INTRODUCTION: Although the antidepressant efficacy of ECT is well documented, patient-reported outcomes after this treatment are less well characterized. The aims of the current meta-analysis are to quantify the impact of an acute course of ECT on health-related quality of life (HRQoL) and to identify related moderators, specifically post-ECT depressive symptom remission and patient age. METHODS: We searched PubMed, PsycINFO, and Web of Science databases for randomized and nonrandomized studies that report on changes in HRQoL measures after an acute course of ECT. Only studies that used the Medical Outcomes Study Short Form 36 (SF-36) instrument were included. A random effects model using the Hedges' g effect size was used in calculating the pre-post ECT outcomes on all 8 SF-36 subscales and the SF-36 total scores including the physical and mental composite scores. Subgroup analyses were conducted using remission status and age as moderators. RESULTS: Four studies contributed to this analysis. Significant improvements across all subscales of the SF-36 were observed. Large and very large effect sizes were present for both the SF-36 physical component score (PCS) and mental health component score (MCS), with the change in MCS being statistically superior to the PCS (MCS, Hedges' g = 1.28; 95% confidence interval, 1.15-1.42; PCS, Hedges' g = 0.97; 95% confidence interval, 0.86-1.07). Medium, large, and very large effect sizes were observed for SF-36 subscales scores. Post-ECT depression remission status was related to HRQoL improvement, with statistically significant differences present between remitters and nonremitters for PCS, MCS, and most SF-36 subscale scores. No significant differences were observed in improvement in HRQoL with ECT based on patient age. CONCLUSIONS: An acute course of ECT for depressive symptoms produces medium to very large effect size improvements in HRQoL across multiple components and subscales measured by the SF-36. The magnitude of the effects reported by ECT patients is greater than those that have been reported in other open-label studies of brain stimulation techniques. This study confirms that ECT plays a vital role in the treatment of the most severely ill patients with depressive disorders.
INTRODUCTION: Although the antidepressant efficacy of ECT is well documented, patient-reported outcomes after this treatment are less well characterized. The aims of the current meta-analysis are to quantify the impact of an acute course of ECT on health-related quality of life (HRQoL) and to identify related moderators, specifically post-ECT depressive symptom remission and patient age. METHODS: We searched PubMed, PsycINFO, and Web of Science databases for randomized and nonrandomized studies that report on changes in HRQoL measures after an acute course of ECT. Only studies that used the Medical Outcomes Study Short Form 36 (SF-36) instrument were included. A random effects model using the Hedges' g effect size was used in calculating the pre-post ECT outcomes on all 8 SF-36 subscales and the SF-36 total scores including the physical and mental composite scores. Subgroup analyses were conducted using remission status and age as moderators. RESULTS: Four studies contributed to this analysis. Significant improvements across all subscales of the SF-36 were observed. Large and very large effect sizes were present for both the SF-36 physical component score (PCS) and mental health component score (MCS), with the change in MCS being statistically superior to the PCS (MCS, Hedges' g = 1.28; 95% confidence interval, 1.15-1.42; PCS, Hedges' g = 0.97; 95% confidence interval, 0.86-1.07). Medium, large, and very large effect sizes were observed for SF-36 subscales scores. Post-ECT depression remission status was related to HRQoL improvement, with statistically significant differences present between remitters and nonremitters for PCS, MCS, and most SF-36 subscale scores. No significant differences were observed in improvement in HRQoL with ECT based on patient age. CONCLUSIONS: An acute course of ECT for depressive symptoms produces medium to very large effect size improvements in HRQoL across multiple components and subscales measured by the SF-36. The magnitude of the effects reported by ECT patients is greater than those that have been reported in other open-label studies of brain stimulation techniques. This study confirms that ECT plays a vital role in the treatment of the most severely ill patients with depressive disorders.
Authors: Takahiro Soda; Declan M McLoughlin; Scott R Clark; Leif Oltedal; Ute Kessler; Jan Haavik; Chad Bousman; Daniel J Smith; Miquel Bioque; Caitlin C Clements; Colleen Loo; Fidel Vila-Rodriguez; Alessandra Minelli; Brian J Mickey; Roumen Milev; Anna R Docherty; Julie Langan Martin; Eric D Achtyes; Volker Arolt; Ronny Redlich; Udo Dannlowski; Narcis Cardoner; Emily Clare; Nick Craddock; Arianna Di Florio; Monika Dmitrzak-Weglarz; Liz Forty; Katherine Gordon-Smith; Mustafa Husain; Wendy M Ingram; Lisa Jones; Ian Jones; Mario Juruena; George Kirov; Mikael Landén; Daniel J Müller; Axel Nordensköld; Erik Pålsson; Meethu Paul; Agnieszka Permoda; Bartlomiej Pliszka; Jamie Rea; Klaus O Schubert; Joshua A Sonnen; Virginia Soria; Will Stageman; Akihiro Takamiya; Mikel Urretavizacaya; Stuart Watson; Maxim Zavorotny; Allan H Young; Eduard Vieta; Janusz K Rybakowski; Massimo Gennarelli; Peter P Zandi; Patrick F Sullivan; Bernhard T Baune Journal: Eur Arch Psychiatry Clin Neurosci Date: 2019-12-04 Impact factor: 5.270
Authors: Aida de Arriba-Arnau; Virginia Soria; Neus Salvat-Pujol; José M Menchón; Mikel Urretavizcaya Journal: Eur Arch Psychiatry Clin Neurosci Date: 2019-12-13 Impact factor: 5.270
Authors: Heidemarie Lex; Steven W Nevers; Erica L Jensen; Yarden Ginsburg; Daniel F Maixner; Brian J Mickey Journal: J Affect Disord Date: 2021-05-18 Impact factor: 6.533
Authors: Pelin Güney; Carl Johan Ekman; Åsa Hammar; Emelie Heintz; Mikael Landén; Johan Lundberg; Pia Nordanskog; Axel Nordenskjöld Journal: J ECT Date: 2020-12 Impact factor: 3.692