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Coman A, Bondevik H. The ethical imperative of trauma-sensitive care for electroconvulsive therapy (ECT). J Ment Health 2024; 33:177-184. [PMID: 37218175 DOI: 10.1080/09638237.2023.2210650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 03/10/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND The empirical literature on the lived experience of electroconvulsive therapy (ECT) is limited, divergent, and largely focused on the experiences of procedures, (adverse) effects, information provision, or decision-making. AIMS This study aimed to investigate aspects related to the lived experience and meaning-making of people who have had ECT. METHOD In-depth interviews with 21 women (21-65 years old) were analyzed using interpretative phenomenological analysis (IPA). FINDINGS A subgroup of nine participants described more negative experiences with ECT. A common factor for these participants was the experience of trauma that remained under-treated. The superordinate themes identified were a lack of trauma-based and recovery-oriented treatment. The rest of the sample (12) expressed more positive experiences with ECT. CONCLUSIONS This study suggests that exploring more broadly the impacts of ECT at the long term offers insights that can help design more person-centered services aligned to the needs of the treatment recipients. Educational modules for mental health care staff should include, besides knowledge on the methods' effectiveness, additional evidence about treatment recipients' subjective concerns and the relevance of trauma and recovery-oriented care models.
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Affiliation(s)
- Alina Coman
- Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | - Hilde Bondevik
- Centre for Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
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Rydberg Sterner T, Dahlin-Ivanoff S, Gudmundsson P, Wiktorsson S, Hed S, Falk H, Skoog I, Waern M. 'I wanted to talk about it, but I couldn't', an H70 focus group study about experiencing depression in early late life. BMC Geriatr 2020; 20:528. [PMID: 33287708 PMCID: PMC7720563 DOI: 10.1186/s12877-020-01908-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 11/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knowledge about experiences of depression among younger-old adults from the general population is limited. The aim was to explore experiences of depression in early late life. METHODS Sixteen participants in the population-based Gothenburg H70 Birth Cohort Studies (12 women and 4 men) who had reported a history of depression between ages 60-70 took part in focus group discussions (n = 4). Data were analyzed using focus group methodology. RESULTS The analysis resulted in the overall theme 'I wanted to talk about it, but I couldn't'. The participants expressed unmet needs of communication about depression with family, friends, and healthcare staff. Participants wanted to know more about the causes and effects of depression, available treatment options and how to avoid recurrence. Lack of knowledge was a source of frustration; trust in health care providers was diminished. Being retired meant that opportunities for communication with co-workers were no longer available, and this made it harder to break negative thought and behavioral patterns. Being depressed meant losing one's normal self, and participants were grieving this. Thoughts of death and suicide were experienced in solitude; knowing that there was an escape could generate a feeling of comfort and control. CONCLUSIONS Younger-old adults have expressed a need to talk about their experiences of depression. They would like to know more about available treatments, potential side effects, and how to avoid recurrence. Care providers also need to be aware there is a need for an existential dialogue about death.
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Grants
- 825-2007-7462, 2016-01590, 11267, 825-2012-5041, RAM 2013-8717, 2015-02830, 2017-00639, 2019-01096 Vetenskapsrådet
- 2001-2835, 2004-0145, 2006-0596, Epilife 2006-1506, 2008-1111, 2010-0870, 2013-0475, 2013-1202, AGECAP 2013-2300, 2013-2496, 2016-07097, 2018-00471 Forskningsrådet om Hälsa, Arbetsliv och Välfärd
- 716681, 715841 the Swedish state under the agreement between the Swedish government and the county councils (ALF)
- Hjärnfonden
- Alzheimerfonden
- Konung Gustaf V:s och Drottning Victorias Frimurarestiftelse
- Fredrik och Ingrid Thurings Stiftelse
- Stiftelsen Handlanden Hjalmar Svenssons
- Gun och Bertil Stohnes Stiftelse
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Affiliation(s)
- Therese Rydberg Sterner
- Centre for Aging and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden.
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.
| | - Synneve Dahlin-Ivanoff
- Centre for Aging and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Pia Gudmundsson
- Centre for Aging and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Stefan Wiktorsson
- Centre for Aging and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Sara Hed
- Centre for Aging and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Sweden
| | - Hanna Falk
- Centre for Aging and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Sweden
| | - Ingmar Skoog
- Centre for Aging and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Sweden
| | - Margda Waern
- Centre for Aging and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Gothenburg, Sweden
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Abstract
BACKGROUND Electroconvulsive therapy (ECT) is a controversial treatment. Research has predominantly focused on clinician assessment of short-term efficacy and, occasionally, on participant experiences of the treatment itself. While service user accounts of the long-term impacts of ECT are reported, they are dispersed throughout the literature and typically tangential to studie's main foci. AIM The aim of this study was to synthesise service-user accounts, within peer-reviewed literature, of long-term impacts of ECT in their daily lives. METHODS A qualitative meta-synthesis was conducted. A systematic literature search identified qualitative articles meeting the inclusion criteria. Results sections of eligible papers were analysed thematically. RESULTS From 16 eligible papers, the review identified 11 long-term impacts, four social influences and five strategies that people employed to navigate these long-term impacts. CONCLUSION Limited research has examined long-term experiences of ECT from service-user perspectives. These lived experience perspectives are required to facilitate peer-to-peer learning and assist future service delivery to align with needs of people living with long-term ECT impacts.
