The Swedish National Quality Registry for ECT

Depression is one of the most frequent causes of functional impairment and death at an early age. Electroconvulsive therapy (ECT) is an established and effective treatment for severe depression. ECT can also be used to treat other psychiatric disorders such as manic episodes, schizophrenia, schizoaffective disorder and cycloid psychosis. National statistics can contribute to reduce differences in access to treatment and quality of treatment. A national registry can also enable research about the short- and long-term effects of the treatment. The primary purpose of the registry is improved effectiveness of the treatment, and reduced side effects.

Coverage rate

About 95 percent.

Registry set-up and funding

In 2008, a regional ECT register was started in 3 counties in Sweden. The National Board of Health and Welfare and the Swedish Psychiatric Association considered it important to document the use of ECT in Sweden in more detail. In 2011, the regional register was expanded to a national quality register with financial support from the Swedish Association of Local Authorities and Regions.

Steering board and organisation

The steering board of the register consists of representatives from all health care regions in Sweden, representatives with specialization in anesthesiology, neuropsychology and ECT-nursing, a representative from the Swedish Psychiatric Association and a representative from a patient’s association. Axel Nordenskjöld, M.D and specialist in psychiatry, is chair of the steering board. A register coordinator, a statistician/epidemiologist and regional nurse coordinators are also involved with the register.

Gathered and documented information

The registry holds detailed information on the patient characteristics, severity of symptoms, indications for therapy, electrical stimulus and seizures, course of treatment, pharmacotherapy (including the post-ECT medication used to reduce the risk of relapse), and side effects. The register is used for both quality assurance and for research. It is a non-mandatory register, and every patient has the option of declining participation. All of the 45 hospitals that provided ECT in Sweden reported to the national quality registry for ECT in 2023. Of the 3 977 patients treated with ECT in Sweden in 2023, 95% opted to participate in the national quality registry. 30 000 patients have been registered in total. Data from the register can be linked to other registries such as the mandatory patient registry of the National Board of Health and Welfare and the registry for social insurance of the Swedish Social Insurance Agency.

Quality indicators

One of the aims of the national quality registry for ECT is to enable monitoring of compliance with the Swedish clinical guidelines for ECT issued in 2014. A number of quality indicators based on the clinical guidelines have been selected. By using the indicators we can survey and study the use of ECT in Sweden and measure patient-reported outcomes.

Brief list of quality indicators

• Proportion of patients documented with an established indication for ECT.
• Proportion of patients with severe depression in psychiatric inpatient care that were treated with ECT.
• Proportion of patients with depression that are evaluated with MADRS or MADRS-S after index-ECT.
• Proportion of patients reaching remission from depression after the ECT.
• Proportion of patients where the result of the self-report measure for memory function (CPRS-memory item) is documented before and after ECT.
• Proportion of patients reporting subjective memory worsening after ECT.

Registry for Repetitive Transcranial Magnetic Stimulation (rTMS)

Since 2018 the register also collects data about Repetitive Transcranial Magnetic Stimulation.

Inclusion criteria for the registry

All patients treated with Electroconvulsive therapy (ECT) in Sweden can be registered.  Procedure codes for Electroconvulsive therapy (ECT): DA006, DA024, DA025

All patients treated with Repetitive Transcranial Magnetic Stimulation in Sweden can be registered.  Procedure codes for Repetitive Transcranial Magnetic Stimulation (rTMS): DU050