Electroconvulsive therapy and occupational functioning in individuals with major depression

Purpose: Electroconvulsive therapy (ECT) is a well-established treatment for severe depressive episodes, but its effect on subsequent occupational functioning remains unclear. This study examined labour market trajectories among individuals with major depression treated with ECT, compared to similar individuals with depression who did not receive ECT. 

Methods: This population-based cohort study included all patients aged 15–55 with a first-time hospital contact for major depression (ICD-10 codes F32 and F33) in Denmark between 2000 and 2022. Patients treated with ECT were identified using the Danish National Patient Registry and matched 1:5 by age and sex to patients not treated with ECT. Labour market outcomes were assessed using data from the Danish Register for Evaluation of Marginalisation, tracking changes in employment and social transfer payments from one year before to three years after ECT/matching. Sequence analysis and Cox proportional hazards regression were used to evaluate time to regained employment, categorized as ≤6 months, 7–12 months, and 1–3 years. 

Results: We included 6672 ECT-treated patients and 27,940 matched non-ECT individuals. At baseline, ECT patients had lower employment rates (6.9 % vs. 39.5 %) but higher education and marriage rates. ECT was associated with slower return to work within 6 months (adjusted HR: 0.59, 95 % CI: 0.54–0.64), but similar or faster return at 7–12 months (HR: 1.12, 95 % CI: 1.01–1.24) and 1–3 years (HR: 1.05, 95 % CI: 0.96–1.14). 

Conclusion: ECT was linked to delayed short-term occupational recovery, but comparable or improved long-term return to work, supporting its continued use in treating major depression.