Electroconvulsive Therapy and Death by Suicide

Bradley V. Watts, MD, MPH; Talya Peltzman, MPH; Brian Shiner, MD, MPH

J Clin Psychiatry 2022;83(3):21m13886

ABSTRACT

Background: It is currently unclear if a course of electroconvulsive therapy (ECT) is associated with a decreased risk of death by suicide. The limited literature based on evidence either does not reflect contemporary practice or else includes patients receiving as few as one treatment. We sought to examine the association of an adequate exposure to ECT treatment with risk of death by suicide in a present-day sample.

Methods: We conducted a study using electronic medical record data from the Department of Veterans Affairs health system from between 2000 and 2017. We compared all-cause and suicide mortality among patients who received an index course of ECT with a comparison group created through propensity score matching.

Results: Our sample included 5,157 index courses of ECT. The suicide death rate in those receiving ECT was 137.34 deaths per 10,000 in 30 days and 804.39 per 10,000 in 365 days. The rate of death by suicide in the control group was 138.65 per 10,000 in 30 days and 564.52 per 10,000 in 1 year. The relative risk of death by suicide comparing those receiving an index course of ECT and the matched group was 0.96 (95% CI, 0.38–1.55; P = .994) in 30 days and 1.38 (95% CI, 0.88–1.87; P = .10) in 1 year.

Conclusion: The risk of suicide mortality 30 days and 1 year following treatment was similar in patients treated with an index course ECT and in a matched group. There was no evidence that an ECT course decreased the risk of death by suicide.

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