Longitudinal Associations of Electroconvulsive Therapy with All-cause Mortality and Suicide Deaths in Depression and Other Psychiatric Disorders: A Systematic Review and Meta-Analysis

Objective: Electroconvulsive therapy (ECT) is among the most effective treatments for mood disorders and other psychotic disorders. This study meta-analyzed the effects of ECT on all-cause mortality and suicide deaths using longitudinal studies. Methods: PubMed/MEDLINE, PsycINFO, Cochrane Library, Embase, and Google Scholar were searched from inception through January 21, 2025, with no language limits. Inclusion criteria were as follow: (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 outcome measures; and (4) clinical trial or longitudinal cohort study designs where the aforementioned interventions preceded the observations of outcome measures. Adjusted hazard ratio [HR] with their corresponding 95% confidence intervals (CIs) were calculated using fixed- or random-effects models. Moderator analyses were also performed. Results: Overall, 17 studies consisting of 1,182,501 individuals (n=40,867 for ECT, n=1,141,634 for those receiving comparable interventions) were included. ECT was associated with a reduction in risk of all-cause mortality (HR, 0.70 [95% CI, 0.61-0.81]; p <0.001), a finding that was consistent at 3 months, 6 months, and 12 months of follow-up. Sex demonstrated a very small moderating effect on this relationship, with ECT being slightly less protective against mortality risk for females compared to males (standardized beta coefficient, -0.01 [-0.01 to 0.00]; p =0.036). Regions also had a moderating effect ( p =0.002). Japan had the largest effect size (HR, 0.17 [0.04-0.72]) and Denmark had the smallest (HR, 0.87 [0.83-0.92]). ECT was associated with a reduction in suicide risk at 3 months of follow-up (HR, 0.53 [0.39-0.72]; 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. ECT, however, was not consistently associated with a reduced risk of suicide.