J ECT. 2022 Mar 1;38(1):13-23. doi: 10.1097/YCT.0000000000000790.
The beneficial effect of electroconvulsive therapy (ECT) on suicidality has been documented in clinical trials, whereas naturalistic studies on the topic are scarce and restricted to individuals with mood disorders. Here, based on population-based data from Danish registers, we aimed to investigate the course of self-harm and suicide attempts preceding and following ECT across 4 major mental disorders. This was done to examine whether data from the real-world clinical setting are compatible with the positive results from clinical trials.
We identified all patients diagnosed with unipolar depression (n = 8843), bipolar disorder (n = 2713), psychotic disorder (n = 2692), or personality disorder (n = 2085) who received ECT for the first time in the period from 2008 to 2019, as well as age-, sex-, diagnosis-, illness duration-, and admission-matched comparison groups not receiving ECT. A mirror-image model was used to examine whether the number of incidents of self-harm/suicide attempts changed following ECT (paired t test).
There were substantial and statistically significant reductions in the number of incidents of self-harm/suicide attempts when comparing the month leading up to and the month following initiation of ECT for all diagnostic groups (unipolar depression: reduction, 83% [P < 0.001]; bipolar disorder: reduction, 72% [P < 0.001]; psychotic disorder: reduction, 82% [P < 0.001]; personality disorder: reduction, 83% [P < 0.001]). The analog results for the comparison groups not receiving ECT suggested that these reductions in self-harm/suicide attempts were partly mediated by a protective effect of admission.
Data from the real-world clinical setting are compatible with results from clinical trials with regard to the protective effect of ECT on suicidality.
临床试验已经证明电抽搐治疗（ECT）对自杀意念的有益作用，而关于这一主题的自然主义研究却很少，并且仅限于心境障碍患者。在这里，我们基于丹麦登记处的基于人群的数据，旨在调查在 4 种主要精神障碍中，ECT 治疗前后的自我伤害和自杀企图的进展情况。这样做是为了检验真实临床环境的数据是否与临床试验的阳性结果一致。
我们确定了 2008 年至 2019 年期间首次接受 ECT 的单相抑郁（n=8843）、双相障碍（n=2713）、精神病性障碍（n=2692）或人格障碍（n=2085）患者，并将其与未接受 ECT 的年龄、性别、诊断、病程和入院相匹配的对照组进行比较。使用镜像模型来检验 ECT 治疗后自我伤害/自杀企图的次数是否发生变化（配对 t 检验）。
与 ECT 治疗前的月份相比，所有诊断组在 ECT 治疗后的月份中，自我伤害/自杀企图的次数都有实质性且具有统计学意义的减少（单相抑郁：减少 83%[P<0.001]；双相障碍：减少 72%[P<0.001]；精神病性障碍：减少 82%[P<0.001]；人格障碍：减少 83%[P<0.001]）。未接受 ECT 的对照组的类似结果表明，这些自我伤害/自杀企图的减少部分是由入院的保护作用介导的。
真实临床环境的数据与临床试验结果一致，即 ECT 对自杀意念有保护作用。
