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Seven year prognosis in depression. Mortality and readmission risk in the Nottingham ECT cohort
1Department of Psychiatry, Addenbrooke's Hospital, Cambridge, UK.
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.