Electroconvulsive therapy in Germany: a nationwide multilevel analysis of determinants, regional patterns, and institutional variation.

Marie Dreger, Andreas Uphaus, David Zilles-Wegner, Alexander Sartorius, Michael Guhra, Stefan Kreisel

Abstract read

In one paragraph

Article in European archives of psychiatry and clinical neuroscience, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0cells of the map it votes in

0citing papers in PubMed

–field-weighted citation impact

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Marie DregerDepartment of Business and Health, Bielefeld University of Applied Sciences and Arts (HSBI), Bielefeld, Germany. marie.dreger@hsbi.de.ORCID https://orcid.org/0000-0001-6879-604X

Andreas UphausDepartment of Business and Health, Bielefeld University of Applied Sciences and Arts (HSBI), Bielefeld, Germany.

David Zilles-WegnerDepartment of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany.

Alexander SartoriusDepartment of Psychiatry and Psychotherapy, Research Group Brain Stimulation, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.

Michael GuhraMedical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Psychiatry and Psychotherapy, Bielefeld University, Bielefeld, Germany.

Stefan KreiselMedical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Psychiatry and Psychotherapy, Bielefeld University, Bielefeld, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Electroconvulsive therapy (ECT) is an effective treatment for severe psychiatric disorders, yet its use may be shaped not only by clinical need but also by structural and institutional factors. Using nationwide 2023 administrative data from the German psychiatric prospective payment system (PEPP), we examined whether regional ECT utilization corresponded to regional diagnostic burden and assessed patient-, institutional-, and regional-level factors associated with receiving ECT. The analysis included 837,762 inpatient psychiatric discharges; in addition, descriptive information on day hospital ECT activity was obtained from publicly available aggregate data. Across inpatient and day hospital settings, 16,312 cases received ECT and 72,193 ECT procedures were documented. Regional ECT rates showed essentially no association with the regional frequency of ECT-relevant diagnoses. ECT provision was also strongly concentrated in larger institutions. In multilevel models, depression, catatonia, schizophrenia-spectrum disorders, bipolar disorder, female sex, older age, and annual psychiatric case volume were positively associated with ECT receipt. However, substantial residual heterogeneity remained at the institutional level (median odds ratio 23.6) after adjustment for case mix and contextual factors. These findings suggest that variation in ECT use in Germany is only weakly aligned with proxies of clinical need and is shaped to a considerable extent by institutional and structural conditions, indicating potential inequities in access to ECT across regions and providers.

Indexed as

Electroconvulsive TherapyHospitals, PsychiatricMental DisordersAdultAgedFemaleGermanyHumansMaleMiddle AgedMultilevel AnalysisAdministrative dataElectroconvulsive therapyGermanyHealth services researchMultilevel analysisRegional variation

Identifiers

PMID42362820

DOI10.1007/s00406-026-02305-y

PMCPMC13562103

What OpenQuestion holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.