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Öberg NP, Lindström SP, Bergqvist E, Ehnvall A, Sellin T, Stefenson A, Sunnqvist C, Waern M, Westrin Å. Last general practitioner consultation during the final month of life: a national medical record review of suicides in Sweden. BMC PRIMARY CARE 2024; 25:256. [PMID: 39010009 PMCID: PMC11247819 DOI: 10.1186/s12875-024-02498-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 06/26/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVES Individuals who die by suicide often consult their general practitioners (GPs) in their final weeks of life. The aim of this study was to gain a deeper knowledge of the clinical characteristics and GP assessments and treatments among individuals who consulted their GPs during the month preceding suicide. Further, we compared these features in those with and without contact with psychiatric services (PC and NPC, respectively) during the two years that preceded the suicide. DESIGN A nationwide retrospective explorative study investigating medical records. SETTING Primary care in Sweden. PARTICIPANTS Individuals who died by suicide in Sweden in 2015 with a GP visit within 30 days of death. RESULTS The study cohort corresponds to one fifth (n = 238) of all suicides that occurred in Sweden in 2015 (n = 1179), representing all those with available primary care records showing contact with a GP during the final 30 days of life (NPC: n = 125; PC: n = 113). The mean age was 58 years ± 19. Patients in the NPC group were older (NPC: 63 years ± 19 vs. PC: 53 years ± 18, p < 0.0001) and presented psychiatric symptoms less often (NPC: 50% vs. PC: 67%, p < 0.006). Somatic symptoms were as common as psychiatric symptoms for the whole sample, being present in more than half of individuals. Suicide risk was noted in only 6% of all individuals. Referral to psychiatric services occurred in 14%, less commonly for the NPC group (NPC: 6% vs. PC: 22%, p < 0.001). Cardiovascular or respiratory symptoms were noted in 19%, more often in the NPC group (NPC: 30% vs. PC: 6%, p < 0.001), as were diagnoses involving the circulatory system (all 10%, NPC:14% vs. PC: 5%, p < 0.020). CONCLUSION A high level of somatic symptoms was observed in primary care patients both with and without psychiatric contact, and this might have influenced GPs' management decisions. Psychiatric symptoms were noted in two thirds of those with psychiatric contact but only half of those without. While GPs noted psychiatric symptoms in over half of all individuals included in the study, they seldom noted suicide risk. These findings highlight the need for increased attention to psychiatric symptoms and suicide risk assessment, particularly among middle-aged and older individuals presenting with somatic symptoms. STRENGTHS AND LIMITATIONS OF THIS STUDY The National Cause of Death Register has excellent coverage of suicide deaths and access to medical records was very good. The medical record review provided detailed information regarding primary care utilization before death by suicide. Because of the lack of statistical power, due to the limited number of persons with GP contact during the last month of life, we chose not to correct for multiple comparisons. Our study approach did not capture the reasons behind GPs' documentation of elevated suicide risk. No systematic inter-rater reliability (IRR) testing was made, however, reviewers received training and continuous support from the research group.
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Affiliation(s)
- Nina Palmqvist Öberg
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, SE-221 84, Sweden.
- Office of Psychiatry and Habilitation, Region Skåne, Lund, SE-221 85, Sweden.
| | - Sara Probert Lindström
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, SE-221 84, Sweden
- Office of Psychiatry and Habilitation, Region Skåne, Lund, SE-221 85, Sweden
| | - Erik Bergqvist
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, SE-221 84, Sweden
- Psychiatric In-patient Clinic, Hallands Sjukhus Varberg, Region Halland, Varberg, SE-432 81, Sweden
| | - Anna Ehnvall
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, SE-413 45, Sweden
- Psychiatric Out-patient Clinic, Region Halland, Varberg, SE-432 43, Sweden
| | - Tabita Sellin
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, SE-701 82, Sweden
| | - Anne Stefenson
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, SE-17177, Sweden
| | - Charlotta Sunnqvist
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, SE-221 84, Sweden
- The Region Skåne Committee on Psychiatriy, Habilitation and Technical Aids, Lund, Sweden
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, SE-413 45, Sweden
- Psychosis Clinic, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, 41345, Sweden
| | - Åsa Westrin
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, SE-221 84, Sweden
- Office of Psychiatry and Habilitation, Region Skåne, Lund, SE-221 85, Sweden
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Alothman D, Lewis S, Fogarty AW, Card T, Tyrrell E. Primary care consultation patterns before suicide: a nationally representative case-control study. Br J Gen Pract 2024; 74:e426-e433. [PMID: 38331442 PMCID: PMC11157587 DOI: 10.3399/bjgp.2023.0509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/01/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Consultation with primary healthcare professionals may provide an opportunity to identify patients at higher suicide risk. AIM To explore primary care consultation patterns in the 5 years before suicide to identify suicide high-risk groups and common reasons for consulting. DESIGN AND SETTING This was a case-control study using electronic health records from England, 2001 to 2019. METHOD An analysis was undertaken of 14 515 patients aged ≥15 years who died by suicide and up to 40 matched live controls per person who died by suicide (n = 580 159), (N = 594 674). RESULTS Frequent consultations (>1 per month in the final year) were associated with increased suicide risk (age- and sex -adjusted odds ratio [OR] 5.88, 95% confidence interval [CI] = 5.47 to 6.32). The associated rise in suicide risk was seen across all sociodemographic groups as well as in those with and without psychiatric comorbidities. However, specific groups were more influenced by the effect of high-frequency consultation (>1 per month in the final year) demonstrating higher suicide risk compared with their counterparts who consulted once: females (adjusted OR 9.50, 95% CI = 7.82 to 11.54), patients aged 15-<45 years (adjusted OR 8.08, 95% CI = 7.29 to 8.96), patients experiencing less socioeconomic deprivation (adjusted OR 6.56, 95% CI = 5.77 to 7.46), and those with psychiatric conditions (adjusted OR 4.57, 95% CI = 4.12 to 5.06). Medication review, depression, and pain were the most common reasons for which patients who died by suicide consulted in the year before death. CONCLUSION Escalating or more than monthly consultations are associated with increased suicide risk regardless of patients' sociodemographic characteristics and regardless of the presence (or absence) of known psychiatric illnesses.
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Affiliation(s)
- Danah Alothman
- School of Medicine, University of Nottingham, Nottingham
| | - Sarah Lewis
- School of Medicine, University of Nottingham, Nottingham
| | | | - Timothy Card
- School of Medicine, University of Nottingham, Nottingham
| | - Edward Tyrrell
- School of Medicine, University of Nottingham, Nottingham
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Doering S, Probert-Lindström S, Ehnvall A, Wiktorsson S, Palmqvist Öberg N, Bergqvist E, Stefenson A, Fransson J, Westrin Å, Waern M. Anxiety symptoms preceding suicide: A Swedish nationwide record review. J Affect Disord 2024; 355:317-324. [PMID: 38552915 DOI: 10.1016/j.jad.2024.03.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/01/2024] [Accepted: 03/23/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND The literature on the relationship between anxiety and suicidal behaviors is limited and findings are mixed. This study sought to determine whether physicians noted anxiety symptoms and suicidality in their patients in the weeks and months before suicide. METHODS Data were derived from a nationwide medical record review of confirmed suicides in Sweden in 2015. Individuals with at least one documented physician consultation in any health care setting during 12 months before suicide (N = 956) were included. Clinical characteristics were compared between decedents with and without a notation of anxiety symptoms. Odds ratios were calculated to estimate associations between anxiety symptoms and suicidality in relation to suicide proximity. RESULTS Anxiety symptoms were noted in half of individuals 1 week before suicide. Patients with anxiety were characterized by high rates of depressive symptoms, ongoing substance use issues, sleeping difficulties, and fatigue. After adjustment for mood disorders, the odds of having a notation of elevated suicide risk 1 week before death were doubled in persons with anxiety symptoms. Associations were similar across time periods (12 months - 1 week). Two-thirds had been prescribed antidepressants at time of death. LIMITATIONS Data were based on physicians' notations which likely resulted in underreporting of anxiety depending on medical specialty. Records were not available for all decedents. CONCLUSIONS Anxiety symptoms were common in the final week before suicide and were accompanied by increases in documented elevated suicide risk. Our findings can inform psychiatrists, non-psychiatric specialists, and GPs who meet and assess persons with anxiety symptoms.
