Gligorovic, for suicide mortality, we found there were 'no differences in a consistent direction across all studies."The authors question our conclusion that 'it is possible that ECT has no effect on suicide mortality," which they describe as an 'unnecessarily negative assessment."We added this statement in response to a reviewer comment and, while it is a theoretically possible explanation for our finding, we consider a much more probable explanation to be the high levels of heterogeneity between included studies.This interpretation would be consistent with the findings of two meta-analyses which, by only including patients with diagnoses of depression, had less clinically heterogenous populations compared to those included in our review.Odermatt et al. (2025), cited in our review, reported that ECT was associated with a statistically significant reduction in the odds ratio for suicide (OR 0.66, 95% CI 0.50-0.88)compared to treatment as usual.Kellner and colleagues also highlight the Chan et al. ( 2025) review and meta-analysis, which reported that ECT use was associated with reduced suicide mortality (RR = 0.67, 95% CI: 0.53-0.85)compared to no ECT use.In further support of the view that high heterogeneity explains the results of our meta-analysis of suicide mortality, we note in our review that 'studies that restricted the study population to patients with a higher severity of depression and accounted for confounding by indication through a wide range of covariates were more likely to show a reduction in suicide mortality.'Taken together, we agree with Kellner and colleagues that these findings suggest that ECT is a safe and effective treatment when prescribed for appropriate indications.
Naismith et al. (Thu,) studied this question.