Association of ECT With Risks of All-Cause Mortality and Suicide in Older Medicare Patients

Rhee, Taeho Greg; Sint, Kyaw; Olfson, Mark; Gerhard, Tobias; Busch, Susan H.; Wilkinson, Samuel T.

doi:10.1176/appi.ajp.2021.21040351

Cited by 39 publications

(34 citation statements)

References 33 publications

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“…The high mortality-and suicide rate among patients receiving ECT is to be expected considering the severity of the mental disorders treated with ECT [37] and is in line with findings from prior studies [6,15,18,38]. This underlines the need for careful monitoring of this patient population following ECT -with emphasis on the risk of suicide.…”

Section: Discussionsupporting

confidence: 79%

See 1 more Smart Citation

Risk factors for suicide following treatment with electroconvulsive therapy: A nationwide study of 11,780 patients

Spanggård

Rohde

Østergaard

2022

Preprint

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Objectives: Despite the well-established anti-suicidal effect of electroconvulsive therapy (ECT), patients receiving ECT remain at high risk of dying from suicide. In the present study, we aimed to quantify this risk and identify risk factors for suicide among patients receiving ECT. Methods: We used nationwide Danish registers to identify all patients that initiated ECT between 2006 and 2016. These patients were matched on sex and age to 10 reference individuals from the general Danish population. First, we compared 2-year suicide risk between patients initiating ECT and the matched reference individuals. Second, we investigated if any patient characteristics were associated with suicide following ECT via Cox proportional-hazards regression. Results: A total of 11,780 patients receiving ECT and 117,800 reference individuals were included in the analyses. Among the patients receiving ECT, 161 (1.4%) died from suicide within two years. Compared to the reference individuals, patients receiving ECT had a substantially elevated suicide rate (Hazard rate ratio (HRR)=44.5, 95%CI=31.1-63.6). Among those receiving ECT, we identified the following risk factors for suicide: Male sex (HRR=2.3, 95%CI=1.7-3.1), age 60-70 years (HRR=1.6, 95%CI=1.0-2.6), Medium-term higher education (HRR=1.5, 95%CI=1.0-2.2); Long-term higher education (HRR=1.9, 95%CI=1.1-3.1), history of substance use disorder (HRR=2.0, 95%CI=1.4-2.8) and history of intentional self-harm/suicide attempt (HRR=4.0, 95%CI=2.8-5.8). Conclusion: Among patients receiving ECT, those who are male, aged 60-70 years, have medium-term to long-term higher education, or have a history of substance use disorder or intentional self-harm/suicide attempt, are at particularly elevated risk of suicide. These findings may guide initiatives to reduce the risk of suicide.

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Section: Discussionsupporting

confidence: 79%

“…The anti-suicidal effect of ECT across mental disorders is well-established [6][7][8][9][10][11][12][13][14][15][16]. However, because the "baseline" risk of suicide among patients receiving ECT is highly elevated, suicide remains a relatively common cause of death for those having received ECT [17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for suicide following treatment with electroconvulsive therapy: A nationwide study of 11,780 patients

Spanggård

Rohde

Østergaard

2022

Preprint

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“…Furthermore, because ECT is usually reserved for the most severely ill patients, observational studies that adequately account for confounding by indication are inherently difficult to conduct. While ECT has consistently been associated with lower risks of all-cause mortality (Jorgensen et al, 2020;Rhee et al, 2021), further carefully conducted research is needed to examine the extent to which ECT may provide protection against suicide risk.…”

Section: Electroconvulsive Therapymentioning

confidence: 99%

Pharmacological and somatic treatment effects on suicide in adults: A systematic review and meta‐analysis

Diaz

Rupp

Kidambi

et al. 2021

Depression and Anxiety

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Background: Suicide is a public health crisis. We conducted a systematic review and meta-analysis of the effects of psychopharmacologic and somatic therapies on suicide risk.Methods: A systematic search of MEDLINE for studies evaluating the effects of pharmacologic (excluding antidepressants) or somatic interventions on suicide risk was conducted. Studies were included if they used a comparison group, reported on suicide death, assessed a psychopharmacological or somatic intervention, and included adults. Study quality was assessed using the Newcastle-Ottawa scale. Fiftyseven studies were included from 2940 reviewed citations.Results: In bipolar disorder, lithium was associated with a reduction in the odds of suicide compared to active controls (odds ratio [OR] = .58, p = .005; k = 12) and compared to placebo/no lithium (OR = .46, p = .009; k = 9). In mixed diagnostic samples, lithium was associated with a reduction in the odds of suicide compared to placebo/no lithium (OR = .27, p < .001; k = 12), but not compared to active controls (OR = .89, p = .468; k = 7). In psychotic disorders, clozapine was associated with a reduction in the odds of suicide (OR = .46, p = .007; k = 7). Associations between suicide death and electroconvulsive therapy (OR = .77, p = .053; k = 11), nonclozapine antipsychotics in bipolar disorder (OR = .73, p = .090; k = 6) and antipsychotics in psychotic disorders (OR = .39, p = .069; k = 6) were not significant.There was no consistent relationship between antiepileptic mood stabilizers and suicide. There were insufficient studies to meta-analyze associations of suicide risk with vagus nerve stimulation, transcranial magnetic stimulation, magnetic seizure therapy, or transcranial direct current stimulation. Conclusion:Lithium and clozapine have consistent data supporting protective effects against suicide in certain clinical contexts.

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“…The mortality rate associated with ECT is 2.1 per 100,000 treatments [69], and all-cause mortality is approximately three per 10,000 ECT [70,71]. Additionally, ECT is associated with a lower one-year all-cause mortality compared with matched control subjects [72].…”

Section: Safety Of Ect In Patients Without Dmc-tmentioning

confidence: 99%

Effectiveness of electroconvulsive therapy in patients lacking decision making capacity: A systematic review and meta-analysis

et al. 2022

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Association of ECT With Risks of All-Cause Mortality and Suicide in Older Medicare Patients

Cited by 39 publications

References 33 publications

Risk factors for suicide following treatment with electroconvulsive therapy: A nationwide study of 11,780 patients

Risk factors for suicide following treatment with electroconvulsive therapy: A nationwide study of 11,780 patients

Pharmacological and somatic treatment effects on suicide in adults: A systematic review and meta‐analysis

Effectiveness of electroconvulsive therapy in patients lacking decision making capacity: A systematic review and meta-analysis

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