Self-Harm and Suicide Attempts Preceding and Following Electroconvulsive Therapy: A Population-Based Study

Area of Science:

• Psychiatry
• Clinical Neuroscience
• Public Health

Background:

• Clinical trials show electroconvulsive therapy (ECT) benefits suicidality.
• Naturalistic studies on ECT and suicidality are limited, especially across diverse mental disorders.

Purpose of the Study:

• To investigate the real-world effectiveness of ECT in reducing self-harm and suicide attempts.
• To compare ECT outcomes in unipolar depression, bipolar disorder, psychotic disorder, and personality disorder.
• To validate clinical trial findings using population-based data.

Main Methods:

• Population-based data from Danish registers (2008-2019).
• Included patients receiving first-time ECT for unipolar depression, bipolar disorder, psychotic disorder, or personality disorder.
• Matched comparison groups not receiving ECT were used; a mirror-image model analyzed self-harm/suicide attempt changes pre- and post-ECT.

Main Results:

• Substantial reductions in self-harm/suicide attempts observed in the month following ECT initiation across all diagnostic groups.
• Reductions were statistically significant: unipolar depression (83%), bipolar disorder (72%), psychotic disorder (82%), and personality disorder (83%).
• Comparison groups showed reductions partly mediated by admission, suggesting ECT's specific protective effect.

Conclusions:

• Real-world clinical data align with clinical trial findings on ECT's protective effect against suicidality.
• ECT demonstrates significant effectiveness in reducing self-harm and suicide attempts in diverse psychiatric populations.
• Findings support the use of ECT as a treatment for suicidality in routine clinical practice.