School of Medical Sciences, Örebro University, Örebro, Sweden.
University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
JAMA Netw Open. 2021 Jul 1;4(7):e2116589. doi: 10.1001/jamanetworkopen.2021.16589.
Electroconvulsive therapy (ECT) is indicated for severe depression, including depression with psychosis, catatonia, and/or an elevated suicide risk. However, the association of ECT with suicide risk is uncertain.
To determine the association between ECT and the risk of suicide in patients with unipolar major depressive disorder.
DESIGN, SETTING, AND PARTICIPANTS: This registry-based cohort study used patient data from Swedish national registers. Patients with a record of inpatient care between January 1, 2012, and October 31, 2018, for moderate depression, severe depression, or severe depression with psychosis were included in the study. Propensity score matching (1:1) was used to balance risk factors for suicide at baseline between patients treated with and without ECT during the inpatient episode.
Data from the Swedish National Quality Register for ECT and the Swedish National Inpatient Register were combined to identify patients who had received ECT during the inpatient episode. National registers were used to identify risk factors for suicide.
Suicide within 3 and 12 months of admission to inpatient care was analyzed. Cox regression analyses were used to adjust for confounders.
The study included 28 557 patients (mean [SD] age, ECT group, 55.9 [18.4] years; non-ECT group, 45.2 [19.2] years; 15 856 women [55.5%]). In the matched sample of 5525 patients in each group, 62 patients (1.1%) in the ECT group and 90 patients (1.6%) in the non-ECT group died of suicide within 12 months (hazard ratio [HR], 0.72; 95% CI, 0.52-0.99). Electroconvulsive therapy was significantly associated with a decreased risk of suicide in patients with psychotic features (HR, 0.20; 95% CI, 0.08-0.54) and those aged 45 to 64 years (HR, 0.54; 95% CI, 0.30-0.99) or 65 years or older (HR, 0.30; 95% CI, 0.15-0.59), but not in patients aged 44 years or younger (HR, 1.22; 95% CI, 0.68-2.16).
The results of this cohort study support the continued use of ECT to reduce suicide risk in hospitalized patients who are severely depressed, especially those who are older than 45 years and those with a psychotic subtype.
电抽搐疗法（ECT）适用于严重抑郁症，包括伴有精神病、紧张症和/或自杀风险升高的抑郁症。然而，ECT 与自杀风险的关联尚不确定。
确定 ECT 与单相重性抑郁障碍患者自杀风险之间的关系。
设计、地点和参与者：这项基于登记的队列研究使用了瑞典国家登记处的患者数据。纳入了 2012 年 1 月 1 日至 2018 年 10 月 31 日期间因中度、重度或伴有精神病的重度抑郁症住院治疗的患者。在住院期间，采用倾向性评分匹配（1:1），以平衡接受和未接受 ECT 治疗的患者自杀风险的基线因素。
结合瑞典国家 ECT 质量登记和瑞典国家住院患者登记的数据，以确定住院期间接受 ECT 的患者。国家登记处用于确定自杀风险因素。
分析入院后 3 个月和 12 个月内的自杀情况。采用 Cox 回归分析调整混杂因素。
该研究纳入了 28557 例患者（平均[标准差]年龄，ECT 组 55.9[18.4]岁；非 ECT 组 45.2[19.2]岁；15856 名女性[55.5%]）。在每组 5525 例匹配患者中，ECT 组有 62 例（1.1%）患者和非 ECT 组有 90 例（1.6%）患者在 12 个月内死于自杀（风险比[HR]，0.72；95%CI，0.52-0.99）。ECT 与伴有精神病特征（HR，0.20；95%CI，0.08-0.54）和 45 至 64 岁（HR，0.54；95%CI，0.30-0.99）或 65 岁及以上（HR，0.30；95%CI，0.15-0.59）患者的自杀风险降低显著相关，但与 44 岁及以下患者（HR，1.22；95%CI，0.68-2.16）的自杀风险降低无关。
这项队列研究的结果支持继续使用 ECT 降低住院严重抑郁患者的自杀风险，尤其是年龄在 45 岁以上和伴有精神病亚型的患者。
