{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T20:51:58Z","timestamp":1793479918453,"version":"4.5.0"},"reference-count":40,"publisher":"Royal College of Psychiatrists","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Br J Psychiatry"],"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Electroconvulsive therapy (ECT) is an established intervention for severe or treatment-resistant psychiatric illnesses, including depression, schizophrenia, mania and catatonia. Despite its efficacy, concerns over its risks have contributed to ongoing stigma and hesitancy regarding its use. Traditional clinical trials have demonstrated the superiority of ECT in symptom reduction compared with other treatments, yet are impractical for assessing rare or long-term outcomes. Observational studies using administrative health data can assess rare or long-term outcomes, but are limited by confounding\/bias. This review synthesises evidence from studies utilising administrative health data and modern statistical methods to address clinically relevant questions about ECT\u2019s association with (a) dementia, (b) major adverse cardiovascular\/cerebrovascular events, (c) suicide deaths and (d) all-cause mortality. Most studies indicate that, after adjusting for confounding, ECT does not increase the risk of dementia or major adverse cardiovascular\/cerebrovascular events. Furthermore, ECT is likely associated with a substantial reduction in suicide mortality and all-cause mortality. Although observational studies cannot fully eliminate unmeasured confounding, the consistency of the findings from diverse investigators and congruence with clinical trials and neuroimaging studies lends support to their validity. These modern observational studies have yielded results that reinforce ECT\u2019s safety and efficacy supporting its position as a life-saving treatment.<\/jats:p>","DOI":"10.1192\/bjp.2026.10613","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T03:57:03Z","timestamp":1776311823000},"page":"1-6","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":3,"title":["Electroconvulsive therapy: improved understanding of long-term risks and benefits from advances in administrative health data"],"prefix":"10.1192","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5299-4794","authenticated-orcid":false,"given":"Tyler S.","family":"Kaster","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03e71c577","id-type":"ROR","asserted-by":"publisher"}],"name":"Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health"},{"name":"University of Toronto"},{"id":[{"id":"https:\/\/ror.org\/03e71c577","id-type":"ROR","asserted-by":"publisher"}],"name":"Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health"},{"name":"University of Toronto"},{"name":"ICES"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taeho Greg","family":"Rhee","sequence":"additional","affiliation":[{"name":"Yale University School of Medicine"},{"name":"VA Connecticut Healthcare System"},{"name":"University of Connecticut School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Adler","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03e71c577","id-type":"ROR","asserted-by":"publisher"}],"name":"Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3427-3950","authenticated-orcid":false,"given":"George","family":"Kirov","sequence":"additional","affiliation":[{"name":"Cardiff University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"S0007125026106138_ref14","doi-asserted-by":"publisher","DOI":"10.1002\/gps.5711"},{"key":"S0007125026106138_ref17","doi-asserted-by":"publisher","DOI":"10.1111\/acps.70005"},{"key":"S0007125026106138_ref19","doi-asserted-by":"publisher","DOI":"10.1097\/YCT.0000000000000859"},{"key":"S0007125026106138_ref11","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1093\/aje\/kwv254","article-title":"Using big data to emulate a target trial when a randomized trial is not available","volume":"183","author":"Robins","year":"2016","journal-title":"Am J Epidemiol"},{"key":"S0007125026106138_ref1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2034954"},{"key":"S0007125026106138_ref26","doi-asserted-by":"publisher","DOI":"10.1002\/da.22451"},{"key":"S0007125026106138_ref29","doi-asserted-by":"publisher","DOI":"10.1016\/j.nsa.2025.105520"},{"key":"S0007125026106138_ref31","doi-asserted-by":"publisher","DOI":"10.1177\/0269881119895518"},{"key":"S0007125026106138_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-443-18496-3.00010-0"},{"key":"S0007125026106138_ref18","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2018.00397"},{"key":"S0007125026106138_ref40","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(21)00168-1"},{"key":"S0007125026106138_ref10","unstructured":"10 U.S. Food and Drug Administration. Framework for FDA\u2019s Real-World Evidence Program . U.S. Food and Drug Administration, 2018 (https:\/\/www.fda.gov\/media\/120060\/download)."},{"key":"S0007125026106138_ref23","doi-asserted-by":"publisher","DOI":"10.1080\/15622975.2021.1995808"},{"key":"S0007125026106138_ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2019.04.024"},{"key":"S0007125026106138_ref39","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.16589"},{"key":"S0007125026106138_ref5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l1079"},{"key":"S0007125026106138_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2021.05.023"},{"key":"S0007125026106138_ref2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)12705-5"},{"key":"S0007125026106138_ref16","doi-asserted-by":"publisher","DOI":"10.1097\/YCT.0000000000000770"},{"key":"S0007125026106138_ref4","volume-title":"Guidance on the Use of Electroconvulsive Therapy","year":"2009"},{"key":"S0007125026106138_ref35","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(22)00077-3"},{"key":"S0007125026106138_ref36","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurpsy.2016.12.005"},{"key":"S0007125026106138_ref38","doi-asserted-by":"publisher","DOI":"10.1002\/gps.6102"},{"key":"S0007125026106138_ref30","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291725102183"},{"key":"S0007125026106138_ref13","doi-asserted-by":"publisher","DOI":"10.1097\/YCT.0000000000000137"},{"key":"S0007125026106138_ref33","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2021.21040351"},{"key":"S0007125026106138_ref32","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.12589"},{"key":"S0007125026106138_ref8","doi-asserted-by":"publisher","DOI":"10.1080\/00273171.2011.568786"},{"key":"S0007125026106138_ref27","doi-asserted-by":"publisher","DOI":"10.1136\/bmjment-2025-302083"},{"key":"S0007125026106138_ref6","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbaa111"},{"key":"S0007125026106138_ref7","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2013-202744"},{"key":"S0007125026106138_ref22","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2018.150"},{"key":"S0007125026106138_ref25","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000002488"},{"key":"S0007125026106138_ref9","doi-asserted-by":"publisher","DOI":"10.1177\/0706743720935647"},{"key":"S0007125026106138_ref28","doi-asserted-by":"publisher","DOI":"10.1002\/wps.21354"},{"key":"S0007125026106138_ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2021.09.108"},{"key":"S0007125026106138_ref34","doi-asserted-by":"publisher","DOI":"10.1097\/YCT.0000000000000665"},{"key":"S0007125026106138_ref20","doi-asserted-by":"publisher","DOI":"10.1097\/YCT.0000000000000227"},{"key":"S0007125026106138_ref37","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2021.63"},{"key":"S0007125026106138_ref15","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(18)30056-7"}],"container-title":["The British Journal of Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0007125026106138","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T03:57:06Z","timestamp":1776311826000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0007125026106138\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,16]]},"references-count":40,"alternative-id":["S0007125026106138"],"URL":"https:\/\/doi.org\/10.1192\/bjp.2026.10613","relation":{},"ISSN":["0007-1250","1472-1465"],"issn-type":[{"value":"0007-1250","type":"print"},{"value":"1472-1465","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,16]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. 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