Association Between Adverse Childhood Experiences and Efficacy of ECT in Adults with Unipolar and Bipolar Depression
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Abstract
Objective: This study aimed to examine the association between adverse childhood experiences (ACEs) and response to electroconvulsive therapy (ECT) in adult patients with unipolar and bipolar depression at Ramathibodi hospital.
Methods: A retrospective-observational study was conducted on patients with unipolar and bipolar depression (≥18 years) who received inpatient ECT at Ramathibodi Hospital, Thailand, from January 2015 to June 2023. ACEs were assessed using the Adverse Childhood Experiences (ACE) Questionnaire - Thai version. The data were analyzed using Chi-square test, Fisher’s Exact test, independent t-test, and binary logistic regression.
Results: The study involved 38 patients diagnosed with major depressive disorder, persistent depressive disorder, or bipolar depression, with a mean age of 45.0 ± 17.4 years. Most of the patients were female (71.1%). This study found that the most prevalent ACE categories were emotional neglect (31.6 %), household mental illness (31.6 %), and physical neglect (26.3 %). After 6 sessions of ECT, 20 patients (52.6%) achieved response. Binary logistic regression showed that no significant association was found between ACE and ECT response (OR = 0.42, 95% CI = 0.05-3.21, p = 0.40). However, younger age (Odds ratio = 0.91, B = -0.09, 95%CI = 0.84-0.96, p = 0.02). and higher stimulus intensity (Odds ratio = 1.01, B = 0.01, 95%CI = 1.00-1.03, p = 0.05) were significant predictors of ECT response.
Conclusion: This study did not find a correlation between ACE and the response to ECT in patients with major depressive disorder. Therefore, ECT may be an effective treatment option for patients with depression, regardless of their history of childhood trauma. However, further research is necessary to understand how adverse childhood experiences affect treatment decisions.
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