Large variations in worldwide ECT utilization have been described (Leiknes et al. 2012) and concerns have been raised that ECT is being underused in some countries (with some patients being deprived of the most effective treatments available) While overused in certain locations (Smith et al. 1985).

To describe ECT utilization rates in European countries and to examine barriers difficulting its accesibility to ECT in Europe

A systematic review was conducted of studies which reported on ECT utilization rates in european countries in the last 25 years

Wide variations in the use of ECT have also been reported among neighbouring countries and even among different regions within the same country. For example, marked differences have been reported among baltic or nordic countries. In Norway, ECT utilization rate ranged from 1,83 to 3,44 treated per 10.000 inhabitants-year, in Belgium from in Flanders to 10,6 in Brussels and in Edinburgh 18-fold differences have been reported among different psychiatric teams within the same hospital. Lack of human and material resources, economic and legal restrictions, lack of agreement between psychiatrists and social prejudices against ECT might be behind these variations.

Action is needed that ensures a more uniform access to ECT. Health education campaigns, clinical practice guidelines development and implementation and ECT training courses promotion could contribute toward this.