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Affiliation(s)
- Sabrina Doering
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
| | - Sara Probert-Lindström
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden; Office of Psychiatry and Habilitation, Region Skåne, Lund, Sweden
| | - Anna Ehnvall
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Psychiatric Outpatient Clinic, Region Halland, Varberg, Sweden
| | - Stefan Wiktorsson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Department of Psychotic Disorders, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Nina Palmqvist Öberg
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden; Office of Psychiatry and Habilitation, Region Skåne, Lund, Sweden
| | - Erik Bergqvist
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden; Psychiatric Inpatient Clinic, Region Halland, Varberg, Sweden
| | - Anne Stefenson
- National Centre for Suicide Research and Prevention, Karolinska Institutet, Stockholm, Sweden
| | - Jesper Fransson
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Åsa Westrin
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden; Office of Psychiatry and Habilitation, Region Skåne, Lund, Sweden
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Department of Psychotic Disorders, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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Martin J, Langley K, Cooper M, Rouquette OY, John A, Sayal K, Ford T, Thapar A. Sex differences in attention-deficit hyperactivity disorder diagnosis and clinical care: a national study of population healthcare records in Wales. J Child Psychol Psychiatry 2024. [PMID: 38864317 DOI: 10.1111/jcpp.13987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Population-based studies have observed sex biases in the diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD). Females are less likely to be diagnosed or prescribed ADHD medication. This study uses national healthcare records, to investigate sex differences in diagnosis and clinical care in young people with ADHD, particularly regarding recognition and treatment of other mental health conditions. METHODS The cohort included individuals diagnosed with ADHD, born between 1989 and 2013 and living in Wales between 2000 and 2019. Routine primary and secondary healthcare record data were used to derive diagnoses of ADHD and other neurodevelopmental and mental health conditions, as well as ADHD and antidepressant medications. Demographic variables included ethnicity, socioeconomic deprivation and contact with social services. RESULTS There were 16,458 individuals diagnosed with ADHD (20.3% females, ages 3-30 years), with a male-to-female ratio of 3.9:1. Higher ratios (4.8:1) were seen in individuals diagnosed younger (<12 years), with the lowest ratio (1.9:1) in those diagnosed as adults (>18). Males were younger at first recorded ADHD diagnosis (mean = 10.9 vs. 12.6 years), more likely to be prescribed ADHD medication and younger at diagnosis of co-occurring neurodevelopmental conditions. In contrast, females were more likely to receive a diagnosis of anxiety, depression or another mental health condition and to be prescribed antidepressant medications, prior to ADHD diagnosis. These sex differences were largely stable across demographic groups. CONCLUSIONS This study adds to the evidence base that females with ADHD are experiencing later recognition and treatment of ADHD. The results indicate that this may be partly because of diagnostic overshadowing from other mental health conditions, such as anxiety and depression, or initial misdiagnosis. Further research and dissemination of findings to the public are needed to improve awareness, timely diagnosis and treatment of ADHD in females.
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Affiliation(s)
- Joanna Martin
- Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Kate Langley
- School of Psychology, Cardiff University, Cardiff, UK
| | - Miriam Cooper
- Neurodevelopmental Service, Cwm Taf Morgannwg University Health Board, Merthyr Tydfil, UK
| | - Olivier Y Rouquette
- Institute of Suicide Prevention and Mental Health, Swansea University, Swansea, UK
| | - Ann John
- Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
- Institute of Suicide Prevention and Mental Health, Swansea University, Swansea, UK
| | - Kapil Sayal
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, Nottingham, UK
- Unit of Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Anita Thapar
- Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
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Dougall N, Savinc J, Maxwell M, Karatzias T, O'Connor RC, Williams B, John A, Cheyne H, Fyvie C, Bisson JI, Hibberd C, Abbott-Smith S, Nolan L, Murray J. Childhood adversity and mental health admission patterns prior to young person suicide (CHASE): a case-control 36 year linked hospital data study, Scotland UK 1981-2017. BJPsych Open 2024; 10:e124. [PMID: 38826035 DOI: 10.1192/bjo.2024.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Childhood adversity is associated with increased later mental health problems and suicidal behaviour. Opportunities for earlier healthcare identification and intervention are needed. AIM To determine associations between hospital admissions for childhood adversity and mental health in children who later die by suicide. METHOD Population-based longitudinal case-control study. Scottish in-patient general and psychiatric records were summarised for individuals born 1981 or later who died by suicide between 1991 and 2017 (cases), and matched controls (1:10), for childhood adversity and mental health (broadly defined as psychiatric diagnoses and general hospital admissions for self-harm and substance use). RESULTS Records were extracted for 2477 'cases' and 24 777 'controls'; 2106 cases (85%) and 13 589 controls (55%) had lifespan hospitalisations. Mean age at death was 23.7; 75.9% were male. Maltreatment or violence-related childhood adversity codes were recorded for 7.6% cases aged 10-17 (160/2106) versus 2.7% controls (371/13 589), odds ratio = 2.9 (95% CI, 2.4-3.6); mental health-related admissions were recorded for 21.7% cases (458/2106), versus 4.1% controls (560/13 589), odds ratio = 6.5 (95% CI, 5.7-7.4); 80% of mental health admissions were in general hospitals. Using conditional logistic models, we found a dose-response effect of mental health admissions <18y, with highest adjusted odds ratio (aOR) for three or more mental health admissions: aORmale = 8.17 (95% CI, 5.02-13.29), aORfemale = 15.08 (95% CI, 8.07-28.17). We estimated that each type of childhood adversity multiplied odds of suicide by aORmale = 1.90 (95% CI, 1.64-2.21), aORfemale = 2.65 (95% CI, 1.94-3.62), and each mental health admission by aORmale = 2.06 (95% CI, 1.81-2.34), aORfemale = 1.78 (95% CI, 1.50-2.10). CONCLUSIONS Our lifespan study found that experiencing childhood adversity (primarily maltreatment or violence-related admissions) or mental health admissions increased odds of young person suicide, with highest odds for those experiencing both. Healthcare practitioners should identify and flag potential 'at-risk' adolescents to prevent future suicidal acts, especially those in general hospitals.
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Affiliation(s)
- Nadine Dougall
- School of Health & Social Care, Edinburgh Napier University, UK
| | - Jan Savinc
- School of Health & Social Care, Edinburgh Napier University, UK
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, UK
| | | | | | - Brian Williams
- School of Health, Social Care & Life Sciences, University of the Highlands & Islands, UK
| | - Ann John
- Department of Population Psychiatry, Suicide and Informatics, Swansea University Medical School, UK; and Public Health Wales, Cardiff, UK
| | - Helen Cheyne
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, UK
| | | | | | - Carina Hibberd
- Faculty of Health Sciences & Sport, University of Stirling, UK
| | - Susan Abbott-Smith
- Child and Adolescent Mental Health Service (CAMHS), NHS Lothian, Edinburgh, UK
| | - Liz Nolan
- Aberlour, Scotland's children's charity (SC007991), Stirling, UK
| | - Jennifer Murray
- School of Health & Social Care, Edinburgh Napier University, UK
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Norman H, Marzano L, Fields B, Brown S, MacDonald Hart S, Kruger I. Characteristics and circumstances of rail suicides in England 2019-2021: A cluster analysis and autopsy study. J Affect Disord 2024; 354:397-407. [PMID: 38461900 DOI: 10.1016/j.jad.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/06/2024] [Accepted: 03/07/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Around 4 % of all suicide deaths in Great Britain occur on the railways. This exploratory study was designed to increase understanding of the individuals that take their lives in this way, and the circumstances of their death. METHOD Data were obtained from fatality investigation files compiled by the British Transport Police (BTP) relating to suspected suicides on the mainline railway in England from April 2019 to March 2021. Cluster analysis was carried out to identify grouped associations of characteristics and circumstances relating to rail suicide. RESULTS A total of 436 files were analysed, representing 93 % of all suspected railway suicides during this period. Cluster analysis identified four groups of almost equal size, distinguished principally by age, living arrangements, employment status and location of death. The study is novel in the way it integrates individual characteristics and circumstances of death. The identified clusters may provide a multidimensional way of conceptualising suicide risk that could inform more targeted interventions at rail locations. LIMITATIONS A high proportion of missing data means that the findings need to be interpreted with caution. It also restricted the multivariate analysis to those categories of information for which sufficient information was available. CONCLUSION The characteristics and circumstances of suicide deaths on the railways are complex and multifaceted. The typology identified in this study may help to target preventative strategies prior to the incident as well as at different location types.
