Brief report
Health-related quality of life following ECT in a large community sample

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Abstract

Background

While electroconvulsive therapy (ECT) is a potent antidepressant, little is known about its long-term effects on health-related quality of life (HRQOL).

Methods

Using a naturalistic, observational design, 283 depressed patients, who received ECT at 7 hospitals in the New York City area, were assessed for HRQOL with the Medical Outcomes Study Short Form - 36 (SF-36) at baseline, several days after ECT, and 24 weeks later. Depression severity was assessed with the Hamilton Rating Scale for Depression, and a neuropsychological battery was also administered.

Results

Baseline SF-36 scores were very low, indicating poor HRQOL. These scores were improved at postECT and at the 24-week follow-up. Unexpectedly, the degree of retrograde amnesia for autobiographical information was associated with better HRQOL in the immediate postECT period, but not at 24-week follow-up. In contrast, improvement in global cognitive status was associated with superior HRQOL at the 24-week time point.

Limitations

This study was limited by the lack of a non-ECT comparison group, and the naturalistic design of treatment.

Conclusions

ECT is associated with improved HRQOL in the short- and long-term, with the enhancements largely explained by improvements in depressive symptoms. The acute cognitive effects of ECT may also influence HRQOL assessment, and evaluations removed in time from the treatment may have greater validity.

Introduction

Patients with major depression report poorer health-related quality of life (HRQOL) compared to patients with hypertension, arthritis, angina and other common medical conditions. (Wells et al., 1989) HRQOL tends to be especially compromised in depressed patients referred for electroconvulsive therapy (ECT).(McCall et al., 1999).

Prior studies of the effects of ECT on HRQOL were mainly conducted in tertiary university settings, (McCall et al., 2001, McCall et al., 2004) and did not include objective measures of cognition. (Casey et al., 1996, Fisher et al., 2004) Research has focused on the immediate postECT period, and long-term changes in HRQOL have not been examined in a sizeable sample of patients who have received ECT. In patients with major depression treated in community settings, we examined changes in HRQOL in the immediate postECT period and at 24-week follow-up, and related these changes to treatment parameters and clinical and cognitive outcomes.

Section snippets

Study sites and study participation

The study was conducted at 7 hospitals in the New York City metropolitan area. The sites included 2 private psychiatric hospitals, 3 community general hospitals, and 2 hospitals at university medical centers. The methods used for patient recruitment, treatment and assessment have been described elsewhere. (Prudic et al., 2004) Briefly, a clinical outcomes evaluator was assigned to each hospital and collected all the research information. The evaluators had no involvement in the care patients

Demographics and clinical outcomes

This sample included 283 persons, aged 55.4 ± 17.5 years, with 62.2% women. Depressive symptoms were severe at baseline, with an average HRSD score of 31.2. Thirty-three percent of patients received only right unilateral electrode placement, while 41.3% received only bilateral ECT, and 25.7% received a mix of electrode placements. Forty-five percent underwent dose titration at their first treatment. Almost 14% of the sample was treated with sine wave, as opposed to brief pulse, stimulation. An

Discussion

The baseline SF-36 subscale scores in this sample of ECT patients were generally lower than what has been reported in a sample of depressed outpatients, (Ware et al., 2003) and comparable to a sample of depressed inpatients (Table 1). (Oslin et al., 2000) The great majority of patients reported some improvement in HRQOL both at the immediate postECT and 24-week follow-up assessments. Fisher et al. also reported improvement in scores on an abbreviated version of the SF-36 immediately after ECT. (

Acknowledgements

Supported by NIMH grants R01 MH59069, R01 MH35636, R01 MH61609, and R01 MH61564.

References (17)

There are more references available in the full text version of this article.

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