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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.

References

McCall, W.V.Electroconvulsive therapy in the era of modern psychopharmacology. Int J Neuropsychopharmacol 2001;4:315–324.CrossRefGoogle ScholarPubMed
Tess, A.V., Smetana, G.W.Medical evaluation of patients undergoing electroconvulsive therapy. N Engl J Med 2009;360:1437–1444.CrossRefGoogle ScholarPubMed
Lisanby, S.H.Electroconvulsive therapy for depression. N Engl J Med 2007;357:1939–1945.CrossRefGoogle ScholarPubMed
Eranti, S.V., McLoughlin, D.M.Electroconvulsive therapy – state of the art. Br J Psychiatry 2003;182:8–9.CrossRefGoogle ScholarPubMed
Kellner, C.H., Greenberg, R.M., Murrough, J.W., Bryson, E.O., Briggs, M.C., Pasculli, R.M.ECT in treatment-resistant depression. Am J Psychiatry 2012;169:1238–1244.CrossRefGoogle ScholarPubMed
McDonald, A., Walter, G.The portrayal of ECT in American movies. J ECT 2001;17:264–274.CrossRefGoogle ScholarPubMed
Kramer, B.A.Use of ECT in California, 1977–1983. Am J Psychiatry 1985;142:1190–1192.Google Scholar
Shiwach, R.S., Reid, W.H., Carmody, T.J.An analysis of reported deaths following electroconvulsive therapy in Texas, 1993–1998. Psychiatr Serv 2001;52:1095–1097.CrossRefGoogle ScholarPubMed
Nuttall, G.A., Bowersox, M.R., Douglass, S.B., McDonald, J., Rasmussen, L.J., Decker, P.A.et al.Morbidity and mortality in the use of electroconvulsive therapy. J ECT 2004;20:237–241.CrossRefGoogle ScholarPubMed
Munk-Olsen, T., Laursen, T.M., Videbech, P., Mortensen, P.B., Rosenberg, R.All-cause mortality among recipients of electroconvulsive therapy: register-based cohort study. Br J Psychiatry 2007;190:435–439.CrossRefGoogle ScholarPubMed
Watts, B.V., Groft, A., Bagian, J.P., Mills, P.D.An examination of mortality and other adverse events related to electroconvulsive therapy using a national adverse event report system. J ECT 2011;27:105–108.CrossRefGoogle ScholarPubMed
Ostergaard, S.D., Bolwig, T.G., Petrides, G.No causal association between electroconvulsive therapy and death: a summary of a report from the Danish Health and Medicines Authority covering 99,728 treatments. J ECT 2014;30:263–264.CrossRefGoogle ScholarPubMed
Goodman, W.K.Electroconvulsive therapy in the spotlight. N Engl J Med 2011;364:1785–1787.CrossRefGoogle ScholarPubMed
Case, B.G., Bertollo, D.N., Laska, E.M., Price, L.H., Siegel, C.E., Olfson, M.et al.Declining use of electroconvulsive therapy in United States general hospitals. Biol Psychiatry 2013;73:119–126.CrossRefGoogle ScholarPubMed
Hsing, A.W., Ioannidis, J.P.Nationwide population science: lessons from the Taiwan National Health Insurance Research Database. JAMA Intern Med 2015;175:1527–1529.CrossRefGoogle ScholarPubMed
Nan-Ping, Y., Yi-Hui, L., Chi-Yu, C., Jin-Chyr, H., I-Liang, Y., Nien-Tzu, C.et al.Comparisons of medical utilizations and categorical diagnoses of emergency visits between the elderly with catastrophic illness certificates and those without. BMC Health Serv Res 2013;13:1–8.CrossRefGoogle Scholar
Liu, C.-Y., Hung, Y., Chuang, Y., Chen, Y., Weng, W., Liu, J.et al.Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. J Health Manag 2006;4:1–22.Google Scholar
Lin, K.B., Lai, K.R., Yang, N.P., Wu, K.S., Ting, H.W., Pan, R.H.et al.Trends and outcomes in the utilization of laparoscopic appendectomies in a low-income population in Taiwan from 2003 to 2011. Int J Equity Health 2015;14:100.CrossRefGoogle Scholar
Quan, H., Sundararajan, V., Halfon, P., Fong, A., Burnand, B., Luthi, J.C.et al.Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005;43:1130–1139.CrossRefGoogle ScholarPubMed
Payne, N.A., Prudic, J.Electroconvulsive therapy: part I. A perspective on the evolution and current practice of ECT. J Psychiatr Pract 2009;15:346–368.CrossRefGoogle ScholarPubMed
Nelson, J.C., Delucchi, K., Schneider, L.S.Efficacy of second generation antidepressants in late-life depression: a meta-analysis of the evidence. Am J Geriatr Psychiatry 2008;16:558–567.CrossRefGoogle Scholar
Payne, N.A., Prudic, J.Electroconvulsive therapy: part II: a biopsychosocial perspective. J Psychiatr Pract 2009;15:369–390.CrossRefGoogle ScholarPubMed
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