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Affiliation(s)
- Hilary Norman
- Department of Psychology, Goldsmiths, University of London, UK.
| | - Lisa Marzano
- Faculty of Science and Technology, Middlesex University, UK
| | - Bob Fields
- Faculty of Science and Technology, Middlesex University, UK
| | - Sophie Brown
- Faculty of Science and Technology, Middlesex University, UK
| | | | - Ian Kruger
- Faculty of Science and Technology, Middlesex University, UK
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Saini P, Hunt A, Blaney P, Murray A. Recognising and Responding to Suicide-Risk Factors in Primary Care: A Scoping Review. JOURNAL OF PREVENTION (2022) 2024:10.1007/s10935-024-00783-1. [PMID: 38801507 DOI: 10.1007/s10935-024-00783-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
The cost of one suicide is estimated to be £1.67 million (2 million euros) to the UK economy. Most people who die by suicide have seen a primary care practitioner (PCP) in the year prior to death. PCPs could aim to intervene before suicidal behaviours arise by addressing suicide-risk factors noted in primary care consultations, thereby preventing suicide and promoting health and wellbeing. This study aimed to conduct a rapid, systematic scoping review to explore how PCPs can effectively recognise and respond to suicide-risk factors. MedLine, CINAHL, PsycINFO, Web of Science and Cochrane Library databases were searched for three key concepts: suicide prevention, mental health and primary care. Two reviewers screened titles, abstracts and full papers independently against the eligibility criteria. Data synthesis was achieved by extracting and analysing study characteristics and findings. Forty-two studies met the eligibility criteria and were cited in this scoping review. Studies were published between 1990 and 2020 and were of good methodological quality. Six themes regarding suicide risk assessment in primary care were identified: Primary care consultations prior to suicide; Reasons for non-disclosure of suicidal behaviour; Screening for suicide risk; Training for primary care staff; Use of language by primary care staff; and, Difference in referral pathways from general practitioners or primary care practitioners. This review focused on better recognition and response to specific suicide-risk factors more widely such as poor mental health, substance misuse and long-term physical health conditions. Primary care is well placed to address the range of suicide-risk factors including biological, physical-health, psychological and socio-economic factors and therefore these findings could inform the development of person-centred approaches to be used in primary care.
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Affiliation(s)
- Pooja Saini
- School of Psychology, Faculty of Health, Suicide and Self-Harm Prevention, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK.
| | - Anna Hunt
- School of Psychology, Faculty of Health, Suicide and Self-Harm Prevention, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Peter Blaney
- School of Psychology, Faculty of Health, Suicide and Self-Harm Prevention, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Annie Murray
- Department of Health and Social Care, Office for Health Improvement and Disparities, Piccadilly Place 3, Manchester, M1 3BN, UK
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DelPozo-Banos M, Rodway C, Lee SC, Rouquette OY, Ibrahim S, Lloyd K, Appleby L, Kapur N, John A. Contacts with primary and secondary healthcare before suicide by those under the care of mental health services: case-control, whole-population-based study using person-level linked routine data in Wales, UK during 2000-2015. BJPsych Open 2024; 10:e108. [PMID: 38725371 PMCID: PMC11094447 DOI: 10.1192/bjo.2024.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND People under the care of mental health services are at increased risk of suicide. Existing studies are small in scale and lack comparisons. AIMS To identify opportunities for suicide prevention and underpinning data enhancement in people with recent contact with mental health services. METHOD This population-based study includes people who died by suicide in the year following a mental health services contact in Wales, 2001-2015 (cases), paired with similar patients who did not die by suicide (controls). We linked the National Confidential Inquiry into Suicide and Safety in Mental Health and the Suicide Information Database - Cymru with primary and secondary healthcare records. We present results of conditional logistic regression. RESULTS We matched 1031 cases with 5155 controls. In the year before their death, 98.3% of cases were in contact with healthcare services, and 28.5% presented with self-harm. Cases had more emergency department contacts (odds ratio 2.4, 95% CI 2.1-2.7) and emergency hospital admissions (odds ratio 1.5, 95% CI 1.4-1.7), but fewer primary care contacts (odds ratio 0.7, 95% CI 0.6-0.9) and out-patient appointments (odds ratio 0.2, 95% CI 0.2-0.3) than controls. Odds ratios were larger in females than males for injury and poisoning (odds ratio: 3.3 (95% CI 2.5-4.5) v. 2.6 (95% CI 2.1-3.1)). CONCLUSIONS We may be missing existing opportunities to intervene, particularly in emergency departments and hospital admissions with self-harm presentations and with unattributed self-harm, especially in females. Prevention efforts should focus on strengthening routine care contacts, responding to emergency contacts and better self-harm care. There are benefits to enhancing clinical audit systems with routinely collected data.
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Affiliation(s)
| | - Cathryn Rodway
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, UK
| | | | | | - Saied Ibrahim
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, UK
| | | | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, UK
| | - Navneet Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, UK; NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, UK; and Mersey Care NHS Foundation Trust, Prescot, UK
| | - Ann John
- Swansea University Medical School, UK
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Lee SC, Rouquette OY, Hawton K, Cleobury L, Spencer S, Lloyd K, Gunnell D, Scourfield J, John A. Understanding Suicide Clusters Through Exploring Self-Harm Behaviors. CRISIS 2024; 45:180-186. [PMID: 37904497 DOI: 10.1027/0227-5910/a000930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Background: There is little information about characteristics and long-term outcomes of individuals who self-harm during a suicide cluster. Aims: To compare characteristics of individuals who self-harmed during a suicide cluster in South Wales (∼10 deaths between December 2007 and March 2008) with others who self-harmed prior to the cluster and to evaluate 10-year self-harm and mortality outcomes. Method: Using records from the hospital serving the catchment area of the suicide cluster, enhanced by national routinely collected linked data, we created the following two groups: individuals who self-harmed (a) during the suicide cluster and (b) 1 year before. We compared individuals' characteristics and performed logistic regression to compute odds ratios of 10-year self-harm and mortality outcomes. Results: Individuals who self-harmed during the cluster were less likely to be hospitalized or have a mental health history than those who self-harmed prior to the cluster. No significant group differences were found for 10-year self-harm outcomes, but all-cause mortality was higher for males. Limitations: Sample size was small, and data were lacking on psychological and social proximity to individuals who died during the suicide cluster. Conclusion: Our findings highlight the importance of long-term healthcare follow-up of those who self-harm during a suicide cluster, particularly males.
