Longitudinal associations of electroconvulsive therapy with all-cause mortality and suicide deaths in severe unipolar or bipolar depression: a systematic review and meta-analysis
Bibliographic record
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.013 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".