, which may be the cause of ECT being performed in elderly females. Japan has the highest rate of aging in the world and that the world population is expected to age rapidly in the future, so other countries may show similar trends to the results of this study globally. The inter-prefectural regional differences in Japan were characterized extreme inequality. Considering that Japan has a national health insurance system and easier access to medical care than other countries, clinical and local problems, rather than systemic problems, would be significant. Since this is a preliminary study using NDB Open Data, detailed reports including the number of patients and target psychiatric disorders are desirable in the future.