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Affiliation(s)
- Sze Chim Lee
- Population Data Science, Swansea University Medical School, Swansea, UK
| | | | - Keith Hawton
- Centre for Suicide Research, University of Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Louise Cleobury
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Sarah Spencer
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Keith Lloyd
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
- National Institute of Health and Care Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, UK
| | - Jonathan Scourfield
- Children's Social Care Research and Development Centre (CASCADE), School of Social Sciences, Cardiff University, UK
| | - Ann John
- Population Data Science, Swansea University Medical School, Swansea, UK
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McCarthy M, Saini P, Nathan PR, Ashworth E, McIntyre J. "No Abnormality Detected": A Mixed-Methods Examination of Emergency Department Coding Practices for People in Suicidal Crisis. Arch Suicide Res 2024:1-14. [PMID: 38602363 DOI: 10.1080/13811118.2024.2337195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
BACKGROUND Accurate identification of suicidal crisis presentations to emergency departments (EDs) can lead to timely mental health support, improve patient experience, and support evaluations of suicide prevention initiatives. Poor coding practices within EDs are preventing appropriate patient care. Aims of the study are (1) examine the current suicide-related coding practices, (2) identify the factors that contribute to staff decision-making and patients receiving the incorrect code or no code. METHOD A mixed-methods study was conducted. Quantitative data were collated from six EDs across Merseyside and Cheshire, United Kingdom from 2019 to 2021. Attendances were analyzed if they had a presenting complaint, chief complaint, or primary diagnosis code related to suicidal crisis, suicidal ideation, self-harm or suicide attempt. Semi-structured interviews were conducted with staff holding various ED positions (n = 23). RESULTS A total of 15,411 suicidal crisis and self-harm presentations were analyzed. Of these, 21.8% were coded as 'depressive disorder' and 3.8% as 'anxiety disorder'. Absence of an appropriate suicidal crisis code resulted in staff coding presentations as 'no abnormality detected' (23.6%) or leaving the code blank (18.4%). The use of other physical injury codes such as 'wound forearm', 'head injury' were common. Qualitative analyses elucidated potential causes of inappropriate coding, such as resource constraints and problems with the recording process. CONCLUSION People attending EDs in suicidal crisis were not given a code that represented the chief presentation. Improved ED coding practices related to suicidal crisis could result in considerable benefits for patients and more effective targeting of resources and interventions.
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Affiliation(s)
- Molly McCarthy
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Pooja Saini
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | | | - Emma Ashworth
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Jason McIntyre
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
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11
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Mughal F, Sheikh A. Cross-sectoral primary care-based approaches to reducing suicides in England. J R Soc Med 2024; 117:4-5. [PMID: 38174699 PMCID: PMC10858719 DOI: 10.1177/01410768231220306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Affiliation(s)
- Faraz Mughal
- School of Medicine, Keele University, Keele, ST5 5BG, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, EH8 9AG, UK
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12
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Gooding P, Haddock G, Harris K, Asriah M, Awenat Y, Cook L, Drake RJ, Emsley R, Huggett C, Jones S, Lobban F, Marshall P, Pratt D, Peters S. The interplay between suicidal experiences, psychotic experiences and interpersonal relationships: a qualitative study. BMC Psychiatry 2023; 23:873. [PMID: 38001403 PMCID: PMC10668454 DOI: 10.1186/s12888-023-05164-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/04/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Suicidal thoughts, acts, plans and deaths are considerably more prevalent in people with non-affective psychosis, including schizophrenia, compared to the general population. Social isolation and interpersonal difficulties have been implicated in pathways which underpin suicidal experiences in people with severe mental health problems. However, the interactions between psychotic experiences, such as hallucinations and paranoia, suicidal experiences, and the presence, and indeed, absence of interpersonal relationships is poorly understood and insufficiently explored. The current study sought to contribute to this understanding. METHODS An inductive thematic analysis was conducted on transcripts of 22, individual, semi-structured interviews with adult participants who had both non-affective psychosis and recent suicidal experiences. A purposive sampling strategy was used. Trustworthiness of the analysis was assured with researcher triangulation. RESULTS Participants relayed both positive and negative experiences of interpersonal relationships. A novel conceptual model is presented reflecting a highly complex interplay between a range of different suicidal experiences, psychosis, and aspects of interpersonal relationships. Three themes fed into this interplay, depicting dynamics between perceptions of i. not mattering and mattering, ii. becoming disconnected from other people, and iii. constraints versus freedom associated with sharing suicidal and psychotic experiences with others. CONCLUSION This study revealed a detailed insight into ways in which interpersonal relationships are perceived to interact with psychotic and suicidal experiences in ways that can be both beneficial and challenging. This is important from scientific and clinical perspectives for understanding the complex pathways involved in suicidal experiences. TRIAL REGISTRATION ClinicalTrials.gov (NCT03114917), 14th April 2017. ISRCTN (reference ISRCTN17776666 .); 5th June 2017). Registration was recorded prior to participant recruitment commencing.
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Affiliation(s)
- Patricia Gooding
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kamelia Harris
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Menita Asriah
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
| | - Yvonne Awenat
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Leanne Cook
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Richard J Drake
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Charlotte Huggett
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Steven Jones
- Lancashire and South Cumbria, NHS Foundation Trust, Lancashire, UK
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Fiona Lobban
- Lancashire and South Cumbria, NHS Foundation Trust, Lancashire, UK
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Paul Marshall
- Lancashire and South Cumbria, NHS Foundation Trust, Lancashire, UK
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sarah Peters
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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13
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Fedorowicz S, Dempsey RC, Ellis NJ, Mulvey O, Gidlow CJ. Quantitative content analysis of Freedom of Information requests examining the extent and variations of tools and training for conducting suicide risk assessments in NHS Trusts across England. BMJ Open 2023; 13:e072004. [PMID: 37884387 PMCID: PMC10603533 DOI: 10.1136/bmjopen-2023-072004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/31/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVES Determining the risk for suicide is a difficult endeavour. Clinical guidance in the UK explicitly advises against using risk assessment tools and scales to determine suicide risk. Based on Freedom of Information (FoI) requests made to NHS Trusts in England, this study provides an overview of suicide risk assessment tools in use, training provided in how to use such assessments, and explores implementation of suicide risk assessment guidance in practice in English NHS Trusts. DESIGN A cross-sectional survey of suicide risk assessment tools and training gathered via FoI requests and subjected to a content analysis. SETTING FoI requests were submitted to NHS Trusts across England. RESULTS A wide variety of suicide risk assessments tools were identified as being used in practice, with several trusts reported using more than one tool to determine suicide risk. Forty-one trusts reported using locally developed, unvalidated, tools to assess risk of suicide and 18 stated they do not use a tool. Ten trusts stated they do not train their staff in suicide risk assessment while 13 reported use of specific suicide risk assessment training. Sixty-two trusts stated they do not centrally record the number of assessments conducted or how many individuals are identified as at risk. Content analysis indicated the frequent wider assessment of risk not restricted to suicide risk. CONCLUSIONS There is wide variation in suicide risk assessment tools being used in practice and some lack of specific training for healthcare staff in determining suicide risk. Few trusts routinely record the number of assessments being conducted or the number of individuals identified at high risk. Implementation of specific training is necessary for the suicide risk assessment process to identify patient needs and develop therapeutic engagement. Routinely recording how many assessments are conducted is a crucial step in improving suicide prevention.
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Affiliation(s)
- Sophia Fedorowicz
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Robert C Dempsey
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Naomi J Ellis
- Faculty of Health Sciences, Staffordshire University, Stoke-on-Trent, UK
| | - Olivia Mulvey
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Christopher J Gidlow
- Centre for Sport, Health and Exercise Research, Staffordshire University, Stoke on Trent, UK
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14
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Hackmann C, Komashie A, Handley M, Murdoch J, Wagner AP, Grünwald LM, Waller S, Kaminskiy E, Zeilig H, Jones J, Bray J, Bagge S, Simpson A, Dalkin SM, Clarkson J, Borghini G, Kipouros T, Rohricht F, Taousi Z, Haighton C, Rae S, Wilson J. Codesigning a systemic discharge intervention for inpatient mental health settings (MINDS): a protocol for integrating realist evaluation and an engineering-based systems approach. BMJ Open 2023; 13:e071272. [PMID: 37709323 PMCID: PMC10503342 DOI: 10.1136/bmjopen-2022-071272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/26/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Transition following discharge from mental health hospital is high risk in terms of relapse, readmission and suicide. Discharge planning supports transition and reduces risk. It is a complex activity involving interacting systemic elements. The codesigning a systemic discharge intervention for inpatient mental health settings (MINDS) study aims to improve the process for people being discharged, their carers/supporters and staff who work in mental health services, by understanding, co-designing and evaluating implementation of a systemic approach to discharge planning. METHODS AND ANALYSIS The MINDS study integrates realist research and an engineering-informed systems approach across three stages. Stage 1 applies realist review and evaluation using a systems approach to develop programme theories of discharge planning. Stage 2 uses an Engineering Better Care framework to codesign a novel systemic discharge intervention, which will be subjected to process and economic evaluation in stage 3. The programme theories and resulting care planning approach will be refined throughout the study ready for a future clinical trial. MINDS is co-led by an expert by experience, with researchers with lived experience co-leading each stage. ETHICS AND DISSEMINATION MINDS stage 1 has received ethical approval from Yorkshire & The Humber-Bradford Leeds (Research Ethics Committee (22/YH/0122). Findings from MINDS will be disseminated via high-impact journal publications and conference presentations, including those with service user and mental health professional audiences. We will establish routes to engage with public and service user communities and National Health Service professionals including blogs, podcasts and short videos. TRIAL REGISTRATION NUMBER MINDS is funded by the National Institute of Health Research (NIHR 133013) https://fundingawards.nihr.ac.uk/award/NIHR133013. The realist review protocol is registered on PROSPERO. PROSPERO REGISTRATION NUMBER CRD42021293255.
