Electroconvulsive therapy (ECT) is an efficacious treatment for many mental disorders, but is underutilized because of fears of adverse effects, including the risk of death.

To provide a full picture of the magnitude of ECT-related mortality worldwide.

We performed a systematic review and meta-analysis (PubMed and Embase) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Only publications reporting on a specific number of ECT treatments as well as specific number of ECT-related deaths were included in our analysis. The ECT-related mortality rate was calculated by dividing the total number of ECT-related deaths by the total number of ECT treatments. The 95% confidence interval (95% CI) of this estimate was calculated using Bernoullis principle of distribution.

Fourteen studies with data from 32 countries reporting on a total of 757,662 ECT treatments met the predefined inclusion criteria. Fifteen cases of ECT-related death were reported – yielding an ECT-related mortality rate of 2.0 per 100,000 treatments (95% CI: 1.0–3.0). In the eight studies published after 2001 (covering 406,229 treatments), no ECT-related deaths were reported.

The ECT-related mortality rate was estimated at 2 per 100,000 treatments. For comparison, a recent meta-analysis on the mortality of general anaesthesia in relation to surgical procedures reported a mortality rate of 3.4 per 100,000. Thus, our systematic review and meta-analysis documents that death caused by ECT is extremely rare. This information can be used to reassure patients in need of ECT.

The authors have not supplied their declaration of competing interest.