Electroconvulsive Therapy for Hospitalized Patients with Depression

Electroconvulsive therapy (ECT), the most effective treatment for depression in psychiatry, is underused due to stigma and lack of information regarding its risks and benefits. The aims of this thesis were to inform evidence-based use of ECT by identifying patient-level factors that influence the use of ECT and determining the association between ECT and rare but clinically important medical and psychiatric outcomes. The thesis included three projects using administrative health data of hospitalized patients with depression in Ontario, Canada between 2007 and 2017. The first project was a comprehensive assessment of patient characteristics associated with receipt of inpatient ECT in Ontario. Both clinically appropriate, and potentially inappropriate factors were associated with receipt of inpatient ECT, suggesting opportunities to increase appropriate utilization. In the second project, the risk of serious medical events associated with ECT compared to no ECT was evaluated using propensity score matching that adjusted for a large set of sociodemographic and clinical variables. There was no clinically significant increased risk of serious medical events – as measured by medical hospitalization or death – with ECT exposure. In the third project, weighting by the odds of the propensity score was used to compare the risk of suicide among individuals receiving ECT vs. similar individuals not receiving ECT in the year following discharge from psychiatric hospitalization. ECT was associated with a significantly reduced risk of suicide and all-cause death. Taken together, these findings provide important data that can be used to support the evidence-based use of ECT in a highly vulnerable clinical population.Ph.D