Effects of Electroconvulsive Therapy on Suicidal Behavior and Emergency Department Use Among Homeless Veterans: A Propensity Score-Matched Study.

Objective: This study examined the effects of electroconvulsive therapy (ECT) on suicidal ideation, suicide attempt, and emergency department use among homeless veterans receiving services in the Veterans Affairs (VA) health care system. Methods: National VA administrative data from 2001 to 2017 were analyzed using propensity score matching to compare 1,524 homeless veterans who received ECT and 3,025 homeless veterans discharged from psychiatric inpatient units serving as matched controls. Results: Homeless veterans who received ECT were significantly less likely to have used any ED services 30 and 90 days after their first ECT session compared to homeless veterans who did not receive ECT (OR = 0.65, 95% CI = 0.60-0.71; OR = 0.86, 95% CI = 0.81-0.93, respectively). Homeless veterans who received ECT showed reductions in suicidal ideation and suicide attempts after ECT, but these reductions were significantly less than homeless veterans who did not receive ECT 30 days, 90 days, and 1 year later (OR = 1.48-2.00). Conclusions: ECT has the potential to reduce ED use among homeless veterans with ECT-responsive psychiatric conditions. Further study is needed on whether the treatment engagement required of ECT participants indirectly reduces use of acute services in this population.