Seven year prognosis in depression. Mortality and readmission risk in the Nottingham ECT cohort.

BACKGROUND

The longer term prognosis of depressed patients treated with ECT is relatively unknown. We describe seven-year mortality and readmission risks for the Nottingham ECT series.

METHOD

Cases were defined and subtyped using the Present State Examination (PSE). Follow-up was naturalistic. Death and readmission were ascertained using the Nottingham case register.

RESULTS

The risk of death was doubled (SMR = 1.99, 95% CI = 1.34-2.84, P < 0.001). The seven-year cumulative probability of remaining without readmission was 0.27 (95% CI 0.19-0.35), being 0.79 (0.71-0.87) at 16 weeks (relapse) and 0.34 (0.24-0.44) thereafter (recurrence readmissions). Multiple regression analysis showed that delusions predicted relapse, while endogenous subtype, absence of psychomotor retardation, and previous history predicted recurrence readmissions.

CONCLUSION

Index ECT treatment predicted high longer-term mortality and readmission risks. PSE/CATEGO-based subtyping identified patients most vulnerable to relapse and recurrence.