{
  "abstract": "Background Electroconvulsive therapy (ECT) is among the most effective treatments for treatment-resistant mood disorders.Objective This study aims to meta-analyse the effects of ECT on all-cause mortality and suicide deaths in severe unipolar or bipolar depression using longitudinal studies.Study selection and analysis PubMed/MEDLINE, PsycINFO, Cochrane Library, Embase and Google Scholar were searched from inception through 21 January 2025. Inclusion criteria were: (1) patients with diagnoses of mental disorders; (2) intervention consisted of ECT compared with placebo, usual care or another intervention; (3) all-cause mortality and suicide deaths as outcomes measures; and (4) clinical trial or longitudinal cohort study designs where the aforementioned interventions preceded the observations of outcome measures. Adjusted HR with their corresponding 95% CIs were estimated using random-effects models. Moderator analyses were also performed.Findings Overall, 17 studies consisting of 1 182 501 individuals (n=40 867 for patients with ECT, n=1 141 634 for patients with non-ECT) were included. 94.1% of the studies focused on patients with unipolar or bipolar depression and one study was focused on schizoaffective disorder. ECT was associated with a reduction in risk of all-cause mortality (HR 0.70 (95% CI 0.61 to 0.81); p<0.001), a finding that was consistent at 3 months, 6 months and 12 months of follow-up. Regions had a moderating effect; Japan had the largest effect size (HR 0.17 (95% CI 0.04 to 0.72)) and Denmark had the smallest (HR 0.87 (95% CI 0.83 to 0.92)). ECT was associated with a reduction in suicide risk at 3 months of follow-up (HR 0.53 (95% CI 0.39 to 0.72); p<0.001) but not at 1, 6 or 12 months of follow-up.Conclusions ECT is associated with a reduced risk of all-cause mortality. However, ECT use for suicide protection appears transient and inconsistent.Clinical implications ECT may be safely used among patients with severe unipolar or bipolar depression.PROSPERO registration number CRD42025641749.",
  "authors": [
    {
      "affiliations": [
        "Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA",
        "Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA"
      ],
      "name": "Taeho Greg Rhee"
    },
    {
      "affiliations": [
        "Department of Biomedical Informatics, Konyang University, Daejeon, Korea (the Republic of)"
      ],
      "name": "Sungryul Shim"
    },
    {
      "affiliations": [
        "Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA"
      ],
      "name": "Madeeha Nasir"
    },
    {
      "affiliations": [
        "Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Roger S. McIntyre"
    },
    {
      "affiliations": [
        "Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada",
        "Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada"
      ],
      "name": "Tyler S. Kaster"
    },
    {
      "affiliations": [
        "Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA"
      ],
      "name": "Samuel T. Wilkinson"
    }
  ],
  "title": "Longitudinal associations of electroconvulsive therapy with all-cause mortality and suicide deaths in severe unipolar or bipolar depression: a systematic review and meta-analysis",
  "uid": "35adece8-05ae-565e-bc65-7fd522256328"
}