Disclosures: Rhee reports no relevant financial disclosures. Please see the abstract for all other disclosures.
September 14, 2021
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Electroconvulsive therapy correlates with lower all-cause mortality

Disclosures: Rhee reports no relevant financial disclosures. Please see the abstract for all other disclosures.
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When used correctly, electroconvulsive therapy can be associated with lower all-cause mortality, according to findings published in The American Journal of Psychiatry.

Previous studies have explored suicide risk during the period following psychiatric hospitalizations and how electroconvulsive therapy (ECT) may reduce all-cause mortality, but many have been inconsistent.

infographic with Rhee quote

“This was the first nationwide cohort study using Medicare claims data,” T. Greg Rhee, PhD, assistant professor of psychiatry and public health at Yale University School of Medicine, told Healio Psychiatry. “It was thus meaningful to look at the effects of ECT on all-cause mortality and suicide rates at the population level.”

Rhee and colleagues investigated ECT in an observational study, in which all patients’ data were taken from the Medicare fee-for-service claims database and the National Death Index from 2010 to 2016. All patients were age 65 or older, had continued Medicare coverage for the 12 months up to index date and had at least one psychiatric hospitalization.

Among the 11,654 patients who met the study criteria, only 10,460 ECT patients had at least one matched control subject for age, gender, principal hospital diagnosis, past-year psychiatric hospitalizations, past-year suicide attempts and Elixhauser comorbidity index. Therefore, there were 31,160 matched control subjects (total n=41,620; 65.4% female; mean age, 74.7 years).

Researchers matched ECT patients in a 1:3 ratio with patients who did not receive ECT. The primary outcome of this study was all-cause mortality and suicide death.

Those in the ECT group experienced lower all-cause mortality for up to 1 year following hospital discharge (adjusted HR=0.61; CI=0.56, 0.66). Although there was a significant association with suicide in the first few months following ECT, it waned over time (1 month: HR=0.44, CI=0.21, 0.91; 2 months: HR= 0.52, CI=0.29, 0.92; 3 months: HR=0.56, CI=0.37, 0.92; 6 months: 0.87, CI=0.59, 1.28; 12 months: 0.92, CI=0.68, 1.25).

Ultimately, ECT correlated with lower 1-year all-cause mortality and with “short-lived protective effects on suicide risk.” There was no significant difference between groups for death by suicide.

“ECT, when appropriately used, can be protective against suicidal behaviors in older adults with severe depression (or those with high risk of suicide),” Rhee said.

This study may not be applicable to younger patients, as all patients were age 65 or older. Another limitation of the study was the impossibility to control for suicide risk factors.