Spanggård Anders, Rohde Christopher, Østergaard Søren Dinesen
Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Acta Psychiatr Scand. 2023 Apr;147(4):333-344. doi: 10.1111/acps.13536. Epub 2023 Feb 15.
Despite the putative anti-suicidal effect of electroconvulsive therapy (ECT), patients receiving ECT remain at high risk of dying from suicide due to the severity of their underlying mental illness. We aimed to quantify this risk and to identify risk factors for suicide among patients receiving ECT.
Using nationwide Danish registers, we identified all patients that initiated ECT between 2006 and 2016. These patients were matched on sex and age to 10 reference individuals from the general Danish population. Firstly, we compared 2-year suicide risk between patients initiating ECT and the matched reference individuals. Secondly, we investigated if any patient characteristics were associated with suicide following ECT via Cox proportional hazards regression.
A total of 11,780 patients receiving ECT and 117,800 reference individuals were included in the analyses. Among the patients receiving ECT, 161 (1.4%) died from suicide within two years. Compared to the reference individuals, patients having received ECT had a substantially elevated suicide rate (Hazard rate ratio (HRR) = 44.48, 95%CI = 31.12-63.59). Among those having received ECT, the following characteristics were associated with suicide: Male sex (adjusted HRR (AHRR) = 2.32, 95%CI = 1.63-3.30), medium-term higher education (AHRR = 2.64, 95%CI = 1.57-4.44); long-term higher education (AHRR = 3.16, 95%CI = 1.68-5.94), history of substance use disorder (AHRR = 1.51, 95%CI = 1.01-2.26) and history of intentional self-harm/suicide attempt (AHRR = 4.18, 95%CI = 2.76-6.32).
Those who are male, have obtained medium-/long-term higher education, or have a history of substance use disorder or intentional self-harm/suicide attempt, are at particularly elevated risk of suicide following ECT. These findings may guide clinical initiatives to reduce suicides.
尽管电休克疗法（ECT）具有假定的抗自杀作用，但由于其潜在精神疾病的严重性，接受ECT治疗的患者死于自杀的风险仍然很高。我们旨在量化这一风险，并确定接受ECT治疗的患者中自杀的风险因素。
利用丹麦全国性登记系统，我们确定了2006年至2016年间开始接受ECT治疗的所有患者。这些患者在性别和年龄上与来自丹麦普通人群的10名对照个体进行匹配。首先，我们比较了开始接受ECT治疗的患者与匹配的对照个体之间的两年自杀风险。其次，我们通过Cox比例风险回归研究是否有任何患者特征与ECT治疗后的自杀有关。
共有11,780名接受ECT治疗的患者和117,800名对照个体纳入分析。在接受ECT治疗的患者中，161人（1.4%）在两年内死于自杀。与对照个体相比，接受ECT治疗的患者自杀率大幅升高（风险率比（HRR）=44.48，95%置信区间=31.12-63.59）。在接受ECT治疗的患者中，以下特征与自杀有关：男性（调整后HRR（AHRR）=2.32，95%置信区间=1.63-3.30）、中等教育程度（AHRR=2.64，95%置信区间=1.57-4.44）；高等教育程度（AHRR=3.16，95%置信区间=1.68-5.94）、物质使用障碍史（AHRR=1.51，95%置信区间=1.01-2.26）和故意自伤/自杀未遂史（AHRR=4.18，95%置信区间=2.76-6.32）。
男性、接受过中等/高等教育、有物质使用障碍史或故意自伤/自杀未遂史的患者，在接受ECT治疗后自杀风险尤其升高。这些发现可能会指导临床采取措施减少自杀。
