ECT, All-Cause Mortality and Suicide: New Study of Older Medicare Patients

 Out on PubMed, from researchers at Yale , Columbia, and Rutgers, is this study:

Association of ECT With Risks of All-Cause Mortality and Suicide in Older Medicare Patients.

Rhee TG, Sint K, Olfson M, Gerhard T, H Busch S, Wilkinson ST.Am J Psychiatry. 2021 Sep 10:appiajp202121040351. doi: 10.1176/appi.ajp.2021.21040351. Online ahead of print.PMID: 34503341

The abstract is copied below:

Objective: This observational study examined the effects of electroconvulsive therapy (ECT) on suicide and all-cause mortality risk in older psychiatric patients.

Methods: Participants were Medicare-insured psychiatric inpatients age 65 or older. Patients receiving ECT were exact-matched to control subjects (in a 1:3 ratio) on age, gender, principal hospital diagnosis, past-year psychiatric hospitalizations, past-year suicide attempts, and Elixhauser comorbidity index. Cox proportional hazard models were risk-adjusted for race, year of hospitalization, rural-urban continuum code, year of index hospitalization, median income of zip code, and all matched covariates to estimate hazard ratios with 95% confidence intervals.

Results: A total of 10,460 patients in the ECT group and 31,160 in the control group were included in the analyses (total N=41,620; 65.4% female; mean age, 74.7 years [SD=7.09]). Compared with the control group, patients receiving ECT had lower all-cause mortality for up to 1 year following hospital discharge (adjusted hazard ratio=0.61, 95% CI=0.56, 0.66). For death by suicide, 1-year survival analysis showed no group difference. A significant association was observed with suicide in the first months following ECT, but this pattern waned over time (1 month: hazard ratio=0.44, 95% CI=0.21, 0.91; 2 months: hazard ratio=0.52, 95% CI=0.29, 0.92; 3 months: hazard ratio=0.56, 95% CI=0.37, 0.92; 6 months: 0.87, 95% CI=0.59, 1.28; 12 months: 0.92, 95% CI=0.68, 1.25).

Conclusions: In this observational study, ECT was associated with lower 1-year all-cause mortality and with short-lived protective effects on suicide risk. These findings support greater consideration of ECT for inpatients with mood disorders at short-term risk of suicide.

Keywords: Bipolar and Related Disorders; Depressive Disorders; Electroconvulsive Therapy (ECT); Major Depressive Disorder; Suicide and Self-Harm.

And from the text:

Discussion:

In a large sample of older Medicare psychiatric inpatients, ECT was associated with a protective though short-lived effect on suicide risk and an enduring protective effect on all-cause mortality risk. As compared with matched patients who did not receive ECT, patients who received ECT had a lower suicide rate during the 3 months following discharge. However, this association was not observed at 6 or 12 months. Patients who received ECT had a lower rate of all-cause mortality for up to 12 months following treatment, consistent with previous research.

...In exploring categories of mortality, ECT patients were less likely to die from a number of causes, including smoking related diseases, cancer (excluding smoking-related cancer), circulatory disease, diabetes, and substance use.While several mechanisms may be at play, one potential way in which ECT might lead to reduction in mortality risk is that improved functioning following ECT allows patients to maintain a healthier lifestyle and to better engage in treatment for whatever medical conditions they face.

...In summary, in this large observational study, ECT was associated with a consistently lower risk of all-cause mortality and a reduced though short-lived association with the risk of suicide death. This report adds to a growing body of research suggesting a positive effect of ECT from a population health perspective. Future efforts should focus on ways to ensure broader implementation of this treatment and to improve the maintenance therapy of severely ill patients who receive ECT.

2021has been a good year for showing that ECT prevents suicide: first the Ronnqvist paper (see blog posts of August 5th and 12th), and now this. This is an important paper in a major journal with well-respected authors and sophisticated methodology. The figures are particularly well done and make the data easy to understand.The two findings, reduced all-cause mortality and short-term reduction of suicide, are both important. That short-term benefit could probably be extended with maintenance ECT.

I recommend a full and careful read of this paper to all healthcare personnel involved with ECT, ~ 20 minutes.