{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T10:26:02Z","timestamp":1786443962030,"version":"build-2736575974"},"reference-count":33,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,12,11]],"date-time":"2017-12-11T00:00:00Z","timestamp":1512950400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bipolar Disorders"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Electroconvulsive therapy (<jats:styled-content style=\"fixed-case\">ECT<\/jats:styled-content>) has long been believed to reduce suicidal tendencies in patients with affective disorders; however, <jats:styled-content style=\"fixed-case\">ECT<\/jats:styled-content> recipients, who constitute the most severely ill and suicidal patients, are not eligible to participate in head\u2010to\u2010head randomized controlled trials. Large\u2010scale studies are required to investigate the anti\u2010suicidal effects of <jats:styled-content style=\"fixed-case\">ECT<\/jats:styled-content> vs psychopharmacotherapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A nationwide retrospective cohort study design was used. Data were obtained from the Taiwan National Health Insurance Research Database. Inpatients with unipolar disorder or bipolar disorder who received <jats:styled-content style=\"fixed-case\">ECT<\/jats:styled-content> (n\u00a0=\u00a0487) were observed from 1 January 2000 to 31 December 2013 for suicide events. The non\u2010<jats:styled-content style=\"fixed-case\">ECT<\/jats:styled-content> control cohort consisted of inpatients with psychopharmacotherapy randomly matched (ratio, 1:4) by age, sex, and diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After potential confounds had been accounted for, the adjusted hazard ratio (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>) was 0.803, indicating that <jats:styled-content style=\"fixed-case\">ECT<\/jats:styled-content> recipients showed a 19.7% lower risk of suicide than control individuals. The stratum\u2010specific adjusted <jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> was 0.79 in patients with unipolar disorder (<jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>.041) and 0.923 in patients with bipolar disorder (<jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>.254). Upon further stratification of the patients with bipolar disorder by their affective states, the adjusted <jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> was 0.805 (<jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>.046) for bipolar depression, 1.048 for bipolar mania (<jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>.538), and 0.976 for mixed bipolar state (<jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>.126).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Compared with psychopharmacotherapy, <jats:styled-content style=\"fixed-case\">ECT<\/jats:styled-content> exerted superior anti\u2010suicidal effects in patients with unipolar disorder and bipolar depression; however, there was a lack of superior anti\u2010suicidal effects of <jats:styled-content style=\"fixed-case\">ECT<\/jats:styled-content> in the treatment of patients with bipolar mania and mixed state.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bdi.12589","type":"journal-article","created":{"date-parts":[[2017,12,11]],"date-time":"2017-12-11T12:51:14Z","timestamp":1512996674000},"page":"539-546","source":"Crossref","is-referenced-by-count":86,"title":["Superior anti\u2010suicidal effects of electroconvulsive therapy in unipolar disorder and bipolar depression"],"prefix":"10.1111","volume":"20","author":[{"given":"Chih\u2010Sung","family":"Liang","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Beitou Branch Tri\u2010Service General Hospital National Defense Medical Center  Taipei Taiwan"},{"name":"Graduate Institute of Medical Sciences National Defense Medical Center  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi\u2010Hsiang","family":"Chung","sequence":"additional","affiliation":[{"name":"School of Public Health National Defense Medical Center  Taipei Taiwan"},{"name":"Taiwanese Injury Prevention and Safety Promotion Association  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei\u2010Shen","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Beitou Branch Tri\u2010Service General Hospital National Defense Medical Center  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia\u2010Kuang","family":"Tsai","sequence":"additional","affiliation":[{"name":"Graduate Institute of Medical Sciences National Defense Medical Center  Taipei Taiwan"},{"name":"Department of Neurology Tri\u2010Service General Hospital National Defense Medical Center  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1138-5586","authenticated-orcid":false,"given":"Wu\u2010Chien","family":"Chien","sequence":"additional","affiliation":[{"name":"School of Public Health National Defense Medical Center  Taipei Taiwan"},{"name":"Department of Medical Research Tri\u2010Service General 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