Effects of Electroconvulsive Therapy on Short-Term Suicide Mortality in a Risk-Matched Patient Population

Abstract

Objective Although evidence has suggested that electroconvulsive therapy (ECT) is effective in reducing suicidal ideation, research establishing the effectiveness of ECT in reducing short-term risk of death by suicide is less conclusive. This study assessed whether receipt of ECT reduced suicide mortality among patients seeking healthcare in Veterans Health Administration hospitals. Methods Annual cohorts of patients who received ECT between 2006 and 2015 were propensity score matched with mental health patients who did not receive ECT. After matching, population averaged adjusted odds were calculated to assess the risk of suicide in the year after receipt of ECT, compared with a control group. Results The study population consisted of 14,810 patients in the ECT cohort and 58,369 matched controls. Matching successfully reduced clinical and demographic differences between cohorts of patients who received ECT and those who did not (asymptotic Kolmogorov-Smirnov statistic = 0.02, P > 0.99). After matching and controlling for remaining between-group differences in an adjusted logistic regression, the odds of suicide in the year after receipt of ECT were not statistically different from those of matched patients who did not receive the procedure (odds ratio = 1.31, 95% confidence interval = 0.94–1.96, P = 0.095). Conclusions Patients who received ECT were at a high risk for suicide. Electroconvulsive therapy did not seem to have a greater effect on decreasing short-term risk for suicide than other types of mental health treatment provided to patients with similar baseline risk.

Neurobiological Basis of Increased Risk for Suicidal Behaviour

“…Electroconvulsive therapy (ECT) is safe and effective in reducing suicidal ideation in drug-resistant depression and schizophrenia in adults and adolescents, including population of pregnant women [118][119][120]. Interestingly, some data suggest that pre-ECT high level of TNF-α predicts a good response to ECT [121], and electroconvulsive therapy decreases inflammatory mediators [122].…”

On this month's Round the Corner: I welcome the argument about ECT

“…Nor is there any evidence that ECT prevents suicide, as is so often claimed. In a study published since our review, 14 810 patients receiving ECT were 1.3 times more likely to die by suicide than 58 369 non-ECT controls (Peltzman 2020).…”

A second independent audit of electroconvulsive therapy in England, 2019: Usage, demographics, consent, and adherence to guidelines and legislation

“…None of the five meta-analyses identified any studies showing long-term benefits. The review's conclusion that there is no evidence ECT prevents suicide, as often claimed, was subsequently confirmed by a study of 14,810 ECT patients and 58,369 controls (Peltzman, Shiner, & Watts, 2020). The review concluded:…”