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Affiliation(s)
- K Wells
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - N Hancock
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - A Honey
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Clarke KA, Barnes M, Ross D. I had no other option: Women, electroconvulsive therapy, and informed consent. Int J Ment Health Nurs 2018; 27:1077-1085. [PMID: 29171898 DOI: 10.1111/inm.12420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2017] [Indexed: 11/30/2022]
Abstract
Electroconvulsive therapy (ECT) is a controversial procedure used in the management of depression. Whilst it may be administered under mental health legislation, it is usually given to people who voluntarily consent. At the practice level, the consent process for ECT requires a detailed explanation of the procedure. The person consenting must have capacity to make this decision, and consent must be given freely and without coercion. Research using a feminist narrative approach unexpectedly highlighted the issue of potential coercion in the context of explaining the procedure. In-depth interviews were used to understand seven women's accounts of deciding to receive ECT. A thematic analysis of their narratives uncovered a shared concern with how they consented to the treatment. Four subthemes were identified that related to the way in which they provided their consent: (i) 'Not enough information'; (ii) 'I had no other choice'; (iii) 'Just go along with it'; and (iv) 'Lacking capacity'. A consent process that includes elements of passive coercion and a lack of timely and appropriate information influences the way some women make decisions. These factors can disempower women at the point of decision-making. A practice shift is needed where women are enabled to have control over decisions. Further, there is a need to adhere more rigorously to noncoercive practice when obtaining consent.
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Affiliation(s)
- Karen-Ann Clarke
- The School of Nursing, Midwifery and Paramedicine, The University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Margaret Barnes
- The School of Nursing, Midwifery and Paramedicine, The University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Dyann Ross
- Social Work Program, The University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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Kring IS, Bergholt MD, Midtgaard J. The perspectives of former recipients and experts on stigmatization related to electroconvulsive therapy in Denmark: A focus group study. J Psychiatr Ment Health Nurs 2018; 25:358-367. [PMID: 29758121 DOI: 10.1111/jpm.12470] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/04/2018] [Accepted: 05/08/2018] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Electroconvulsive therapy (ECT) has existed worldwide for nearly 80 years. ECT is a fast-working and potentially life-saving treatment, but it is considered controversial. Although frequently mentioned, stigmatization in relation to ECT has not been systematically explored so far. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper provides new insight into both recipient and expert perspectives on ECT. It identifies several issues of stigmatization related to ECT and suggests that full recovery following ECT might be jeopardized due to both stigmatization and self-stigmatization. The study suggests that most of the stigmatizing behaviors can be ascribed to (a lack of) available knowledge of and experience with ECT. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Being aware of and listening to the needs of former ECT-recipients seems essential to increase their treatment options and support care as well as a will to prioritize this patient group. For example, by addressing the potential stigma issues in follow-up groups and helping to distribute sober, factual information about ECT in society. Providing written information and psychoeducation for patients and relatives before, during, and after ECT, in addition to supporting active use of diaries, might be valuable remedies for helping patients feel adequately informed and able to accept the pros and cons of ECT during and after treatment period. ABSTRACT: Introduction Electroconvulsive therapy (ECT) has existed worldwide for nearly 80 years. Although fast-working and potentially life-saving treatment, ECT is regarded as a strongly controversial treatment and stigmatization is frequently mentioned in relation to it. However, no systematic research in this area has taken place so far. Aim The aim of this qualitative study was to explore the experiences and attitudes of former recipients of ECT and of experts professionally involved with ECT to identify potential stigmatization. Method Two focus groups, one comprising four recipients of ECT and the other seven professional experts, were conducted. Data from each focus group were analyzed separately using a framework-analysis. Results The analysis yielded three major themes for the first focus group interview: ambivalent attitudes, discrediting and exclusion, and survival strategies and three major themes for the second focus group interview: dramatic depictions of ECT, an overlooked and rare treatment, and anti-stigmatization strategies. Discussion and implications for practice Stigmatizing attitudes and behaviors in relation to ECT are closely related to one's personal and factual knowledge, and there is a great need for multi-facetted approaches if social acceptance and recognition are to be achieved. This study provides new knowledge on a scarcely examined area while also introducing suitable methods for anti-stigmatization and empowerment.