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Affiliation(s)
- Corinna Hackmann
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- Noriwch Medical School, The University of East Anglia, Norwich, UK
| | - Alexander Komashie
- Department of Enginering, University of Cambridge School of Technology, Cambridge, UK
| | - Melanie Handley
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Jamie Murdoch
- School of Life Course and Population Sciences, King's College London, London, UK
| | - Adam P Wagner
- NIHR Collaboration for Leadership in Applied Health Research & Care (CLAHRC) East of England, Cambridge, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Lisa Marie Grünwald
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Sam Waller
- Engineering Design Centre, University of Cambridge, Cambridge, UK
| | - Emma Kaminskiy
- School of Psychology and Sports Science, Anglia Ruskin University, Chelmsford, UK
| | - Hannah Zeilig
- London College of Fashion, University of the Arts London, London, UK
| | - Julia Jones
- Centre for Research in Primary & Community Care, University of Hertfordshire, Hatfield, UK
| | | | - Sophie Bagge
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Alan Simpson
- Health Services and Population Research, King's College London, London, UK
| | - Sonia Michelle Dalkin
- Department of Social Work, Education & Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - John Clarkson
- Engineering Design Centre, University of Cambridge, Cambridge, UK
| | | | | | - Frank Rohricht
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Zohra Taousi
- Hertfordshire and Peterborough NHS Foundation Trust, St Albans, UK
| | - Catherine Haighton
- Department of Social Work, Education & Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | | | - Jon Wilson
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- Noriwch Medical School, The University of East Anglia, Norwich, UK
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15
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Underwood JFG, DelPozo-Banos M, Frizzati A, Rai D, John A, Hall J. Neurological and psychiatric disorders among autistic adults: a population healthcare record study. Psychol Med 2023; 53:5663-5673. [PMID: 36189783 PMCID: PMC10482712 DOI: 10.1017/s0033291722002884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 07/29/2022] [Accepted: 08/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Co-occurring psychiatric disorders are common in autism, with previous studies suggesting 54-94% of autistic individuals develop a mental health condition in their lifetime. Most studies have looked at clinically-recruited cohorts, or paediatric cohorts followed into adulthood, with less known about the autistic community at a population level. We therefore studied the prevalence of co-occurring psychiatric and neurological conditions in autistic individuals in a national sample. METHODS This retrospective case-control study utilised the SAIL Databank to examine anonymised whole population electronic health record data from 2001 to 2016 in Wales, UK (N = 3.6 million). We investigated the prevalence of co-occurring psychiatric and selected neurological diagnoses in autistic adults' records during the study period using International Classification of Diseases-10 and Read v2 clinical codes compared to general population controls matched for age, sex and deprivation. RESULTS All psychiatric conditions examined were more common amongst adults with autism after adjusting for age, sex and deprivation. Prevalence of attention-deficit hyperactivity disorder (7.00%), bipolar disorder (2.50%), obsessive-compulsive disorder (3.02%), psychosis (18.30%) and schizophrenia (5.20%) were markedly elevated in those with autism, with corresponding odds ratios 8.24-10.74 times the general population. Depression (25.90%) and anxiety (22.40%) were also more prevalent, with epilepsy 9.21 times more common in autism. CONCLUSIONS We found that a range of psychiatric conditions were more frequently recorded in autistic individuals. We add to understanding of under-reporting and diagnostic overshadowing in autism. With increasing awareness of autism, services should be cognisant of the psychiatric conditions that frequently co-occur in this population.
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Affiliation(s)
- Jack F. G. Underwood
- Division of Psychological Medicine and Clinical Neurosciences, Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, UK
| | | | - Aura Frizzati
- Cedar Healthcare Technology Research Centre, Cardiff & Vale University Health Board, Cardiff, UK
| | - Dheeraj Rai
- Bristol Medical School, Bristol Population Health Science Institute, Bristol, UK
| | - Ann John
- Population Data Science, Medical School, Swansea University, Swansea, UK
| | - Jeremy Hall
- Division of Psychological Medicine and Clinical Neurosciences, Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, UK
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16
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Tournier M, Bénard-Laribière A, Jollant F, Hucteau E, Diop PY, Jarne-Munoz A, Pariente A, Oger E, Bezin J. Risk of suicide attempt and suicide associated with benzodiazepine: A nationwide case crossover study. Acta Psychiatr Scand 2023; 148:233-241. [PMID: 37339778 DOI: 10.1111/acps.13582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/27/2023] [Accepted: 05/06/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Previous studies that found an association between benzodiazepines and suicidal behaviours were confounded by indication bias. AIMS To limit this bias, a case crossover study (CCO) was conducted to estimate the risk of suicide attempt and suicide associated with benzodiazepines. METHOD Patients ≥16 years, with hospitalised suicide attempt or suicide between 2013 and 2016, and at least one benzodiazepine dispensing within the 120 days before their act were selected in the nationwide French reimbursement healthcare system databases (SNDS). For each patient, frequency of benzodiazepine dispensing was compared between a risk period (days -30 to -1 before the event) and two matched reference periods (days -120 to -91, and -90 to -61). RESULTS A total of 111,550 individuals who attempted suicide and 12,312 suicide victims were included, of who, respectively, 77,474 and 7958 had recent psychiatric history. Benzodiazepine dispensing appeared higher in the 30-day risk period than in reference ones. The comparison yielded adjusted odds ratios of 1.74 for hospitalised suicide attempt (95% confidence interval 1.69-1.78) and 1.45 for suicide (1.34-1.57) in individuals with recent psychiatric history, and of 2.77 (2.69-2.86) and 1.80 (1.65-1.97) for individuals without. CONCLUSION This nationwide study supports an association between recent benzodiazepine use and both suicide attempt and suicide. These results strengthen the need for screening for suicidal risk carefully before initiation and during treatment when prescribing benzodiazepines. REGISTRATION NO EUPAS48070 (http://www.ENCEPP.eu).
