Validity of diagnoses, treatment dates, and rating scales in the Swedish national quality register for electroconvulsive therapy

Ahmad, Irma; Sandberg, Matilda; Brus, Ole; Ekman, Carl Johan; Hammar, Åsa; Landén, Mikael; Lundberg, J.; Nordanskog, Pia; Knorring, Lars von; Nordenskjöld, Axel

doi:10.1080/08039488.2021.1939416

Cited by 11 publications

(7 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This study was a register‐based study of in‐ or outpatients who received ECT for the treatment of depression, using data from the Swedish National Quality Register for ECT and the Swedish Patient Register. The Swedish National Quality Register for ECT contains information on ECT series, such as when the treatment series started and ended, symptom severity before and after treatment, and diagnosis used as an indication for treatment 21,22 23 …”

Section: Methodsmentioning

confidence: 99%

“…The Swedish National Quality Register for ECT contains information on ECT series, such as when the treatment series started and ended, symptom severity before and after treatment, and diagnosis used as an indication for treatment. 21,22 The Swedish Patient Register contains information on whether patients were treated as outpatients or inpatients and diagnoses made (85%-95% of diagnoses were valid). 23 Because this was a register-based study, no informed consent was obtained from participants.…”

Section: Limitationsmentioning

confidence: 99%

See 1 more Smart Citation

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

Sienaert

Brus

Lambrichts

et al. 2022

Acta Psychiatr Scand

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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

Sienaert

Brus

Lambrichts

et al. 2022

Acta Psychiatr Scand

Self Cite

View full text Add to dashboard Cite

show abstract

“…17 The Swedish National Quality Registry for ECT (Q-ECT) is an opt-out register with 90% coverage 21 and high validity. 22 It contains detailed information on ECT administered across all ECT centers in Sweden. In this study, Q-ECT was combined with several other national registers to yield data on demographic and clinical factors as potential prognostic factors associated with response to ECT in patients with mania.…”

Section: Introductionmentioning

confidence: 99%

“…One study reported that greater severity of manic symptoms was associated with a better response to ECT, although this association was not confirmed in the study by Mukherjee and collegues . The Swedish National Quality Registry for ECT (Q-ECT) is an opt-out register with 90% coverage and high validity . It contains detailed information on ECT administered across all ECT centers in Sweden.…”

Section: Introductionmentioning

confidence: 99%

Association of Clinical and Demographic Characteristics With Response to Electroconvulsive Therapy in Mania

et al. 2022

Self Cite

View full text Add to dashboard Cite

IMPORTANCEKnowledge of the effectiveness of electroconvulsive therapy (ECT) in the treatment of manic episodes is based on clinical experience, but empirical evidence is scarce. Moreover, prognostic factors associated with response to ECT in patients with mania are poorly understood. OBJECTIVE To investigate the response to ECT in patients with manic episodes. DESIGN, SETTING, AND PARTICIPANTS This nationwide, register-based observational cohort study was conducted using data from patients admitted to psychiatric departments in Sweden that reported data to the Swedish National Quality Registry for ECT (Q-ECT). Patients admitted to any hospital in Sweden and receiving ECT for a manic episode between 2012 and 2019 were considered for inclusion (605 individuals). The outcome, Clinical Global Impression Improvement scale (CGI-I) score, was available in 571 patients. Data from several national registers were combined to determine clinical and sociodemographic factors. Analysis of data occurred from April through September 2021.EXPOSURES Patients treated with ECT for a mania were identified from the Q-ECT. MAIN OUTCOMES AND MEASURESResponse to ECT was defined by a CGI-I score of 1 (very much improved) or 2 (much improved). Remission was defined as a Clinical Global Impression Severity scale (CGI-S) score of 1 (reference range or not ill) or 2 (minimally ill) within 1 week after ECT.Univariate and multivariable regression models were used to investigate associations of sociodemographic factors, psychopharmacology, and comorbidities with response. RESULTS Among 571 patients with mania treated with ECT (211 [37.0%] men; median [IQR] age, 46 [31-59] years), 482 patients (84.4%) responded to ECT. Comorbid anxiety and obsessivecompulsive disorder (OCD) were associated with lower odds of response to ECT (adjusted odds ratio [aOR], 0.48; 95% CI, 0.25-0.90 and aOR, 0.17; 95% CI, 0.06-0.56, respectively). Patients who were markedly ill (aOR, 2.93; 95% CI, 1.23-7.00), severely ill (aOR, 2.60; 95% CI, 1.06-6.34), or among the most extremely ill (aOR, 7.94; 95% CI, 2.16-29.21) according to CGI-S score had higher odds of response than those with mild or moderate illness. CONCLUSIONS AND RELEVANCEThis study found that ECT was associated with improvement for mania in clinical settings, with especially high response rates in patients with severe illness and those without comorbid anxiety or OCD.

show abstract

“…Diagnoses in the registers used for this study were recorded in regular clinical settings, meaning that diagnostic methods may have varied, although the validity of psychiatric diagnoses has been found to be high in both the NPR 27 and Q-ECT. 28 The outcome was measured with the CGI-I instead of depression rating scales, and assessments were non-blinded. The method used for defining TRD does not include non-pharmacological treatments, does not require switching between antidepressant classes and makes assumptions about medication failure when a new prescription is filled, meaning that some patients may have been misclassified as having TRD if they did not actually take the collected medication or dropped out because of side-effects.…”

Section: Discussionmentioning

confidence: 99%

Response to electroconvulsive therapy in treatment-resistant depression: nationwide observational follow-up study

et al. 2023

Self Cite

View full text Add to dashboard Cite

Background Previous studies have not investigated response rates after electroconvulsive therapy (ECT) in patients with non-psychotic treatment-resistant depression (TRD). Aims To assess and compare the response rate of ECT for patients with TRD and non-TRD, in a large and clinically representative patient sample. Method Patients aged ≥18 years, who were treated for a unipolar, non-psychotic depressive episode with at least one ECT session as part of a first-time, index ECT series between 1 January 2011 and 31 December 2017 were included from the Swedish National Quality Register for ECT. Patients who had initiated a third consecutive trial of antidepressants or add-on medications before start of ECT were classified as having TRD. Patients not meeting criteria for TRD were classified as non-TRD. The main outcome was response to ECT according to the Clinical Global Impressions – Improvement Scale (CGI-I), scored as 1 or 2 (‘very much’ or ‘much improved’ after ECT, respectively). Logistic regression was used to compare outcome measures between TRD and non-TRD, adjusting for potential confounders. Results A total of 4244 patients were included. Of these, 1121 patients had TRD and 3123 patients had non-TRD. The CGI-I response rate was 65.9% in the TRD group compared with 75.9% in the non-TRD group (adjusted odds ratio 0.64, 95% CI 0.54–0.75). Older age and more severe depression were predictors of response in patients with TRD. Conclusions A clear majority of patients with TRD, as well as patients with non-TRD, responded to ECT, although the response rate was somewhat lower for TRD.

show abstract

Validity of diagnoses, treatment dates, and rating scales in the Swedish national quality register for electroconvulsive therapy

Cited by 11 publications

References 18 publications

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

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

Association of Clinical and Demographic Characteristics With Response to Electroconvulsive Therapy in Mania

Response to electroconvulsive therapy in treatment-resistant depression: nationwide observational follow-up study

Contact Info

Product

Resources

About