Predictors of regained occupational functioning after electroconvulsive therapy (ECT) in patients with major depressive disorder—A population based cohort study

Abstract

Nordenskjöld A, von Knorring L, Brus O, Engström I. Predictors of regained occupational functioning after electroconvulsive therapy (ECT) in patients with major depressive disorder—A population based cohort study. Nord J Psychiatry 2012;Early Online:1–8. Aims: The aim of the present study is to investigate the rate of regained occupational functioning among patients treated with electroconvulsive therapy (ECT) for major depression and to define predictors of time to regained occupational functioning. Methods: A nested cohort study was performed of patients treated by ECT for unipolar major depressive disorder registered in the Quality register for ECT and in the Swedish Social Insurance Agency registry. Predictive values of single clinical variables and their relative importance were tested with Cox regression analysis. Results: 394 patients were identified. Of those, 266 were on non-permanent sick leave and 128 on disability pension during ECT. Within 1 year post-ECT, 71% of the patients with non-permanent sick leave regained occupational functioning. Factors independently associated with a statistically significant increased time to regained occupational functioning were longer duration of sick leave pre-ECT, milder depression pre-ECT, less complete improvement with ECT, benzodiazepine treatment after ECT and co-morbid substance dependence. Conclusions: A large proportion of the patients do not return to work within several months post-ECT. Paradoxically, patients with more severe depression pre-ECT had a reduced time to regained occupational functioning, indicating a larger effect in this patients group of the treatment. Moreover, the period with sick leave compensation might be reduced if ECT is initiated within the first 3 months of sick leave. Clinical implications: Most patients on non-permanent sick leave regain occupational functioning after ECT. However, it usually takes a few months even in symptomatically improved patients.

• ECT
• major depressive disorder
• treatment outcome

Acknowledgements

This study was supported by the Uppsala-Örebro Regional Research Council and Research Committee of Örebro County Council. We would like to thank Andreas Carlborg, M.D., Ph.D., and Tomas Ljung M.D., for their support of the study. We would like to thank all the nurses who collected the information from the charts including Ann-Charlotte Fridenberger at the Quality register for ECT.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.