{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T13:42:01Z","timestamp":1776692521996,"version":"3.51.2"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>This research aims to explore the levels of knowledge, attitudes, and willingness (KAW) of patients with bipolar disorder (BD) regarding electroconvulsive therapy (ECT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross-sectional survey was conducted in Nanjing from April 10 to November 3, 2024, using a validated questionnaire [Cronbach's \u03b1 = 0.936, Kaiser\u2013Meyer\u2013Olkin (KMO) = 0.917]. Participants completed structured items assessing knowledge, attitudes, and willingness toward ECT. Data analysis involved descriptive statistics, non-parametric tests, Spearman correlation, multivariate logistic regression, and structural equation modeling (SEM).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study successfully enrolled 479 participants. Of these, 282 participants (58.87%) were female. One hundred and sixty seven respondents (34.86%) had previously undergone ECT. The mean knowledge, attitude, and willingness scores were 5.57 \u00b1 4.84 (possible range: 0\u201316), 29.08 \u00b1 6.21 (possible range: 9\u201345), and 21.49 \u00b1 5.14 (possible range: 6\u201330), respectively. SEM analysis showed that electroconvulsive therapy (\u03b2 = \u22120.377, <jats:italic>P<\/jats:italic> = 0.014), years of BD (\u03b2 = 0.196, <jats:italic>P<\/jats:italic> = 0.014) had direct effects on knowledge. Knowledge (\u03b2 = 0.526, <jats:italic>P<\/jats:italic> = 0.023) directly affected attitude. Meanwhile, electroconvulsive therapy (\u03b2 = \u22120.198, <jats:italic>P<\/jats:italic> = 0.013) and years of BD (\u03b2 = 0.103, <jats:italic>P<\/jats:italic> = 0.016) indirectly affected attitude. Knowledge (\u03b2 = 0.107, <jats:italic>P<\/jats:italic> = 0.018), attitude (\u03b2 = 0.674, <jats:italic>P<\/jats:italic> = 0.009), and gender (\u03b2 = 0.104, <jats:italic>P<\/jats:italic> = 0.020) directly affected willingness. Knowledge (\u03b2 = 0.355, <jats:italic>P<\/jats:italic> = 0.011), electroconvulsive therapy (\u03b2 = \u22120.174, <jats:italic>P<\/jats:italic> = 0.015), and years of BD (\u03b2 = 0.090, <jats:italic>P<\/jats:italic> = 0.020) indirectly affected willingness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The study found that bipolar disorder patients generally lack knowledge and hold negative attitudes but demonstrate a relatively high willingness to accept ECT treatment. Targeted educational programs are recommended to improve understanding, shift attitudes, and enhance acceptance of this treatment in clinical willingness.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1572046","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T04:10:44Z","timestamp":1750824644000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Knowledge, attitudes, and willingness of bipolar disorder patients toward electroconvulsive therapy: a cross-sectional 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