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Utilization of Electroconvulsive Therapy for Older Homeless Adults Covered by Medicare

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Abstract

This study sought to examine the association between homelessness and receipt of electroconvulsive therapy (ECT) among older Medicare beneficiaries with homelessness. Among individuals with major depressive disorder who were older (age 65+) Medicare beneficiaries (2014–2015 data), we compared clinical and sociodemographic characteristics among those who were homeless and received ECT, those who were not homeless and received ECT, those who were homeless and did not receive ECT, and those who were domiciled and did not receive ECT. The unadjusted rate of ECT use among older homeless individuals with depression (1.46%) was higher than the rate of ECT use among older non-homeless individuals with depression (0.41%). Among all individuals receiving ECT, homeless individuals started as inpatients at a greater rate (94.0% v. 72.6%) and transitioned to outpatient ECT at a lower rate (23.8% v. 44.5%) compared to their domiciled counterparts. The individuals in the ECT/homeless group had more psychiatric comorbidities compared to all other groups. After adjusting for significant covariates, homelessness was associated with a lower odds ratio (0.74, 95% CI 0.55–0.99) of receiving ECT. Our data suggest that ECT can be provided to homeless individuals at rates comparable to domiciled individuals. The psychosocial support typically required for an ECT course may prove difficult for homeless patients in the outpatient setting, which may be an area for further development.

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Acknowledgements

This work was funded by the Veterans Health Administration National Center on Homelessness among Veterans. Dr. Wilkinson also acknowledges funding support from the Yale Department of Psychiatry. The funding agency had no role on this intellectual contribution from the study conception to journal publication. The views here belong to the authors alone and do not represent the views of any agency of the federal government.

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Authors and Affiliations

  1. Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06511, USA

    Samuel T. Wilkinson MD & Taeho Greg Rhee PhD

  2. Interventional Psychiatric Service, Yale School of Medicine, New Haven, CT, 06511, USA

    Samuel T. Wilkinson MD

  3. School of Public Health, University of Texas Health Science Center At Houston, San Antonio campus, Houston, TX, 78229, USA

    Jack Tsai PhD

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  1. Samuel T. Wilkinson MD
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  2. Taeho Greg Rhee PhD
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  3. Jack Tsai PhD
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Contributions

formulated research questions: all authors; design study: all authors; analyzing data: TGR; writing article: STW; revising article: all authors.

Corresponding author

Correspondence to Samuel T. Wilkinson MD.

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Human Subjects Protection and Informed Consent

The study procedures for this secondary analysis of restricted data were approved by the Institutional Review Board (HIC #2000022916) at Yale School of Medicine. Informed consent was not deemed necessary by the IRB.

Conflicts of Interest

Dr. Wilkinson has received contract funding from Janssen, Sage Therapeutics, and Oui Therapeutics for the conduct of clinical trials administered through Yale University. He has received consulting fees from Janssen, Oui Therapeutics, Sage Therapeutics, and Biohaven Pharmaceuticals. The other authors have no conflicts to disclose.

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Wilkinson, S.T., Rhee, T.G. & Tsai, J. Utilization of Electroconvulsive Therapy for Older Homeless Adults Covered by Medicare. Psychiatr Q 92, 1825–1837 (2021). https://doi.org/10.1007/s11126-021-09946-3

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  • DOI: https://doi.org/10.1007/s11126-021-09946-3

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