Evidence map›Paper›PMID 34503341›Full record

Observational studyThe American journal of psychiatry2021

Association of ECT With Risks of All-Cause Mortality and Suicide in Older Medicare Patients.

Taeho Greg Rhee, Kyaw Sint, Mark Olfson, Tobias Gerhard, Susan H Busch, Samuel T Wilkinson

Open access · greenAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in The American journal of psychiatry, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed, 3 pooled it
6.1field-weighted citation impact, top 3% 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

23 citing papers in PubMed, 3 syntheses or guidelines pooled it, 60 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Article
  5. A unified voice for evidence-based psychiatry: a global response to the WHO guidance on ECT.European archives of psychiatry and clinical neuroscience · 2026
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  8. Advances in the Clinical Application of Neurostimulation in Major Depression.Advances in experimental medicine and biology · 2026
    Review
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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

6 authors at 1 institution in 1 country.

Taeho Greg RheeDepartment of Community Medicine and Health Care, School of Medicine, University of Connecticut, Farmington (Rhee); Yale Depression Research Program, Department of Psychiatry, Yale School of Medicine, New Haven, Conn. (Rhee, Wilkinson); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn. (Sint); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (Olfson); Center for Pharmacoepidemiology and Treatment Science and Department of Pharmacy Practice and Administration, Rutgers University, Piscataway, N.J. (Gerhard); Yale School of Public Health, Yale University, New Haven, Conn. (Busch); Interventional Psychiatry Service, Department of Psychiatry, Yale School of Medicine, New Haven, Conn. (Wilkinson).
Kyaw SintDepartment of Community Medicine and Health Care, School of Medicine, University of Connecticut, Farmington (Rhee); Yale Depression Research Program, Department of Psychiatry, Yale School of Medicine, New Haven, Conn. (Rhee, Wilkinson); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn. (Sint); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (Olfson); Center for Pharmacoepidemiology and Treatment Science and Department of Pharmacy Practice and Administration, Rutgers University, Piscataway, N.J. (Gerhard); Yale School of Public Health, Yale University, New Haven, Conn. (Busch); Interventional Psychiatry Service, Department of Psychiatry, Yale School of Medicine, New Haven, Conn. (Wilkinson).
Mark OlfsonDepartment of Community Medicine and Health Care, School of Medicine, University of Connecticut, Farmington (Rhee); Yale Depression Research Program, Department of Psychiatry, Yale School of Medicine, New Haven, Conn. (Rhee, Wilkinson); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn. (Sint); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (Olfson); Center for Pharmacoepidemiology and Treatment Science and Department of Pharmacy Practice and Administration, Rutgers University, Piscataway, N.J. (Gerhard); Yale School of Public Health, Yale University, New Haven, Conn. (Busch); Interventional Psychiatry Service, Department of Psychiatry, Yale School of Medicine, New Haven, Conn. (Wilkinson).
Tobias GerhardDepartment of Community Medicine and Health Care, School of Medicine, University of Connecticut, Farmington (Rhee); Yale Depression Research Program, Department of Psychiatry, Yale School of Medicine, New Haven, Conn. (Rhee, Wilkinson); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn. (Sint); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (Olfson); Center for Pharmacoepidemiology and Treatment Science and Department of Pharmacy Practice and Administration, Rutgers University, Piscataway, N.J. (Gerhard); Yale School of Public Health, Yale University, New Haven, Conn. (Busch); Interventional Psychiatry Service, Department of Psychiatry, Yale School of Medicine, New Haven, Conn. (Wilkinson).
Susan H BuschDepartment of Community Medicine and Health Care, School of Medicine, University of Connecticut, Farmington (Rhee); Yale Depression Research Program, Department of Psychiatry, Yale School of Medicine, New Haven, Conn. (Rhee, Wilkinson); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn. (Sint); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (Olfson); Center for Pharmacoepidemiology and Treatment Science and Department of Pharmacy Practice and Administration, Rutgers University, Piscataway, N.J. (Gerhard); Yale School of Public Health, Yale University, New Haven, Conn. (Busch); Interventional Psychiatry Service, Department of Psychiatry, Yale School of Medicine, New Haven, Conn. (Wilkinson).
Samuel T WilkinsonDepartment of Community Medicine and Health Care, School of Medicine, University of Connecticut, Farmington (Rhee); Yale Depression Research Program, Department of Psychiatry, Yale School of Medicine, New Haven, Conn. (Rhee, Wilkinson); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn. (Sint); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (Olfson); Center for Pharmacoepidemiology and Treatment Science and Department of Pharmacy Practice and Administration, Rutgers University, Piscataway, N.J. (Gerhard); Yale School of Public Health, Yale University, New Haven, Conn. (Busch); Interventional Psychiatry Service, Department of Psychiatry, Yale School of Medicine, New Haven, Conn. (Wilkinson).
Yale New Haven Hospital · US

Funding

Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9M
Yale-CORE Career Development Program in Patient-Centered Outcomes ResearchK12HS023000 · AHRQ · YALE UNIVERSITY · PI KRUMHOLZ, HARLAN MARC · 2014 to 2018
$3.4M
Effects of electroconvulsive therapy on suicide in geriatrics patients with major depressive disorder: a nationwide cohort study using propensity score matching and instrumental variable analysisR21MH117438 · NIMH · YALE UNIVERSITY · PI WILKINSON, SAMUEL · 2019 to 2020
$682k
AHRQ HHS K12 HS023000NCATS NIH HHS UL1 TR001863NIMH NIH HHS R21 MH117438
6 · The paper itself

Abstract

objectiveThis observational study examined the effects of electroconvulsive therapy (ECT) on suicide and all-cause mortality risk in older psychiatric patients.

methodsParticipants were Medicare-insured psychiatric inpatients age 65 or older. Patients receiving ECT were exact-matched to control subjects (in a 1:3 ratio) on age, gender, principal hospital diagnosis, past-year psychiatric hospitalizations, past-year suicide attempts, and Elixhauser comorbidity index. Cox proportional hazard models were risk-adjusted for race, year of hospitalization, rural-urban continuum code, year of index hospitalization, median income of zip code, and all matched covariates to estimate hazard ratios with 95% confidence intervals.

resultsA total of 10,460 patients in the ECT group and 31,160 in the control group were included in the analyses (total N=41,620; 65.4% female; mean age, 74.7 years [SD=7.09]). Compared with the control group, patients receiving ECT had lower all-cause mortality for up to 1 year following hospital discharge (adjusted hazard ratio=0.61, 95% CI=0.56, 0.66). For death by suicide, 1-year survival analysis showed no group difference. A significant association was observed with suicide in the first months following ECT, but this pattern waned over time (1 month: hazard ratio=0.44, 95% CI=0.21, 0.91; 2 months: hazard ratio=0.52, 95% CI=0.29, 0.92; 3 months: hazard ratio=0.56, 95% CI=0.37, 0.92; 6 months: 0.87, 95% CI=0.59, 1.28; 12 months: 0.92, 95% CI=0.68, 1.25).

conclusionsIn this observational study, ECT was associated with lower 1-year all-cause mortality and with short-lived protective effects on suicide risk. These findings support greater consideration of ECT for inpatients with mood disorders at short-term risk of suicide.

Indexed as

MortalityAgedAged, 80 and overCause of DeathElectroconvulsive TherapyFemaleHumansMaleMedicareRisk FactorsSuicideUnited StatesBipolar and Related DisordersDepressive DisordersElectroconvulsive Therapy (ECT)Major Depressive DisorderSuicide and Self-Harm

Identifiers

PMID34503341
PMCPMC8639649
OpenAlexW3198456353

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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.