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In-hospital mortality among electroconvulsive therapy recipients: A 17-year nationwide population-based retrospective study

Published online by Cambridge University Press:  23 March 2020

C.-S. Liang ,
C.-H. Chung ,
C.-K. Tsai  and
W.-C. Chien
C.-S. Liang
Affiliation:
Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
C.-H. Chung
Affiliation:
School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, ROC
C.-K. Tsai
Affiliation:
Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
W.-C. Chien*
Affiliation:
School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
*
*Corresponding author. School of Public Health 4109R, No.161, Section 6, Min-Chuan East Road, Neihu District, Taipei City 11490, Taiwan, ROC. Tel.: +886 2 8792 3100; fax: +886 2 8792 3147. E-mail address:chih1005@hotmail.com.tw (W.-C. Chien).
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Abstract

Background

Electroconvulsive therapy (ECT) remains irreplaceable in the treatment of several psychiatric conditions. However, evidence derived using data from a national database to support its safety is limited. The aim of this study was to investigate in-hospital mortality among patients with psychiatric conditions treated with and without ECT.

Methods

Using data from the Taiwan National Health Insurance Research Database from 1997 to 2013, we identified 828,899 inpatients with psychiatric conditions, among whom 0.19% (n = 1571) were treated with ECT.

Results

We found that ECT recipients were more frequently women, were younger and physically healthier, lived in more urbanized areas, were treated in medical centers, and had longer hospital stays. ECT recipients had lower odds of in-hospital mortality than did those who did not receive ECT. Moreover, no factor was identified as being able to predict mortality in patients who underwent ECT. Among all patients, ECT was not associated with in-hospital mortality after controlling for potential confounders.

Conclusion

ECT was indicated to be safe and did not increase the odds of in-hospital mortality. However, ECT appeared to be administered only on physically healthy but psychiatrically compromised patients, a pattern that is in opposition with the scientific evidence supporting its safety. Moreover, our data suggest that ECT is still used as a treatment of last resort in the era of modern psychiatry.

Keywords

Electroconvulsive therapyDeathIn-hospital mortalitySafetyNational database
Type
Original article
Information
European Psychiatry , Volume 42 , May 2017 , pp. 29 - 35
Copyright
Copyright © European Psychiatric Association 2017

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Footnotes

Abbreviations: ECT, electroconvulsive therapy; NHIRD, National Health Insurance Research Database; NHI, National Health Insurance; ICD-9-CM, International Classification of Diseases9th Revision, Clinical Modification; CCI, Charlson Comorbidity Index; GEE, generalized estimating equations; OR, odds ratio.

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