Childhood maltreatment and outcomes following electroconvulsive therapy in adults with depression.
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Authors
Jelovac, Ana
Mohan, Christopher
Whooley, Emma
Igoe, Anna
McCaffrey, Cathal
McLoughlin, Declan M
Issue Date
2024-09-05
Type
Journal Article
Language
en
Keywords
childhood maltreatment , depression , electroconvulsive therapy , remission , response
Alternative Title
Abstract
Childhood maltreatment is associated with less favourable treatment outcomes with pharmacotherapy and psychotherapy for depression. It is unknown whether this increased risk of treatment resistance in maltreated individuals extends to electroconvulsive therapy (ECT).
This retrospective cohort study included 501 consecutive adult referrals for an acute course of twice-weekly ECT for unipolar or bipolar depression at an academic inpatient centre in Ireland between 2016 and 2024. Retrospectively reported physical and sexual childhood maltreatment were assessed on hospital admission. Response was defined as a score of 1 or 2 and remission was defined as a score of 1 on the Clinical Global Impression - Improvement scale 1-3 days after final ECT session. Logistic regression analyses were used to examine the associations between childhood maltreatment and ECT nonresponse and nonremission, adjusting for covariates. Mediation analyses were conducted to explore the role of psychiatric comorbidities, persistent depressive symptoms lasting 2 years or more in the current episode, and baseline depression severity.
Compared to the group with no childhood maltreatment, the childhood maltreatment group had similar odds of ECT nonresponse (adjusted odds ratio = 1.47, 95% CI = 0.85-2.53) but significantly elevated odds of ECT nonremission (adjusted odds ratio = 3.75, 95% CI = 1.80-7.81). In a mediation analysis, presence of persistent depressive symptoms mediated 7.4% of the total effect of childhood maltreatment on ECT nonremission.
Individuals with exposure to childhood maltreatment may be less likely to achieve full remission following a course of ECT.
This retrospective cohort study included 501 consecutive adult referrals for an acute course of twice-weekly ECT for unipolar or bipolar depression at an academic inpatient centre in Ireland between 2016 and 2024. Retrospectively reported physical and sexual childhood maltreatment were assessed on hospital admission. Response was defined as a score of 1 or 2 and remission was defined as a score of 1 on the Clinical Global Impression - Improvement scale 1-3 days after final ECT session. Logistic regression analyses were used to examine the associations between childhood maltreatment and ECT nonresponse and nonremission, adjusting for covariates. Mediation analyses were conducted to explore the role of psychiatric comorbidities, persistent depressive symptoms lasting 2 years or more in the current episode, and baseline depression severity.
Compared to the group with no childhood maltreatment, the childhood maltreatment group had similar odds of ECT nonresponse (adjusted odds ratio = 1.47, 95% CI = 0.85-2.53) but significantly elevated odds of ECT nonremission (adjusted odds ratio = 3.75, 95% CI = 1.80-7.81). In a mediation analysis, presence of persistent depressive symptoms mediated 7.4% of the total effect of childhood maltreatment on ECT nonremission.
Individuals with exposure to childhood maltreatment may be less likely to achieve full remission following a course of ECT.
Description
Citation
Jelovac, A., Mohan, C., Whooley, E., Igoe, A., McCaffrey, C., & McLoughlin, D. M. (2024). Childhood maltreatment and outcomes following electroconvulsive therapy in adults with depression. Acta psychiatrica Scandinavica, 10.1111/acps.13756. Advance online publication. https://doi.org/10.1111/acps.13756
Publisher
License
© 2024 The Author(s). Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.
Journal
Acta psychiatrica Scandinavica
Volume
Issue
PubMed ID
ISSN
1600-0447