title: Electroconvulsive Therapy and All-Cause Mortality in Texas, 1998-2013.
abstract: BACKGROUND
  Electroconvulsive therapy (ECT) remains an effective treatment for major depressive disorder. Since 1995, Texas has maintained an ECT database including patient diagnoses and outcomes, and reporting any deaths within 14 days of receiving an ECT treatment, encompassing a total of 166,711 ECT treatments administered in Texas over the previously unreported period of 1998 to 2013.
  
  
  METHODS
  Descriptive analysis summarized information on deaths reported during the 16-year period-cause of death, type of treatment (index or maintenance) and patient demographics. Multiple logistic regression of death incidence by treatment session was performed to determine whether patient age, sex, race, diagnosis, or year of treatment was associated with death after ECT.
  
  
  RESULTS
  Of those deaths occurring within 1 day of an ECT treatment, the death rate was 2.4 per 100,000 treatments. Looking at all deaths within 14 days of an ECT treatment, the death rate increased to 18 per 100,000 treatments but included all deaths regardless of likelihood of causal association with ECT, for example, accidents and suicides, the latter a leading cause of death among individuals with severe major depression or other disorders for which ECT is indicated. Death rate increased significantly with increasing patient age (P = 0.001) and male sex (P = 0.009), and there was a nonsignificant trend toward increased death amongst patients with bipolar disorder or schizophrenia (P = 0.058) versus depression.
  
  
  CONCLUSIONS
  Our data indicate that ECT is in general a safe procedure with respect to the likelihood of immediate death. Suicide remains a significant risk in ECT patients, despite evidence that ECT reduces suicidal ideation.
authors.affiliation: From the *Durham Veterans Affairs Medical Center, Durham; †Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC; ‡Mental Health and Substance Abuse Division, Texas Department of State Health Services, Austin; §University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Nora M
authors.initials: NM
authors.lastname: Dennis
authors.forename: Paul A
authors.initials: PA
authors.lastname: Dennis
authors.forename: Alan
authors.initials: A
authors.lastname: Shafer
authors.forename: Richard D
authors.initials: RD
authors.lastname: Weiner
authors.forename: Mustafa M
authors.initials: MM
authors.lastname: Husain
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001714:Bipolar Disorder / Q000401:mortality / Q000628:therapy; D002423:Cause of Death; D003865:Major Depressive Disorder / Q000401:mortality / Q000628:therapy; D004565:Electroconvulsive Therapy / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012559:Schizophrenia / Q000401:mortality / Q000628:therapy; D012737:Sex Factors; D059020:Suicidal Ideation; D013405:Suicide / Q000706:statistics & numerical data; D013781:Texas / Q000453:epidemiology