Effects of Electroconvulsive Therapy on Short-Term Suicide Mortality in a Risk-Matched Patient Population

Objective Although evidence has suggested that electroconvulsive therapy (ECT) is effective in reducing suicidal ideation, research establishing the effectiveness of ECT in reducing short-term risk of death by suicide is less conclusive. This study assessed whether receipt of ECT reduced suicide mortality among patients seeking healthcare in Veterans Health Administration hospitals. Methods Annual cohorts of patients who received ECT between 2006 and 2015 were propensity score matched with mental health patients who did not receive ECT. After matching, population averaged adjusted odds were calculated to assess the risk of suicide in the year after receipt of ECT, compared with a control group. Results The study population consisted of 14,810 patients in the ECT cohort and 58,369 matched controls. Matching successfully reduced clinical and demographic differences between cohorts of patients who received ECT and those who did not (asymptotic Kolmogorov-Smirnov statistic = 0.02,P> 0.99). After matching and controlling for remaining between-group differences in an adjusted logistic regression, the odds of suicide in the year after receipt of ECT were not statistically different from those of matched patients who did not receive the procedure (odds ratio = 1.31, 95% confidence interval = 0.94-1.96,P= 0.095). Conclusions Patients who received ECT were at a high risk for suicide. Electroconvulsive therapy did not seem to have a greater effect on decreasing short-term risk for suicide than other types of mental health treatment provided to patients with similar baseline risk.