Association Between Early Initiation of Electroconvulsive Therapy and Length of Stay in Acute Psychiatric Inpatients

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