{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T13:32:42Z","timestamp":1790343162405,"version":"4.1.0"},"reference-count":45,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"unspecified","delay-in-days":302,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100012621","name":"University College London Hospitals Biomedical Research Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012621","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Psychol. Med."],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Suicide and self-harm in people with depression are major public health concerns; electroconvulsive therapy (ECT) is a treatment recommended in UK clinical guidelines for severe mood disorders. We aimed to investigate published literature on the effect of ECT on the incidence of suicide, self-harm, and the recorded presence of suicidal thoughts (suicide-related outcomes). We hypothesized that ECT would be associated with a reduced incidence of suicide-related outcomes and all-cause mortality. We reviewed systematically all eligible studies as specified in our protocol (PROSPERO 293393). We included studies that compared ECT against a comparator treatment, and which included suicide-related outcomes or mortality. We searched Medline, EMBASE, and PsycINFO on January 24, 2022, updated to February 12, 2025. We identified 12,313 records and, after deduplication, screened 8,281 records on title and abstract and 212 on full-text, identifying 17 eligible studies. Studies showed significant heterogeneity in methodology, outcomes, time points chosen, and study populations. Three included studies investigated change in the suicidality domain on psychological rating scales: two showed a reduction in the ECT group; the other was underpowered for this outcome. Meta-analysis of suicide outcomes showed significant statistical heterogeneity and did not detect differences in a consistent direction. Meta-analysis of other mortality outcomes showed reductions in the risk of all-cause mortality (log relative risk [logRR]: \u22120.29; 95% CI: \u22120.53, \u22120.05) and non-suicide mortality (logRR: \u22120.21; 95% CI: \u22120.35, \u22120.07). Further high-quality studies are needed, which should seek to minimize biases (particularly confounding by indication) and report a wider range of suicide-related outcomes.<\/jats:p>","DOI":"10.1017\/s0033291725102183","type":"journal-article","created":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T11:19:43Z","timestamp":1761823183000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":14,"title":["Systematic review and meta-analysis of the effectiveness of ECT in reducing suicidal ideation, self-harm, suicide, and mortality"],"prefix":"10.1017","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6204-248X","authenticated-orcid":false,"given":"Hamish","family":"Naismith","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02jx3x895","id-type":"ROR","asserted-by":"publisher"}],"name":"University College London"},{"name":"North London NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6869-1010","authenticated-orcid":false,"given":"Jack","family":"Wilson","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02jx3x895","id-type":"ROR","asserted-by":"publisher"}],"name":"University College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4490-9219","authenticated-orcid":false,"given":"Harry","family":"Costello","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02jx3x895","id-type":"ROR","asserted-by":"publisher"}],"name":"University College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2460-0508","authenticated-orcid":false,"given":"Neil M.","family":"Davies","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02jx3x895","id-type":"ROR","asserted-by":"publisher"}],"name":"University College London"},{"name":"University College London"},{"name":"Norwegian University of Science and Technology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9742-1359","authenticated-orcid":false,"given":"Alexandra","family":"Pitman","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02jx3x895","id-type":"ROR","asserted-by":"publisher"}],"name":"University College London"},{"name":"North London NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3071-2338","authenticated-orcid":false,"given":"Robert","family":"Howard","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02jx3x895","id-type":"ROR","asserted-by":"publisher"}],"name":"University College London"},{"name":"North London NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"key":"S0033291725102183_r10","doi-asserted-by":"publisher","DOI":"10.1017\/S2045796016001049"},{"key":"S0033291725102183_r6","first-page":"1","article-title":"Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: Systematic reviews and economic modelling studies","volume":"9","author":"Greenhalgh","year":"2005","journal-title":"Health Technology Assessment (Winchester, England)"},{"key":"S0033291725102183_r16","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)00173-8"},{"key":"S0033291725102183_r28","doi-asserted-by":"publisher","DOI":"10.1016\/j.nsa.2025.105520"},{"key":"S0033291725102183_r29","doi-asserted-by":"publisher","DOI":"10.1080\/15622975.2021.1995808"},{"key":"S0033291725102183_r34","doi-asserted-by":"publisher","DOI":"10.1097\/YCT.0000000000000117"},{"key":"S0033291725102183_r35","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2017.1670"},{"key":"S0033291725102183_r3","doi-asserted-by":"publisher","DOI":"10.1002\/brb3.2144"},{"key":"S0033291725102183_r37","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"l4898","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"S0033291725102183_r38","volume-title":"EPPI-reviewer: Advanced software for systematic reviews, maps and evidence synthesis","author":"Thomas","year":"2024"},{"key":"S0033291725102183_r41","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v036.i03"},{"key":"S0033291725102183_r19","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.133.6.514"},{"key":"S0033291725102183_r31","volume-title":"R: A language and environment for statistical computing","year":"2022"},{"key":"S0033291725102183_r36","doi-asserted-by":"publisher","DOI":"10.1097\/YCT.0000000000000736"},{"key":"S0033291725102183_r43","first-page":"1","article-title":"Mortality after electroconvulsive therapy","author":"Watts","year":"2021","journal-title":"The British Journal of Psychiatry"},{"key":"S0033291725102183_r45","unstructured":"World Health Organization. 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