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Affiliation(s)
- Marie Tournier
- University of Bordeaux, INSERM, BPH, Team AHeaD, U1219, Bordeaux, France
- Hospital Charles Perrens, Bordeaux, France
| | | | - Fabrice Jollant
- Moods Research Team, INSERM UMR-1178, CESP, Le Kremlin-Bicêtre, France
- Department of Psychiatry, School of Medicine, University Paris-Saclay & Academic Hospital (CHU) Bicêtre, APHP, Le Kremlin-Bicêtre, France
| | - Emilie Hucteau
- University of Bordeaux, INSERM, BPH, Team AHeaD, U1219, Bordeaux, France
| | - Papa-Yatma Diop
- University of Bordeaux, INSERM, BPH, Team AHeaD, U1219, Bordeaux, France
| | - Ana Jarne-Munoz
- University of Bordeaux, INSERM, BPH, Team AHeaD, U1219, Bordeaux, France
| | - Antoine Pariente
- University of Bordeaux, INSERM, BPH, Team AHeaD, U1219, Bordeaux, France
- CHU de Bordeaux, Clinical Pharmacology Unit, INSERM, U1219, Bordeaux, France
| | - Emmanuel Oger
- EA 7449 REPERES (Pharmacoepidemiology and Health Services Research), Rennes 1 University, Rennes, France
| | - Julien Bezin
- University of Bordeaux, INSERM, BPH, Team AHeaD, U1219, Bordeaux, France
- CHU de Bordeaux, Clinical Pharmacology Unit, INSERM, U1219, Bordeaux, France
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17
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Langley K, Del Pozo-Banos M, Daalsgard S, Paranjothy S, Riglin L, John A, Thapar A. Can a nation-wide e-cohort of ADHD and ASD in childhood be established using Welsh routinely available datasets? BMJ Open 2023; 13:e071851. [PMID: 37604636 PMCID: PMC10445352 DOI: 10.1136/bmjopen-2023-071851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/24/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVES We investigated the feasibility and validity of establishing a nationwide e-cohort of individuals with a diagnosis of attention deficit hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) for future longitudinal research. DESIGN Individuals with a childhood diagnosis of ADHD/ASD as recorded on routinely available healthcare datasets were compared with matched controls and a sample of directly assessed individuals with ADHD. SETTING This study used data from the Welsh Secure Anonymised Information Linkage Databank in Wales, UK. Routinely collected data from primary care, emergency department and hospital admissions were linked at person level. PARTICIPANTS All individuals in Wales, UK born between 1 January 1991 and 31 December 2000. Individuals with a recorded diagnosis of ADHD and/or ASD by age 18 years were identified using International Classification of Diseases, 10th Revision and National Health Service (NHS) READ codes and matched to 3 controls each and 154 individuals with ADHD recruited from an established research study. OUTCOME MEASURES Recorded service use for anxiety and depression, alcohol and drug use and self-harm including emergency department use in young adulthood (age 16-25 years). RESULTS 7726 individuals had a recorded diagnosis of ADHD (80% male) and 5001 of ASD (79% male); 1.4% and 0.9% of the population, respectively. Cox's regression analyses showed ADHD was associated with increased risks of anxiety/depression (HR: 2.36, 95% CI: 2.20 to 2.53), self-harm (HR: 5.70, 95% CI: 5.07 to 6.40), alcohol (HR: 3.95, 95% CI: 3.42 to 4.56), drug use (HR: 5.88, 95% CI: 5.08 to 6.80) and emergency department service use (HR: 1.36, 95% CI: 1.31 to 1.41). Those with ASD were at increased risk of anxiety/depression (HR: 2.11, 95% CI: 1.91 to 2.34), self-harm (HR: 2.93, 95% CI: 2.45 to 3.50) and drug use (HR: 2.21, 95% CI: 1.66 to 2.95) but not alcohol use. The ADHD e-cohort were similar to the directly assessed cohort. CONCLUSIONS Our identification strategy demonstrated the feasibility of establishing a large e-cohort of those with ADHD/ASD with expected patterns of poorer early adult outcomes, demonstrating a valid method of identifying large samples for future longitudinal studies without selective attrition.
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Affiliation(s)
- Kate Langley
- School of Psychology, Cardiff University, Cardiff, UK
| | - Marcos Del Pozo-Banos
- Population Data Science, Swansea University, Swansea, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Søren Daalsgard
- National Centre for Register-based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Child and Adolescent Psychiatry, Mental Health Services of the Capital Region, Glostrup, Denmark
| | | | - Lucy Riglin
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
- Division of Psychological Medicine and Clinical Neurosciences; Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Ann John
- Population Data Science, Swansea University, Swansea, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Anita Thapar
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
- Division of Psychological Medicine and Clinical Neurosciences; Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
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18
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Mughal F, Bojanić L, Rodway C, Graney J, Ibrahim S, Quinlivan L, Steeg S, Tham SG, Turnbull P, Appleby L, Webb RT, Kapur N. Recent GP consultation before death by suicide in middle-aged males: a national consecutive case series study. Br J Gen Pract 2023; 73:e478-e485. [PMID: 37130612 PMCID: PMC10170520 DOI: 10.3399/bjgp.2022.0589] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/28/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Reducing suicide risk in middle-aged males (40-54 years) is a national priority. People have often presented to their GP within 3 months before suicide thus highlighting an opportunity for early intervention. AIM To describe the sociodemographic characteristics and identify antecedents in middle-aged males who recently consulted a GP before dying by suicide. DESIGN AND SETTING This study was a descriptive examination of suicide in a national consecutive sample of middle-aged males in 2017 in England, Scotland, and Wales. METHOD General population mortality data were obtained from the Office for National Statistics and National Records of Scotland. Information was collected about antecedents considered relevant to suicide from data sources. Logistic regression examined associations with final recent GP consultation. Males with lived experience were consulted during the study. RESULTS In 2017, a quarter (n = 1516) of all suicide deaths were in middle-aged males. Data were attained on 242 males: 43% had their last GP consultation within 3 months of suicide; and a third of these males were unemployed and nearly half were living alone. Males who saw a GP recently before suicide were more likely to have had recent self-harm and work-related problems than males who had not. Having a current major physical illness, recent self-harm, presenting with a mental health problem, and recent work-related issues were associated with having a last GP consultation close to suicide. CONCLUSION Clinical factors were identified that GPs should be alert to when assessing middle-aged males. Personalised holistic management may have a role in preventing suicide in these individuals.
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Affiliation(s)
- Faraz Mughal
- School of Medicine, Keele University, Keele; honorary clinical research fellow, Division of Psychology and Mental Health, University of Manchester, Manchester; affiliate, NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester
| | - Lana Bojanić
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), School of Health Sciences, University of Manchester, Manchester
| | - Cathryn Rodway
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), School of Health Sciences, University of Manchester, Manchester
| | - Jane Graney
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), School of Health Sciences, University of Manchester, Manchester
| | - Saied Ibrahim
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), School of Health Sciences, University of Manchester, Manchester
| | - Leah Quinlivan
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester
| | - Sarah Steeg
- School of Health Sciences, University of Manchester, Manchester
| | - Su-Gwan Tham
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), School of Health Sciences, University of Manchester, Manchester
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), School of Health Sciences, University of Manchester, Manchester
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), School of Health Sciences, University of Manchester, Manchester
| | - Roger T Webb
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester
| | - Nav Kapur
- NCISH, School of Health Sciences, University of Manchester, Manchester; Manchester Academic Health Sciences Centre, Manchester; Greater Manchester Mental Health NHS Foundation Trust, Manchester; NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester
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19
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Kwon M, Lawn S, Kaine C. Understanding Men's Engagement and Disengagement When Seeking Support for Mental Health. Am J Mens Health 2023; 17:15579883231157971. [PMID: 36880329 PMCID: PMC9996733 DOI: 10.1177/15579883231157971] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Men are less likely to utilize health care services compared with women. When it comes to mental health, men have been reported to hold more reluctant attitudes toward engaging with mental health services. Current studies have predominantly been quantitative and focused on understanding effective strategies to promote men's engagement and why men may avoid help-seeking or may not seek help early; few studies exist of men's disengagement from services. Much of this research has been undertaken from the services' perspective. The study reported here attempts to gain better insight into the reasons men give for their disengagement from mental health services and what men say will reengage them back into the system. This research was a secondary analysis of data collected by a national survey conducted by Lived Experience Australia (LEA). Responses of 73 male consumers were gathered and analyzed. Analysis of the responses was split into two themes with associated subthemes: (1) Why men disengage: (1.1) Autonomy; (1.2) Professionalism; (1.3) Authenticity; and (1.4) Systemic Barriers; and (2) What will help men reengage: (2.1) Clinician-driven reconciliation, (2.2) Community and Peer Workers; and (2.3) Ease of reentry. Findings highlight strategies to prevent disengagement such as creating open and honest therapeutic environments and improving men's mental health literacy while providing care. Evidence-based approaches to reengage male consumers are suggested along with an emphasis on men's strong preferences for community-based mental health services and peer workers.
