Jelovac Ana, Mohan Christopher, Whooley Emma, Igoe Anna, McCaffrey Cathal, McLoughlin Declan M
Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin, Ireland.
Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
Acta Psychiatr Scand. 2025 Jan;151(1):46-55. doi: 10.1111/acps.13756. Epub 2024 Sep 5.
Childhood maltreatment is associated with less favourable treatment outcomes with pharmacotherapy and psychotherapy for depression. It is unknown whether this increased risk of treatment resistance in maltreated individuals extends to electroconvulsive therapy (ECT).
This retrospective cohort study included 501 consecutive adult referrals for an acute course of twice-weekly ECT for unipolar or bipolar depression at an academic inpatient centre in Ireland between 2016 and 2024. Retrospectively reported physical and sexual childhood maltreatment were assessed on hospital admission. Response was defined as a score of 1 or 2 and remission was defined as a score of 1 on the Clinical Global Impression - Improvement scale 1-3 days after final ECT session. Logistic regression analyses were used to examine the associations between childhood maltreatment and ECT nonresponse and nonremission, adjusting for covariates. Mediation analyses were conducted to explore the role of psychiatric comorbidities, persistent depressive symptoms lasting 2 years or more in the current episode, and baseline depression severity.
Compared to the group with no childhood maltreatment, the childhood maltreatment group had similar odds of ECT nonresponse (adjusted odds ratio = 1.47, 95% CI = 0.85-2.53) but significantly elevated odds of ECT nonremission (adjusted odds ratio = 3.75, 95% CI = 1.80-7.81). In a mediation analysis, presence of persistent depressive symptoms mediated 7.4% of the total effect of childhood maltreatment on ECT nonremission.
Individuals with exposure to childhood maltreatment may be less likely to achieve full remission following a course of ECT.
儿童期受虐待与抑郁症药物治疗和心理治疗的疗效较差有关。受虐待个体治疗抵抗风险增加的情况是否也适用于电休克治疗（ECT）尚不清楚。
这项回顾性队列研究纳入了2016年至2024年期间在爱尔兰一家学术住院中心连续501例因单相或双相抑郁症接受每周两次急性ECT治疗的成年转诊患者。在入院时对回顾性报告的儿童期身体和性虐待情况进行评估。反应定义为在临床总体印象-改善量表上评分为1或2，缓解定义为在最后一次ECT治疗后1-3天评分为1。采用逻辑回归分析来检验儿童期虐待与ECT无反应和未缓解之间的关联，并对协变量进行调整。进行中介分析以探讨精神共病、当前发作中持续两年或更长时间的持续性抑郁症状以及基线抑郁严重程度的作用。
与无儿童期虐待的组相比，儿童期虐待组ECT无反应的几率相似（调整后的优势比=1.47，95%置信区间=0.85-2.53），但ECT未缓解的几率显著升高（调整后的优势比=3.75，95%置信区间=1.80-7.81）。在中介分析中，持续性抑郁症状的存在介导了儿童期虐待对ECT未缓解总效应的7.4%。
经历过儿童期虐待的个体在接受ECT治疗后可能较难实现完全缓解。
