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 machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.028 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.013 | 0.035 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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 source (direct Gemma or distilled Codex), 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".