Examining Attitudes and Ethical Concerns about Electroceutical Therapies for Major Depression:
Key Findings from a National 4-Year Study
What factors shape ethical concerns, attitudes, and beliefs people hold regarding Psychiatric Electroceutical Interventions (PEIs) to treat neuropsychiatric conditions such as treatment-resistant depression?
As new PEIs are being developed and tested, it is urgent to clearly understand these concerns and to address them for professional and patient alike.
A recent NIH Brain Initiative study examined key views from over 3,500 psychiatrists, patients and the general public surrounding four specific PEIs:
• electroconvulsive therapy (ECT)
• repetitive transcranial magnetic stimulation (rTMS)
• deep brain stimulation (DBS)
• adaptive brain implants (ABIs)
When people lack clear information about the merits and use of a therapeutic intervention, these views can prevent them from accepting the intervention and/or reduce needed treatment referrals.
Our findings identify key issues that scholars and practitioners must address to help PEIs reach their full potential, as well as issues that can inform policy making for the responsible use of PEIs.
Among stakeholder groups, psychiatrists reported more favorable views of PEIs than did non-clinicians (the general public, caregivers, and patients). Throughout the survey, the three non-clinician groups had very similar attitudes and concerns.
Across treatment modalities, participants viewed rTMS more favorably than ECT and the two implantable PEIs (DBS and ABIs) as least favorable overall.
By Stakeholder Group
Compared to psychiatrists, non-clinicians perceived their assigned PEI as more invasive.
SCALE
1 not at all
2 minimally
3 somewhat
4 moderately
5 substantially
6 greatly
Compared to psychiatrists, non-clinicians perceived their assigned PEI as riskier but also just as beneficial.
SCALE
1 not at all
2 minimal
3 slight
4 moderate
5 substantial
6 great
By Treatment Modality
Participants reported more positive affect toward ECT and rTMS relative to the implantables PEIs.
SCALE
1 most negative
2 more negative
3 slightly negative
4 neutral
5 slightly positive
6 more positive
7 most positive
By Stakeholder Group AND Treatment Modality
The most frequently mentioned barrier to the use of PEIs by each stakeholder group was “limited evidence of the treatment’s effectiveness.” The percentages of non-clinicians perceiving this as the most important barrier were similar across treatment modality, while the same percentages of psychiatrists varied greatly by treatment.
Each non-clinician stakeholder group most frequently mentioned “limited evidence of the treatment’s safety” as their top ethical concern about the use of PEIs. The percentages of non-clinicians identifying this as their top ethical concern were similar across treatment modality. Psychiatrists most frequently mentioned “patient not getting the treatment when it would actually help them” as their top ethical concern about the use of PEIs. The percentages of psychiatrists identifying this as their top ethical concern varied greatly across treatment modality.
In many instances, psychiatrists’ views about PEIs—including affect, perceived risk, and perceived barriers to treatment and other ethical concerns—were significantly different than those of patients, caregivers, and the general public.
The study’s findings are important for a few reasons. When people are uninformed or misinformed about the merits and use of a therapeutic intervention, their views may prevent them from accepting a safe and effective intervention and also may reduce needed referrals for treatment. Conversely, uncritical and unrealistic expectations together with unbridled enthusiasm may lead to premature acceptance and uptake.
Stigma emerged as a key concept underlying several of the views we measured, including affect and perceived barriers.
Stigma associated with PEIs likely compounds the enduring stigma attached to mental disorders. This heightened stigma may further inhibit those who may most benefit from such interventions from seeking out and adhering to these mental health treatments.
Educational materials, more up-to-date [practical] guidelines, and evidence-informed policies could demystify these procedures and highlight current evidence about PEIs. In this way, they would improve treatment-related decision-making for health care professionals, patients, and their families.
For more details regarding the different findings, please check the resources links below or visit the Cabrera Lab at Penn State University.
Research presented on this website was supported by the BRAIN Initiative in the US National Institute of Mental Health of the National Institutes of Health under award number RF1MH117802 (PI: Laura Y. Cabrera). This funding source had no influence on the study design; the collection, analysis, and interpretation of data; the creation and design of this website; or the decision to make this website public. The content on this website is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
We thank the members of our Scientific Advisory Board—Galit Pelled (MSU), Tom Tomlinson (MSU), and Alik S. Widge (University of Minnesota)—as well as our students and collaborators: Emily Castillo (MSU), Sandra Cai Chen (Penn State University), Marissa Cortright (MSU), Maryssa M. C. Miller (MSU), Gerald Nowak III (MSU), Megan Russ (MSU), Jodi Tyron (Pine Rest Christian Mental Health Services), and Eleni Varelas (MSU).
We thank our participants for their time and insightful responses.
Copyright 2022. All rights reserved. Laura Y. Cabrera, Aaron M. McCright, Robyn Bluhm, and Eric D. Achtyes.
