Evidence map›Paper›PMID 31189487›Full record

ArticleBJPsych open2019

Lithium for suicide and readmission prevention after electroconvulsive therapy for unipolar depression: population-based register study.

Ole Brus, Yang Cao, Åsa Hammar, Mikael Landén, Johan Lundberg, Pia Nordanskog, Axel Nordenskjöld

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BJPsych open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
2.1field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it, 28 citations in OpenAlex.

  1. Pooled it
  2. Preventing relapse in patients with major depressive disorder after an effective acute course of electroconvulsive therapy.Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 6 institutions in 2 countries.

Ole BrusStatistician, Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, Sweden.
Yang CaoStatistician, Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University; and Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Sweden.ORCID https://orcid.org/0000-0002-3552-9153
Åsa HammarProfessor, Department of Biological and Medical Psychology, University of Bergen; and Division of Psychiatry, Haukeland University Hospital, Norway.
Mikael LandénProfessor, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University; and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.
Johan LundbergPhysician and Associate Professor, Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet; and Stockholm County Council, Sweden.
Pia NordanskogPhysician, Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University; and Department of Psychiatry, Region Östergötland, Sweden.
Axel NordenskjöldPhysician, University Health Care Research Centre, Faculty of Health and Medical Sciences, Örebro University, Sweden.
Örebro University · SEHaukeland University Hospital · NOKarolinska Institutet · SELinköping University · SEStatistics Sweden · SEStockholm County Council · SE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundElectroconvulsive therapy (ECT) is effective for unipolar depression but relapse and suicide are significant challenges. Lithium could potentially lower these risks, but is used only in a minority of patients.AimsThis study quantifies the effect of lithium on risk of suicide and readmission and identifies factors that are associate with readmission and suicide.

methodThis population-based register study used data from the Swedish National Quality Register for ECT and other Swedish national registers. Patients who have received ECT for unipolar depression as in-patients between 2011 and 2016 were followed until death, readmission to hospital or the termination of the study at the end of 2016. Cox regression was used to estimate hazard ratios (HR) of readmission and suicide in adjusted models.

resultsOut of 7350 patients, 56 died by suicide and 4203 were readmitted. Lithium was prescribed to 638 (9%) patients. Mean follow-up was 1.4 years. Lithium was significantly associated with lower risk of suicide (P = 0.014) and readmission (HR 0.84 95% CI 0.75-0.93). The number needed to be treated with lithium to prevent one readmission was 16. In addition, the following factors were statistically associated with suicide: male gender, being a widow, substance use disorder and a history of suicide attempts. Readmission was associated with young age, being divorced or unemployed, comorbid anxiety disorder, nonpsychotic depression, more severe symptoms before ECT, no improvement with ECT, not receiving continuation ECT or antidepressants, usage of antipsychotics, anxiolytics or benzodiazepines, severity of medication resistance and number of previous admissions.

conclusionsMore patients could benefit from lithium treatment.Declaration of interestNone.

Indexed as

antidepressantsDepressive disorderselectroconvulsive therapyinpatient treatmentlithiumsuicide

Identifiers

PMID31189487
PMCPMC6582214
OpenAlexW2947768733

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.