Liang Chih-Sung, Chung Chi-Hsiang, Ho Pei-Shen, Tsai Chia-Kuang, Chien Wu-Chien
Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
Bipolar Disord. 2018 Sep;20(6):539-546. doi: 10.1111/bdi.12589. Epub 2017 Dec 11.
Electroconvulsive therapy (ECT) has long been believed to reduce suicidal tendencies in patients with affective disorders; however, ECT recipients, who constitute the most severely ill and suicidal patients, are not eligible to participate in head-to-head randomized controlled trials. Large-scale studies are required to investigate the anti-suicidal effects of ECT vs psychopharmacotherapy.
A nationwide retrospective cohort study design was used. Data were obtained from the Taiwan National Health Insurance Research Database. Inpatients with unipolar disorder or bipolar disorder who received ECT (n = 487) were observed from 1 January 2000 to 31 December 2013 for suicide events. The non-ECT control cohort consisted of inpatients with psychopharmacotherapy randomly matched (ratio, 1:4) by age, sex, and diagnosis.
After potential confounds had been accounted for, the adjusted hazard ratio (HR) was 0.803, indicating that ECT recipients showed a 19.7% lower risk of suicide than control individuals. The stratum-specific adjusted HR was 0.79 in patients with unipolar disorder (P = .041) and 0.923 in patients with bipolar disorder (P = .254). Upon further stratification of the patients with bipolar disorder by their affective states, the adjusted HR was 0.805 (P = .046) for bipolar depression, 1.048 for bipolar mania (P = .538), and 0.976 for mixed bipolar state (P = .126).
Compared with psychopharmacotherapy, ECT exerted superior anti-suicidal effects in patients with unipolar disorder and bipolar depression; however, there was a lack of superior anti-suicidal effects of ECT in the treatment of patients with bipolar mania and mixed state.
长期以来，人们一直认为电休克疗法（ECT）可降低情感障碍患者的自杀倾向；然而，ECT治疗对象是病情最严重且有自杀倾向的患者，他们无资格参与直接比较的随机对照试验。需要大规模研究来调查ECT与心理药物治疗相比的抗自杀效果。
采用全国性回顾性队列研究设计。数据来自台湾国民健康保险研究数据库。观察2000年1月1日至2013年12月31日期间接受ECT治疗的单相障碍或双相障碍住院患者（n = 487）的自杀事件。非ECT对照组由通过年龄、性别和诊断随机匹配（比例为1:4）的接受心理药物治疗的住院患者组成。
在考虑潜在混杂因素后，调整后的风险比（HR）为0.803，表明接受ECT治疗的患者自杀风险比对照组低19.7%。单相障碍患者的分层特异性调整后HR为0.79（P = 0.041），双相障碍患者为0.923（P = 0.254）。对双相障碍患者按情感状态进一步分层后，双相抑郁的调整后HR为0.805（P = 0.046），双相躁狂为1.048（P = 0.538），双相混合状态为0.976（P = 0.126）。
与心理药物治疗相比，ECT对单相障碍和双相抑郁患者具有更好的抗自杀效果；然而，ECT在治疗双相躁狂和混合状态患者时缺乏更好的抗自杀效果。
