Retrospective Study on Suicide/Suicidal Ideation During Depression: Treatment Data (Including ECT) From China

 Out on PubMed, from researchers in China, is this study:

Real-world evidence from a retrospective study on suicide during depression: clinical characteristics, treatment patterns and disease burden.

Wang H, Lyu N, Huang J, Fu B, Shang L, Yang F, Zhao Q, Wang G.BMC Psychiatry. 2024 Apr 19;24(1):300. doi: 10.1186/s12888-024-05726-y.PMID: 38641767

The abstract is copied below:

Background: Suicide stands as both a primary symptom and the direst outcome of major depressive disorder (MDD). The scarcity of effective treatment strategies makes managing MDD patients with suicide especially challenging. Hence, it is crucial to investigate disease characteristics and efficacious therapeutic strategies for these patients, drawing insights from disease databases and real-world data.

Methods: In this retrospective study, MDD patients hospitalized between January 2013 and December 2020 were investigated using Electronic Health Records (EHR) data from Beijing Anding Hospital. The study enrolled 4138 MDD patients with suicidal ideation or behavior (MDS) and 3848 without (MDNS). Demographic data, clinical attributes, treatment approaches, disease burden, and re-hospitalization within one year of discharge were extracted and compared.

Results: Patients in the MDS group were predominantly younger and female, exhibiting a higher prevalence of alcohol consumption, experiencing frequent life stress events, and having an earlier onset age. Re-hospitalizations within six months post-discharge in the MDS group were significantly higher than in the MDNS group (11.36% vs. 8.91%, p < 0.001). Moreover, a more considerable fraction of MDS patients underwent combined electroconvulsive therapy treatment (56.72% vs. 43.71%, p < 0.001). Approximately 38% of patients in both groups were prescribed two or more therapeutic regimes, and over 90% used antidepressants, either alone or combined. Selective serotonin reuptake inhibitors (SSRIs) were the predominant choice in both groups. Furthermore, antidepressants were often prescribed with antipsychotics or mood stabilizers. When medication alterations were necessary, the favoured options involved combination with antipsychotics or transitioning to alternative antidepressants. Yet, in the MDS group, following these initial modifications, the addition of mood stabilizers tended to be the more prioritized alternative.

Conclusions: MDD patients with suicidal ideation or behaviour displayed distinctive demographic and clinical features. They exhibited intricate treatment patterns, a pronounced burden of illness, and an increased likelihood of relapse.

Keywords: Major depressive disorder; Real-world study; Suicide; Treatment pattens.

The report is here.

And from the text:

Here is another large-scale study from China, with data that are either difficult to believe, or so divergent in practice as to be merely a curiosity. More than half of all their depressed patients with suicidal ideation/behavior get ECT, as well >40% without SI? Really? Am I reading this correctly?

While I have always argued for "right sizing" the prescription of ECT, I have meant an increase from ~1-2% to 5-7% of seriously depressed patients. 

Not sure what to make of all this; comments welcome!