Risk factors for suicide among patients having received treatment with electroconvulsive therapy: A nationwide study of 11,780 patients

IF 5.3 2区医学 Q1 PSYCHIATRY Acta Psychiatrica Scandinavica Pub Date : 2023-02-06 DOI:10.1111/acps.13536

Anders Spangg?rd, Christopher Rohde, S?ren Dinesen ?stergaard

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Abstract

Objectives

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.

Methods

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.

Results

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).

Conclusions

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.

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接受电休克治疗的患者自杀的危险因素:一项涉及11780名患者的全国性研究

尽管电惊厥治疗(ECT)被认为具有抗自杀作用，但由于其潜在精神疾病的严重程度，接受ECT治疗的患者仍然存在死于自杀的高风险。我们的目的是量化这种风险，并确定接受ECT的患者自杀的危险因素。方法使用丹麦全国范围内的登记册，我们确定了2006年至2016年期间接受ECT治疗的所有患者。这些患者在性别和年龄上与丹麦普通人群中的10名参考个体相匹配。首先，我们比较了开始ECT的患者和匹配的参照个体的2年自杀风险。其次，我们通过Cox比例风险回归调查是否有任何患者特征与ECT后自杀相关。结果共纳入11780例ECT患者和117800例对照个体。在接受ECT治疗的患者中，161人(1.4%)在两年内死于自杀。与对照组相比，接受ECT治疗的患者自杀率明显升高(危险率比(HRR) = 44.48, 95%CI = 31.12-63.59)。在接受电休克治疗的患者中，以下特征与自杀相关:男性(调整HRR = 2.32, 95%CI = 1.63-3.30)、中期高等教育(AHRR = 2.64, 95%CI = 1.57-4.44);长期高等教育(AHRR = 3.16, 95%CI = 1.68 ~ 5.94)、物质使用障碍史(AHRR = 1.51, 95%CI = 1.01 ~ 2.26)、故意自残/自杀未遂史(AHRR = 4.18, 95%CI = 2.76 ~ 6.32)。结论男性、接受过中长期高等教育、有药物使用障碍史或有故意自残/自杀企图者，电痉挛治疗后自杀风险特别高。这些发现可以指导临床减少自杀。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Psychiatrica Scandinavica 医学-精神病学

CiteScore

11.20

自引率

3.00%

发文量

135

审稿时长

6-12 weeks

期刊介绍： Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.