Completed suicide and recent electroconvulsive therapy in Finland

In the research phase of the National Suicide Prevention Project in Finland, all completed suicides in Finland (N = 1,397) within a 12-month period were comprehensively examined by using the psychological autopsy method. In this study, we examined the number of cases having received electroconvulsive therapy (ECT) during the 3 final months before suicide. Only two such cases (0.14% of all suicides) were found, a figure remarkably low considering the high prevalence of severe depression in the suicide population. In both of the two cases, the quality of treatment was questionable, and suicide occurred during a depressive relapse. The findings indirectly support earlier reports suggesting ECT to have a preventive effect concerning suicide. However, alternative explanations, such as low base rate of use of ECT in Finland during the study period, or withholding ECT from some patients because of comorbidity, as well as a combined effect of all the three factors, need also to be considered. Among all suicides, those within 3 months after ECT are rare, and the possible efficacy of ECT in preventing suicide warrants further study.