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Affiliation(s)
| | | | - Julie Midtgaard
- Department of Public Health, University Hospitals' Center of Health Research (UCSF) and Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
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Ejaredar M, Hagen B. I was told it restarts your brain: knowledge, power, and women’s experiences of ECT. J Ment Health 2014; 23:31-7. [DOI: 10.3109/09638237.2013.841870] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Corcoran J, Brown E, Davis M, Pineda M, Kadolph J, Bell H. Depression in older adults: a meta-synthesis. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2013; 56:509-534. [PMID: 23869566 DOI: 10.1080/01634372.2013.811144] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Depression in older adults is often overlooked and dismissed as a part of aging. A body of knowledge-both quantitative and qualitative-has developed on the topic of depression in older adults. Meta-analyses and systematic reviews have been used to synthesize the quantitative findings of studies, and our research seeks to synthesize the qualitative studies that have been conducted on elders' experience with depression. Thirteen studies met inclusion criteria, and 4 major themes were extracted: experiences, causes, recovery, and barriers to treatment. These themes are detailed and their implications for practice are explored.
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Affiliation(s)
- Jacqueline Corcoran
- School of Social Work, Virginia Commonwealth University, Richmond, VA 23284, USA.
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Hirshbein L. Historical essay: electroconvulsive therapy, memory, and self in America. JOURNAL OF THE HISTORY OF THE NEUROSCIENCES 2012; 21:147-169. [PMID: 22428737 DOI: 10.1080/0964704x.2011.577393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Electroconvulsive Therapy (ECT) practitioners and anti-ECT activists have divergent interpretations of both the treatment and its history. Despite claims by ECT opponents that practitioners do not acknowledge memory side effects, the published literature on the procedure demonstrates psychiatrists' awareness of this issue. And though current ECT practitioners claim that memory side effects were mostly the result of outmoded methods, investigators continue to publish studies that indicate ongoing memory problems. This article explores the conflict between pro- and anti-ECT groups around the issue of memory side effects in the broader context of changes in American psychiatry and society.
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Affiliation(s)
- Laura Hirshbein
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA.
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Leiknes KA, Berg RC, Smedslund G, Jarosch-von Schweder L, Øverland S, Hammerstrøm KT, Høie B. Electroconvulsive therapy for depression. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2011. [DOI: 10.1002/14651858.cd009105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kari A Leiknes
- Norwegian Knowledge Centre for the Health Services; Postboks 7004 St. Olavs plass Oslo N-0130 Norway
| | - Rigmor C Berg
- Norwegian Knowledge Centre for the Health Services; Postboks 7004 St. Olavs plass Oslo N-0130 Norway
| | - Geir Smedslund
- Norwegian Knowledge Centre for the Health Services; Postboks 7004 St. Olavs plass Oslo N-0130 Norway
| | - Lindy Jarosch-von Schweder
- NTNU-Faculty of Medicine, Department of Neuroscience; Department of Research and Development, St. Olavs University Hospital; Trondheim Norway
| | - Simon Øverland
- University of Bergen; Department for Health Promotion and Development; Bergen Norway
| | - Karianne T Hammerstrøm
- Norwegian Knowledge Centre for the Health Services; Postboks 7004 St. Olavs plass Oslo N-0130 Norway
| | - Bjørg Høie
- Norwegian Knowledge Centre for the Health Services; Postboks 7004 St. Olavs plass Oslo N-0130 Norway
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Abstract
This article presents findings and analysis stemming from a two-year qualitative study that explored, in their own voices, women's lived experience of electroshock. Feminist standpoint theory frames and provides the moorings for both the validity and methodology of this woman-centered inquiry. In addition, nurses' experiences with and views of ECT are explored and compared to the experiences reported by the women recipients themselves. Vulnerability and disconnection as emergent themes are presented for the nursing profession's sober consideration. The nurses interviewed believed electroshock culminated in a net gain for patients, but for the majority of the women interviewed, electroshock resulted in damage and devastating loss. This article closes with pressing questions for nurses to ask ourselves as we enter the second decade of this new and promising millennium.
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Allan J, Dixon A. Older women's experiences of depression: a hermeneutic phenomenological study. J Psychiatr Ment Health Nurs 2009; 16:865-73. [PMID: 19930360 DOI: 10.1111/j.1365-2850.2009.01465.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This hermeneutic phenomenological study, informed by Max van Manen and Martin Heidegger, describes what it is like for four older women to live with depression. Each participant was interviewed up to three times. Interviews were semi-structured, audiotaped and transcribed verbatim. Data were analysed using van Manen's methodological themes and Heidegger's philosophical concepts of Being-in-the-world and Being-with-others. The themes that emerged were: self-loathing; being overwhelmed by the feelings; hiding from the world; the struggle of everyday life; Being-alone; misinterpreting self and other people; the stigma of mental illness - society and self; and seeking understanding from other people. The findings revealed that depression had a major effect on the women's beliefs about themselves, resulting in a self-loathing and a feeling of failure. The participants described how their self-loathing caused them to believe that other people thought badly of them, which led to their withdrawal. Their inability to connect contributed to them feeling alone and isolated. These women were more able to talk to other people when they were met with understanding. This has implications for the therapeutic nurse-patient relationship, which is fundamental to mental health nursing, because the relationship should be based upon an understanding of the patient's world.
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Affiliation(s)
- J Allan
- Mental Health Nurse, School of Nursing, Otago Polytechnic, Dunedin, New Zealand.
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