Brief reportHealth-related quality of life following ECT in a large community sample
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.
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2018, Journal of Psychiatric ResearchCitation Excerpt :In naturalistic studies, improvement in HRQOL was sustained over 6-months after ECT in patients with sustained remission, with HRQOL values indistinguishable from healthy population norms (McCall et al., 2013). In contrast, depressive relapse after ECT was associated with worsening in HRQOL (McCall et al., 2006). HRQOL is central to understanding the overall net risks and benefits of treatments, including those of ECT.
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2016, Journal of Affective DisordersCitation Excerpt :In addition, improvements in HRQOL and functioning have been found to be greater in ECT recipients compared with hospitalised depressed patients only treated with medications (Fisher et al., 2004; McCall et al., 2001). Increases in HRQOL after ECT for depression have been mostly associated with remission status (McCall et al., 2006; McCall et al., 2011). It is also plausible, however, that different ECT treatment approaches (combination of electrode-placement and pulse-width) have differential effects on HRQOL outcomes because of their different impact on efficacy and cognitive side effects (Kellner et al., 2010; Loo et al., 2015; Sackeim et al., 1993; Sackeim et al., 2007; Sackeim et al., 2008).
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2014, Brain StimulationCitation Excerpt :The clinical significance of these results are also supported by the observation in our exploratory analysis that among those patients who achieved the most significant symptomatic clinical outcome, namely remission of illness, the aggregate MCS score nearly doubled compared to those patients who did not remit. The subjects who participated in this study have characteristics commonly seen in patients with TRD, including patients who receive ECT [33]. These included moderate to severe symptoms at study entry, recurrence, chronicity, and multiple antidepressant treatments in the current episode [12,34–36].
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2013, Journal of Affective DisordersCitation Excerpt :ECT leads to short-term improvement in HRQOL for most patients (McCall et al., 2011, 2004, 2006), and sustained remission after ECT produces further improvement in HRQOL with near-normalization of HRQOL values. Unfortunately, not all patients benefit from ECT and depressive relapse is common after acute response, leading to a loss of improvement in HRQOL (McCall et al., 2011, 2006). Only a minority of patients achieves sustained remission following ECT.