In this issue of JAMA Psychiatry, Slade et al¹ take on difficult questions about the effects of electroconvulsive therapy (ECT) on patient health outcomes. Specifically, the authors try to measure the causal effect of ECT on inpatient hospital readmission for psychiatric reasons among patients with severe psychiatric conditions. The challenge with this question is that patients who receive ECT are likely different from patients who don’t receive ECT over a range of factors that may also affect readmission risks. For example, ECT might be appropriate for patients with greater demonstrated compliance with treatments or patients with particular kinds of insurance. Such patients would likely have higher or lower readmission rates, even in the absence of ECT. To address concerns about biases, the authors propose instrumental variable (IV) statistical analyses.

在本期《JAMA精神病学》中，Slade等人¹就电惊厥疗法（ECT）对患者健康结果的影响提出一些棘手的问题。具体而言，作者试图评估ECT在精神病严重患者中因精神病原因住院住院再住院的因果关系。这个问题的挑战在于，接受ECT治疗的患者可能与未接受ECT治疗的患者在一系列因素上也可能有所不同，这些因素也可能影响再入院风险。例如，ECT可能适合于对治疗依从性更高的患者或具有特定保险类型的患者。即使没有ECT，此类患者的再入院率也可能更高或更低。为了解决对偏差的担忧，作者提出了工具变量（IV）的统计分析。