Electroconvulsive Therapy during the COVID-19 Pandemic: Nationwide Data from Denmark

Using nationwide Danish data, this study reveals that electroconvulsive therapy (ECT) provision experienced a significant but temporary reduction during the initial phase of the COVID-19 pandemic, while remaining resilient during subsequent lockdowns, highlighting the need to prioritize safeguarding access to this critical treatment in future public health crises.

The Gist

Imagine the healthcare system as a massive, busy city. Inside this city, there is a very special, high-stakes emergency service called Electroconvulsive Therapy (ECT). Think of ECT not as a scary movie scene, but as a "fire extinguisher" for the mind. When someone's mental health crisis gets so severe that they are in immediate danger, this treatment is the tool that puts out the fire and saves their life.

Now, picture the year 2020 as a giant, unexpected storm hitting the city: the COVID-19 pandemic. When this storm arrived, the whole city went into "lockdown." Roads were closed, buildings were sealed, and everyone was told to stay home. Naturally, the emergency services had to change how they operated.

This paper is like a detective story that looks at the records of Denmark's "mental health fire department" to see what happened to their emergency calls during this storm. Here is what they found, broken down simply:

1. The First Shockwave

When the storm first hit in March 2020, the city panicked. Just like people stopped going to the grocery store or the gym out of fear, many people stopped going to the hospital for their mental health treatments.

• The Analogy: Imagine a busy highway where the cars (patients) suddenly stop driving because everyone is scared of the traffic jam ahead.
• The Result: The number of "fire extinguishers" (ECT treatments) used dropped sharply. The researchers calculated that about 1,366 people who desperately needed this life-saving treatment didn't get it during those first few months. It was a temporary gap in the safety net.

2. The Bounce Back

Here is the good news: The city didn't stay paralyzed.

• The Analogy: After the initial shock, the emergency crews realized, "We can't stop saving lives just because of the storm." They found a way to keep the fire trucks moving safely.
• The Result: Once the first lockdown eased, the number of treatments went back up. If you add those "missed" treatments from early 2020 to the ones that actually happened, the total number of lives saved in 2020 was almost the same as in 2019 (before the storm) and 2022 (after the storm). This proves the system didn't break; it just stumbled for a moment and then caught its balance.

3. The Later Storms

The researchers looked at the second and third times the city went into lockdown.

• The Analogy: By the second and third storms, the firefighters had learned how to drive through the rain. They had new protocols and were ready.
• The Result: Unlike the first time, the number of treatments didn't drop at all. The service remained steady and strong.

The Big Lesson

The main takeaway from this study is that while the pandemic caused a temporary pause in this critical treatment, the Danish healthcare system showed incredible resilience. They managed to get back on track quickly.

The Warning for the Future:
The authors are saying, "If a storm like this hits again, we must make sure our emergency fire trucks are the first things we protect." We cannot let fear of the virus stop us from saving lives that are already in danger. We need to have a plan to keep these critical doors open, especially right at the beginning of a crisis, so no one is left without their "fire extinguisher."

Technical Summary

Technical Summary: Electroconvulsive Therapy during the COVID-19 Pandemic in Denmark

1. Problem Statement
The global COVID-19 pandemic exerted significant pressure on healthcare systems, leading to reported declines in psychiatric interventions, including Electroconvulsive Therapy (ECT). ECT is a critical, life-saving treatment for severe mental illnesses (e.g., treatment-resistant depression, catatonia). While anecdotal reports and smaller studies suggested a reduction in ECT utilization during the pandemic, there was a lack of comprehensive, nationwide data to quantify the extent of this disruption, identify specific temporal patterns, and determine whether the decline was a temporary anomaly or a sustained shift in service delivery.

2. Methodology

• Data Source: The study utilized the Danish National Patient Register, a comprehensive administrative database covering the entire population of Denmark.
• Study Period: Data was analyzed for all ECT treatments administered from September 2019 to May 2025.
• Analytical Approach:
  • Descriptive Analysis: Weekly treatment numbers were visualized to track trends across three distinct national COVID-19 lockdown periods.
  • Temporal Comparison: The study compared ECT volumes during the initial pandemic phase (specifically the first lockdown: March 11 to May 18, 2020) against pre-pandemic baselines and subsequent periods.
  • Post-hoc Estimation: The researchers calculated the volume of "missed" treatments during the initial disruption by comparing observed numbers against expected baselines. These missed treatments were added to the actual 2020 totals to create an "adjusted" annual volume for comparison with 2019 and 2022 figures.

3. Key Contributions

• First Nationwide Quantification: This study provides the first comprehensive, nationwide dataset quantifying the impact of the pandemic on ECT utilization in Denmark, filling a critical gap in global mental health service research.
• Temporal Granularity: By analyzing data on a weekly basis, the study offers high-resolution insights into how healthcare systems responded dynamically to different phases of the pandemic, rather than relying on broad annual averages.
• Differentiation of Pandemic Phases: The research distinguishes between the impact of the initial, high-uncertainty phase of the pandemic versus subsequent lockdowns, revealing that the disruption was not uniform across the entire crisis period.

4. Results

• Initial Disruption: A notable reduction in ECT treatments was observed in the weeks immediately preceding and during the first lockdown (March–May 2020).
• Quantification of Missed Care: Post-hoc estimation indicated approximately 1,366 "missed" treatments occurred during the initial pandemic phase of 2020.
• Resilience and Recovery:
  • When the 1,366 missed treatments were added to the 27,033 treatments actually delivered in 2020, the adjusted total closely approximated the annual volumes seen in 2019 and 2022.
  • This suggests the 2020 decline represented a temporary disruption rather than a permanent reduction in capacity or demand.
  • Subsequent Lockdowns: In contrast to the first lockdown, ECT activity during the second and third national lockdowns remained largely unaffected, indicating that healthcare systems adapted and stabilized ECT provision over time.

5. Significance and Implications

• Clinical Resilience: The findings demonstrate that while the initial shock of a pandemic can severely disrupt critical psychiatric services, healthcare systems possess the capacity to recover and maintain service levels in subsequent phases.
• Policy Recommendations: The study highlights the critical need to safeguard timely access to ECT during the early, chaotic phases of future pandemics. Since ECT is often a last-resort, life-saving intervention for severe mental illness, delays can have severe clinical consequences.
• Future Preparedness: Health authorities should prioritize maintaining ECT infrastructure and protocols specifically during the onset of global health crises to prevent the accumulation of "missed" treatments that could exacerbate the burden of severe mental illness.