Electroconvulsive therapy reduces suicide risk in those hospitalized with depression

Treatment with electroconvulsive therapy significantly reduced the risk of death by suicide among those hospitalized with depression in the year following discharge, according to a study published in Lancet Psychiatry.

“Electroconvulsive therapy is considered one of the most effective treatments for depression. Evidence suggests that electroconvulsive therapy results in symptom remission in more than 60% of patients,” Tyler S. Kaster, PhD, of the Temerty Centre for Addiction and Mental Health in Toronto, and colleagues wrote.

Kaster and colleagues sought to examine the risk of death by suicide after psychiatric hospitalization in patients with depression following electroconvulsive therapy (ECT) treatment compared to those who did not.

The researchers conducted a propensity score-weighted, retrospective cohort study, which utilized linked population-level administrative health data to discover 67,327 psychiatric hospitalization records (27,231 men, 40,096 women; mean age, 45.1 years) of adults with depression who had been admitted to a hospital in Ontario, Canada, for more than 3 days between April 1, 2007, and Dec. 31, 2017.

The primary outcome was death by suicide identified using administrative health records within 1 year following discharge. Cox proportional hazards model was used to estimate the cause-specific hazard ratio (csHR) for ECT-exposed and unexposed individuals. Secondary outcomes were non-suicide death and all-cause mortality.

From the initial cohort, 4,982 patients were exposed to ECT and 62,345 were not. Results showed that ECT was associated with a significantly reduced risk of suicide death (csHR, 0.53; 95% CI, 0.31–0.92) and was also associated with a significantly reduced risk of all-cause mortality (HR, 0.75; 95% CI, 0.58–0.97), but not non-suicide death (csHR, 0.83; 95% CI, 0.61–1.12). Accounting for non-suicide death as a competing risk had no effect on the findings.

“These findings support the view that electroconvulsive therapy can be a lifesaving treatment in patients with severe depression,” Kaster and colleagues wrote.