Association between pulse width and health-related quality of life after electroconvulsive therapy in patients with unipolar or bipolar depression: an observational register-based study

Abstract

Aims

To examine the association between pulse width and HRQoL measured within one week after electroconvulsive therapy (ECT) and at six-month follow-up in patients with unipolar or bipolar depression.

Methods

This was an observational register study using data from the Swedish National Quality Registry for ECT (2011–2019). Inclusion criteria were: age ≥18 years; index treatment for unipolar/bipolar depression; unilateral electrode placement; information on pulse width; EQ-5D measurements before and after ECT. Multiple linear regressions were performed to investigate the association between pulse width (<0.5 ms; 0.5 ms; >0.5 ms) and HRQoL (EQ-5D-3L index; EQ VAS) one week after ECT (primary outcome) and six months after ECT (secondary outcome).

Results

The sample included 5,046 patients with unipolar (82%) or bipolar (18%) depression. At first ECT session, 741 patients (14.7%) had pulse width <0.5 ms, 3,639 (72.1%) had 0.5 ms, and 666 (13.2%) had >0.5 ms. There were no statistically significant associations between pulse width and HRQoL one week after ECT. In the subsample of patients with an EQ-5D index recorded six months after ECT (n = 730), patients receiving 0.5 ms had significantly lower HRQoL (−0.089) compared to <0.5 ms, after adjusting for demographic and clinical characteristics (p = .011). The corresponding analysis for EQ VAS did not show any statistically significant associations.

Conclusion

No robust associations were observed between pulse width and HRQoL after ECT. On average, significant improvements in HRQoL were observed one week and six months after ECT for patients with unipolar or bipolar disease, independent of the pulse width received.

Keywords:

• Depressive disorders
• electroconvulsive therapy
• pulse width
• quality of life
• eq-5d

Acknowledgments

We would like to express our gratitude to all patients and health care personnel who provided data to the Swedish National Quality Register for ECT. Some of the data in this study was summarized previously in a PhD dissertation defense at Karolinska Institutet.

Disclosure statement

The study was funded by Region Stockholm within a research program that was part of a license agreement between Region Stockholm and the EuroQol Research Foundation. OE and EH have received travel grants from the EuroQol Research Foundation. JAJ is a member of the EuroQol group. AN, SK, and NZ declare no conflict of interest.

Data availability statement

Access to data is restricted by Swedish law. General information about obtaining access to data is available from the corresponding author Olivia Ernstsson upon request.

Additional information

Funding

The study was funded by Region Stockholm within a license agreement between Region Stockholm and the EuroQol Research Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Notes on contributors

Olivia Ernstsson

Olivia Ernstsson, has an educational background in Public Health, Health Economics and Outcomes Research, and is an affiliated researcher at Karolinska Institutet. Her research focuses on Real World Evidence (RWE) and application and evaluation of methods to measure and value health and quality of life.

Emelie Heintz

Emelie Heintz, is a health economist and the head of Stockholm Center for Health Economics (StoCHE), Region Stockholm. Her research interests concern the development and application of different methods to measure and value health and quality of life as well as the application of cost-effectiveness analyses in health care.

Axel Nordenskjöld

Axel Nordenskjöld, is a psychiatrist at the Unit for brain stimulation, University Hospital Örebro. He is an associate professor at the Faculty of Medicine and Health, Örebro University, Sweden, and registrar for the Swedish National Quality Register for ECT.

Jeffrey A. Johnson

Jeffrey A. Johnson, is a Professor and Interim Dean, School of Public Health, University of Alberta. Dr. Johnson has led research in health services, health outcomes and policy. He has been particularly interested in the measurement of patient-reported health outcomes in assessing health system quality and population health.

Seher Korkmaz

Seher Korkmaz, is a Clinical Pharmacologist working as a senior advisor in the Dept. of Digitalization and IT, Region Stockholm. She has extensive experience in development, management, and evaluation of digital solutions in health care, e.g. quality registers, clinical decision support systems and healthcare utilization databases.

Niklas Zethraeus

Niklas Zethraeus, is an associate Professor of Health Economics at Karolinska Institutet, Sweden. His research focuses on the economic evaluation of health care interventions. The work supports decision-making that aims to enhance the efficiency in allocation of health care resources to improve health.