Self-Harm and Suicide Attempts Preceding and Following Electroconvulsive Therapy

Salagre, Estela; Rohde, Christopher; Østergaard, Søren Dinesen

doi:10.1097/yct.0000000000000790

Cited by 13 publications

(16 citation statements)

References 33 publications

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“…10 A recent Danish population-based study that included more than 10,000 patients with unipolar depression, bipolar disorder, psychotic disorder, or personality disorder reported substantial significant reductions in the number of self-harm incidents and suicide attempts from the month preceding to the month following the initiation of ECT across all diagnostic groups. 11 Moreover, two recent large cohort studies revealed that ECT was associated with reductions in the risk of death by suicide in patients with depression. 12,13 However, data from the Danish National Patient Registry reported that ECT was associated with an increased risk of suicide in those with moderate depression, which most likely arose through bias by indication.…”

Section: Introductionmentioning

confidence: 99%

“…By the end of a treatment course, 80% of patients with depression who reported experiencing suicidal thoughts and behaviors, defined as a score of 3 or 4 on the suicide item of the Hamilton Depression Rating Scale (HDRS), had a score of 0 10 . A recent Danish population‐based study that included more than 10,000 patients with unipolar depression, bipolar disorder, psychotic disorder, or personality disorder reported substantial significant reductions in the number of self‐harm incidents and suicide attempts from the month preceding to the month following the initiation of ECT across all diagnostic groups 11 …”

Section: Introductionmentioning

confidence: 99%

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Suicidal ideation and ECT, ECT and suicidal ideation: A register study

Sienaert

Brus

Lambrichts

et al. 2022

Acta Psychiatr Scand

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Objective Although electroconvulsive therapy (ECT) is anti‐suicidal, it is not known whether the presence of suicidal ideation (SI) at baseline predicts response and remission after ECT. The aim of the study was to analyze the impact of baseline SI on response and remission following ECT treatment in a large sample of patients with depression and to assess SI before and after ECT. Methods This population‐based register study used data from the Swedish National Quality Register for ECT and the Swedish Patient Register. Patients aged 18 years or older who had received ECT for a unipolar or bipolar depressive episode between 2011 and 2018 were included in the study. SI was defined as a score of ≥4 on the last item of the Montgomery–Åsberg Depression Rating Scale – Self Assessment (MADRS‐S). Using a logistic regression model, SI at baseline was used to predict response and remission following ECT, while controlling for depression severity, psychotic symptoms, presence of a comorbid personality disorder, age, sex, electrode position, unipolar or bipolar disorder, and number of previous suicide attempts at baseline. Results In patients who exhibited SI at baseline, 53.7% (N = 632) of cases showed a response to ECT, whereas 68.4% (N = 690) of patients without SI showed a response. In addition, 27.2% (N = 320) of cases with SI achieved remission, whereas 48.5% (N = 489) of cases without SI achieved remission. The odds of achieving response and remission for patients with SI were 0.75 and 0.58 times, respectively, those for patients without SI. Of the 1178 patients with pre‐treatment SI, 75.64% (N = 891) exhibited no SI at the end of treatment. Moreover, in this subgroup, the presence of a personality disorder, higher MADRS‐S‐score, and younger age were associated with persistent SI. Conclusion The presence of SI was associated with lower ECT response and remission rates. Nevertheless, depressive symptoms and SI were reduced in a large proportion of patients across both patient groups. Clinicians should be aware of the lower likelihood of achieving a successful outcome following ECT in younger patients who present with a non‐psychotic depressive episode, SI, and (suspected) personality disorders. More research is warranted regarding if these patients can achieve similar or better results with other treatments.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Suicidal ideation and ECT, ECT and suicidal ideation: A register study

Sienaert

Brus

Lambrichts

et al. 2022

Acta Psychiatr Scand

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“…3 To the extent that cognitive adverse effects are a concern in a particular patient, Miller et al 4 found that high power in the electroencephalogram theta band predicts greater acute cognitive adverse effects from high-dose right unilateral ECT, thus creating an opportunity to monitor the ictal electroencephalogram and accordingly adjust the stimulus dose early in the treatment course. A rarer adverse effect of ECT is the occurrence of tardive seizure after the ECT session, and the impression of the rarity of this event is confirmed in this issue of the Journal by Warren et al 5 On a different note, although ECT is an acknowledged strategy to quiet suicidal ideation, [6][7][8][9] the corresponding literature on transcranial magnetic stimulation (TMS) and suicidal ideation has been sparse. Therefore, we welcome the randomized clinical trial by Hines et al 10 showing that intensive, thrice-daily TMS was superior to sham TMS in rapidly relieving acute suicidal ideation.…”

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confidence: 90%

Editor's Roundup for Issue 2 of 2022

McCall¹

2022

J ECT

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“…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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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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Self-Harm and Suicide Attempts Preceding and Following Electroconvulsive Therapy

Abstract: Supplemental digital content is available in the text.

Cited by 13 publications

References 33 publications

Suicidal ideation and ECT, ECT and suicidal ideation: A register study

Suicidal ideation and ECT, ECT and suicidal ideation: A register study

Editor's Roundup for Issue 2 of 2022

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

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