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Affiliation(s)
- Minjoo Kwon
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,Lived Experience Australia, Adelaide, South Australia, Australia
| | - Christine Kaine
- Lived Experience Australia, Adelaide, South Australia, Australia
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20
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Quinlivan L, Gorman L, Marks S, Monaghan E, Asmal S, Webb RT, Kapur N. Liaison psychiatry practitioners' views on accessing aftercare and psychological therapies for patients who present to hospital following self-harm: multi-site interview study. BJPsych Open 2023; 9:e34. [PMID: 36803955 PMCID: PMC9970172 DOI: 10.1192/bjo.2023.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Timely provision of aftercare following self-harm may reduce risks of repetition and premature death, but existing services are frequently reported as being inadequate. AIMS To explore barriers and facilitators to accessing aftercare and psychological therapies for patients presenting to hospital following self-harm, from the perspective of liaison psychiatry practitioners. METHOD Between March 2019 and December 2020, we interviewed 51 staff members across 32 liaison psychiatry services in England. We used thematic analyses to interpret the interview data. RESULTS Barriers to accessing services may heighten risk of further self-harm for patients and burnout for staff. Barriers included: perceived risk, exclusionary thresholds, long waiting times, siloed working and bureaucracy. Strategies to increase access to aftercare included: (a) improving assessments and care plans via input from skilled staff working in multidisciplinary teams (e.g. including social workers and clinical psychologists); (b) supporting staff to focus on assessments as therapeutic intervention; (c) probing boundaries and involving senior staff to negotiate risk and advocate for patients; and (d) building relationships and integration across services. CONCLUSIONS Our findings highlight practitioners' views on barriers to accessing aftercare and strategies to circumvent some of these impediments. Provision of aftercare and psychological therapies as part of the liaison psychiatry service were deemed as an essential mechanism for optimising patient safety and experience and staff well-being. To close treatment gaps and reduce inequalities, it is important to work closely with staff and patients, learn from experiences of good practice and implement change more widely across services.
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Affiliation(s)
- Leah Quinlivan
- Centre for Mental Health and Safety, University of Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, UK; and National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
| | - Louise Gorman
- Centre for Mental Health and Safety, University of Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, UK; and National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
| | - Stephen Marks
- Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, UK
| | - Elizabeth Monaghan
- National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
| | - Sadika Asmal
- National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
| | - Roger T Webb
- Centre for Mental Health and Safety, University of Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, UK; and National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
| | - Nav Kapur
- Centre for Mental Health and Safety, University of Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, UK; National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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21
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Fedorowicz SE, Dempsey RC, Ellis N, Phillips E, Gidlow C. How is suicide risk assessed in healthcare settings in the UK? A systematic scoping review. PLoS One 2023; 18:e0280789. [PMID: 36730243 PMCID: PMC10045566 DOI: 10.1371/journal.pone.0280789] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/09/2023] [Indexed: 02/03/2023] Open
Abstract
A high proportion of people contact healthcare services in the 12 months prior to death by suicide. Identifying people at high-risk for suicide is therefore a key concern for healthcare services. Whilst there is extensive research on the validity and reliability of suicide risk assessment tools, there remains a lack of understanding of how suicide risk assessments are conducted by healthcare staff in practice. This scoping review examined the literature on how suicide risk assessments are conducted and experienced by healthcare practitioners, patients, carers, relatives, and friends of people who have died by suicide in the UK. Literature searches were conducted on key databases using a pre-defined search strategy pre-registered with the Open Science Framework and following the PRISMA extension for scoping reviews guidelines. Eligible for inclusion were original research, written in English, exploring how suicide risk is assessed in the UK, related to administering or undergoing risk assessment for suicide, key concepts relating to those experiences, or directly exploring the experiences of administering or undergoing assessment. Eighteen studies were included in the final sample. Information was charted including study setting and design, sampling strategy, sample characteristics, and findings. A narrative account of the literature is provided. There was considerable variation regarding how suicide risk assessments are conducted in practice. There was evidence of a lack of risk assessment training, low awareness of suicide prevention guidance, and a lack of evidence relating to patient perspectives of suicide risk assessments. Increased inclusion of patient perspectives of suicide risk assessment is needed to gain understanding of how the process can be improved. Limited time and difficulty in starting an open discussion about suicide with patients were noted as barriers to successful assessment. Implications for practice are discussed.
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Affiliation(s)
- Sophia E. Fedorowicz
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, Staffordshire, United Kingdom
| | - Robert C. Dempsey
- Faculty of Health and Education, Department of Psychology, Manchester Metropolitan University, Manchester, United Kingdom
- * E-mail:
| | - Naomi Ellis
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, Staffordshire, United Kingdom
| | - Elliott Phillips
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, Staffordshire, United Kingdom
| | - Christopher Gidlow
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, Staffordshire, United Kingdom
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22
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John A, Lee SC, Puchades A, Del Pozo-Baños M, Morgan K, Page N, Moore G, Murphy S. Self-harm, in-person bullying and cyberbullying in secondary school-aged children: A data linkage study in Wales. J Adolesc 2023; 95:97-114. [PMID: 36210647 DOI: 10.1002/jad.12102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/31/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Although the evidence base on bullying victimization and self-harm in young people has been growing, most studies were cross-sectional, relied on self-reported non-validated measures of self-harm, and did not separate effects of in-person and cyberbullying. This study aimed to assess associations of self-harm following in-person bullying at school and cyberbullying victimization controlling for covariates. METHODS School survey data from 11 to 16 years pupils collected in 2017 from 39 Welsh secondary schools were linked to routinely collected data. Inverse probability weighting was performed to circumvent selection bias. Survival analyses for recurrent events were conducted to evaluate relative risks (adjusted hazard ratios [AHR]) of self-harm among bullying groups within 2 years following survey completion. RESULTS A total of 35.0% (weighted N = 6813) of pupils reported being bullied, with 18.1%, 6.4% and 10.5% being victims of in-person bullying at school only, cyberbullying only and both in-person bullying at school and cyberbullying respectively. Adjusting for covariates, effect sizes for self-harm were significant after being in-person bullied at school only (AHR = 2.2 [1.1-4.3]) and being both in-person bullied at school and cyberbullied (AHR = 2.2 [1.0-4.7]) but not being cyberbullied only (AHR = 1.2 [0.4-3.3]). Feeling lonely during recent summer holidays was also a robust predictor (AHR = 2.2 [1.2-4.0]). CONCLUSIONS We reaffirm the role of in-person bullying victimization on self-harm. Pupils were twice as likely to self-harm following in-person bullying as their nonvictimised peers. Interventions for young people that minimize the potential impacts of bullying on self-harm should also include strategies to prevent loneliness.
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Affiliation(s)
- Ann John
- Population Data Science, Swansea University Medical School, Swansea, UK
- Public Health Wales, 2 Capital Quarter, Cardiff, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Sze Chim Lee
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Alice Puchades
- Population Data Science, Swansea University Medical School, Swansea, UK
- Public Health Wales, 2 Capital Quarter, Cardiff, UK
| | - Marcos Del Pozo-Baños
- Population Data Science, Swansea University Medical School, Swansea, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Kelly Morgan
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Nicholas Page
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Graham Moore
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Simon Murphy
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
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23
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Osborne D, De Boer K, Meyer D, Nedeljkovic M. Raising Suicide in Medical Appointments-Barriers and Facilitators Experienced by Young Adults and GPs: A Mixed-Methods Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:822. [PMID: 36613144 PMCID: PMC9820164 DOI: 10.3390/ijerph20010822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
The aim of this review was to understand the barriers and facilitators facing GPs and young adults in raising and addressing suicide in medical appointments. A mixed-methods systematic review was conducted of qualitative and quantitative studies. The focus was papers that explored barriers and facilitators experienced by young adults aged 18 to 26, and GPs working in primary care environments. Nine studies met the inclusion criteria. Four studies provided information on young adults' views, four on GPs, and one considered both GP and young adults' viewpoints. Nine barrier and seven facilitator themes were identified. Unique to this review was the recognition that young adults want GPs to initiate the conversation about suicide. They see this as a GP's responsibility. This review further confirmed that GPs lack the confidence and skills to assess suicide risk in young adults. Both findings combined could explain previous results for reduced identification of suicide risk in this cohort. GP training needs considerable focus on addressing skill deficiencies and improving GP confidence to assess suicide risk. However, introducing suicide risk screening in primary care for young adults should be a priority as this will overcome the need for young adults to voluntarily disclose thoughts of suicide.
