Association of ECT with risks of all-cause mortality and suicide in older Medicare patients

1. In a cohort of older adults with mood disorders in the United States, electroconvulsive therapy (ECT) was associated with lower all-cause mortality and short-term protective effects on suicide risk. 

Evidence Rating Level: 2 (Good) 

Studies show that individuals suffering from mood disorders are at a greater risk for premature mortality. Similarly, rates of suicide are higher amongst this population. Electroconvulsive therapy (ECT) is a possible intervention that may reduce all-cause mortality and suicide in patients suffering from psychiatric disorders. However, the results from various research studies have been inconsistent. Therefore, this retrospective cohort study aimed to evaluate the effect of ECT on all-cause mortality and suicide in older adults on Medicare. It utilized data from the Medicare fee-for-service claims database. The study matched ECT patients with those who did not receive ECT in a 1:3 ratio based on various characteristics. The study included 10,460 patients who received ECT and 31,160 who did not receive ECT. Exposure was defined as having had one or more ECT treatments during index hospitalization. The primary outcomes assessed were all-cause mortality and suicide death. The study demonstrated that compared with the control group, the ECT group had significantly all-cause mortality for up to 1 year (hazard ratio, 0.61; 95% CI, 0.56-0.66). However, over the 1-year follow-up, there was no significant difference between the groups in rate of suicide death. Therefore, the study concluded that ECT may offer benefit for all-cause mortality, yet it did not influence suicide death. Future studies should therefore further evaluate the effects of ECT beyond 12 months and preferably through randomized controlled study design. 

Click to read the study in AJP

Image: PD

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