Association Between Early Initiation of Electroconvulsive Therapy and Length of Stay in Acute Psychiatric Inpatients: A Retrospective Cohort Study in Taiwan

J ECT. 2026 Feb 12. doi: 10.1097/YCT.0000000000001249. Online ahead of print.

ABSTRACT

OBJECTIVES: Electroconvulsive therapy (ECT) provides rapid relief for severe psychiatric disorders, but its impact on hospital length of stay (LOS) remains unclear in Asian settings. We hypothesized that early ECT (≤7 d after admission) would reduce LOS in acute psychiatric inpatients in Taiwan.

METHODS: In this retrospective cohort study in Northern Taiwan (January 2022 to December 2023), we analyzed 552 admissions (428 patients; mean age, 41.9 y; 55.6% female). Two hundred three (36.8%) received ECT (mean 5.8 sessions; 87.2% early). Primary outcome was LOS; secondary outcomes included CGI scores and timely discharge (≤21 d). Analyses used multivariable regressions and 1:1 propensity score matching (PSM; n=406) to adjust for age, sex, MDD, schizophrenia spectrum disorders, and dementia. Logistic regressions assessed early ECT’s association with discharge timing.

RESULTS: Unadjusted LOS was shorter with ECT (-4.7 d; 95% CI: -7.7 to -1.7; P=0.003), but nonsignificant after adjustment (P=0.560) or PSM (P=0.459). Delayed ECT increased LOS (β=1.20 d per day; 95% CI: 0.95-1.45; P<0.001); schizophrenia increased LOS (β=13.23; 95% CI: 7.94-18.52; P<0.001). Early ECT predicted timely discharge (≤21 d: adjusted OR, 22.34; 95% CI: 5.92-84.27; P<0.001). Schizophrenia reduced ≤21-day odds (adjusted OR, 0.18; 95% CI: 0.06-0.51; P=0.001), while MDD shortened LOS (β=-4.51; 95% CI: -7.90 to -1.12; P=0.009).

CONCLUSIONS: ECT alone did not reduce overall LOS after adjustments. Early ECT is associated with timely discharge in acute psychiatric inpatients, particularly MDD, supporting its integration to optimize efficiency in Asian systems.

PMID:41678318 | DOI:10.1097/YCT.0000000000001249