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24
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Bondesson E, Alpar T, Petersson IF, Schelin MEC, Jöud A. Health care utilization among individuals who die by suicide as compared to the general population: a population-based register study in Sweden. BMC Public Health 2022; 22:1616. [PMID: 36008801 PMCID: PMC9404588 DOI: 10.1186/s12889-022-14006-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 08/12/2022] [Indexed: 11/21/2022] Open
Abstract
Background Globally, 700 000 people die every year by suicide. Health care consultation patterns the period before suicide could be one potential way to identify people at risk for suicide. Therefore, this study examines health care patterns up to one year prior to the suicide by age, sex and prior diagnoses and specifically investigates if and how this differs from the general population of Skåne, Sweden. Methods This cohort study includes all individuals, aged 15 and older, that died by suicide in Region Skåne, Sweden from 2004 to 2015 (n = 1653). The individuals were identified through the Cause of death register and then linked to the Skåne healthcare register. Health care data was analyzed as proportions consulting different types of health care the month and year preceding the suicide, we also investigated the impact of age, sex and the occurrence of prior psychiatric and pain diagnoses. Additionally, we compared the proportion of consulting care among the suicide victims and the general population of Skåne. Results In the month before their death, 53% of the suicide victims had any health care consultation, compared with 20% in the general population of Skåne, a given month (p < 0.0001). The corresponding figures for the year prior to suicide was 86% among those who died by suicide, compared to 69% in the general population of Skåne, a given year (p < 0.0001). Women, and those having a documented history of psychiatric diagnosis were more likely to have health care consultations in the month and year preceding suicide (p < 0.001), compared to men and suicide victims without a history of psychiatric disease. Older adults that died by suicide, were less likely to consult psychiatric care compared to the younger suicide victims (p < 0.001). Conclusion A majority of the suicide victims consulted health care in the near time before death and the proportion of seeking health care was significantly higher than in the general population of Skåne and higher among female suicide victims as compared to males. Alternative preventive screening measures should be considered for individuals consulting health care, especially for older people and individuals outside the psychiatric care.
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Affiliation(s)
- Elisabeth Bondesson
- Faculty of Medicine, Department of Clinical Sciences Lund, Division of Orthopaedics, Lund University, Lund, Sweden. .,Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden. .,Faculty of Medicine, Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
| | - Tori Alpar
- Faculty of Medicine, Department of Clinical Sciences Lund, Division of Orthopaedics, Lund University, Lund, Sweden
| | - Ingemar F Petersson
- Faculty of Medicine, Department of Clinical Sciences Lund, Division of Orthopaedics, Lund University, Lund, Sweden.,Department of Research and Education, Skåne University Hospital, Lund, Sweden
| | - Maria E C Schelin
- Faculty of Medicine, Department of Clinical Sciences Lund, Division of Orthopaedics, Lund University, Lund, Sweden.,Department of Research and Education, Skåne University Hospital, Lund, Sweden.,Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
| | - Anna Jöud
- Faculty of Medicine, Department of Clinical Sciences Lund, Division of Orthopaedics, Lund University, Lund, Sweden.,Faculty of Medicine, Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.,Department of Research and Education, Skåne University Hospital, Lund, Sweden
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25
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Bergqvist E, Probert-Lindström S, Fröding E, Palmqvist-Öberg N, Ehnvall A, Sunnqvist C, Sellin T, Vaez M, Waern M, Westrin Å. Health care utilisation two years prior to suicide in Sweden: a retrospective explorative study based on medical records. BMC Health Serv Res 2022; 22:664. [PMID: 35581647 PMCID: PMC9115926 DOI: 10.1186/s12913-022-08044-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/28/2022] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Previous literature has suggested that identifying putative differences in health care seeking patterns before death by suicide depending on age and gender may facilitate more targeted suicide preventive approaches. The aim of this study is to map health care utilisation among individuals in the two years prior to suicide in Sweden in 2015 and to examine possible age and gender differences. METHODS Design: A retrospective explorative study with a medical record review covering the two years preceding suicide. SETTING All health care units located in 20 of Sweden's 21 regions. PARTICIPANTS All individuals residing in participating regions who died by suicide during 2015 (n = 949). RESULTS Almost 74% were in contact with a health care provider during the 3 months prior to suicide, and 60% within 4 weeks. Overall health care utilisation during the last month of life did not differ between age groups. However, a higher proportion of younger individuals (< 65 years) were in contact with psychiatric services, and a higher proportion of older individuals (≥ 65 years) were in contact with primary and specialised somatic health care. The proportion of women with any type of health care contact during the observation period was larger than the corresponding proportion of men, although no gender difference was found among primary and specialised somatic health care users within four weeks and three months respectively prior to suicide. CONCLUSION Care utilisation before suicide varied by gender and age. Female suicide decedents seem to utilise health care to a larger extent than male decedents in the two years preceding death, except for the non-psychiatric services in closer proximity to death. Older adults seem to predominantly use non-psychiatric services, while younger individuals seek psychiatric services to a larger extent.
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Affiliation(s)
- Erik Bergqvist
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Baravägen 1, 221 85, Lund, Sweden.
- Psychiatric In-Patient Clinic, Hallands Sjukhus Varberg, Region Halland, 432 81, Varberg, Sweden.
| | - Sara Probert-Lindström
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Baravägen 1, 221 85, Lund, Sweden
- Office of Psychiatry and Habilitation, Region Skåne, 221 85, Lund, Sweden
| | - Elin Fröding
- School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, 551 11, Jönköping, Sweden
- Region Jonköpings Län, Jönköping, Sweden
| | - Nina Palmqvist-Öberg
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Baravägen 1, 221 85, Lund, Sweden
- Office of Psychiatry and Habilitation, Region Skåne, 221 85, Lund, Sweden
| | - Anna Ehnvall
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, 413 45, Gothenburg, Sweden
- Psychiatric Out-Patient Clinic, Region Halland, 432 43, Varberg, Sweden
| | - Charlotta Sunnqvist
- Faculty of Health and Society, Department of Care Science, Malmö University, 214 28, Malmö, Sweden
| | - Tabita Sellin
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, 701 82, Örebro, Sweden
| | - Marjan Vaez
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, 413 45, Gothenburg, Sweden
- Psychosis Clinic, Sahlgrenska University Hospital, Region Västra Götaland, 431 30, Mölndal, Sweden
| | - Åsa Westrin
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Baravägen 1, 221 85, Lund, Sweden
- Office of Psychiatry and Habilitation, Region Skåne, 221 85, Lund, Sweden
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26
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DelPozo-Banos M, Lee SC, Friedmann Y, Akbari A, Torabi F, Lloyd K, Lyons RA, John A. Healthcare contacts with self-harm during COVID-19: An e-cohort whole-population-based study using individual-level linked routine electronic health records in Wales, UK, 2016-March 2021. PLoS One 2022; 17:e0266967. [PMID: 35476839 PMCID: PMC9045644 DOI: 10.1371/journal.pone.0266967] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/31/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Reduced rates of help seeking by those who self-harmed during the COVID-19 pandemic have been reported. OBJECTIVES To understand changes in healthcare service contacts for self-harm during the COVID-19 pandemic across primary, emergency and secondary care. METHODS This retrospective cohort study used routine electronic healthcare data for Wales, United Kingdom, from 2016 to March 14, 2021. Population-based data from primary care, emergency departments and hospital admissions were linked at individual-level. All Welsh residents aged ≥10 years over the study period were included in the study. Primary, emergency and secondary care contacts with self-harm at any time between 2016 and March 14, 2021 were identified. Outcomes were counts, incidence, prevalence and proportion of self-harm contacts relative to all contacts in each and all settings, as well as the proportion of people contacting one or more settings with self-harm. Weekly trends were modelled using generalised estimated equations, with differences between 2020 (to March 2021) and comparison years 2016-2018 (to March 2017-2019) quantified using difference in differences, from which mean rate of odds ratios (μROR) across years was reported. RESULTS The study included 3,552,210 individuals over the study period. Self-harm contacts reduced across services in March and December 2020 compared to previous years. Primary care contacts with self-harm reduced disproportionately compared to non-self-harm contacts (μROR = 0.7, p<0.05), while their proportion increased in emergency departments during April 2020 (μROR = 1.3, p<0.05 in 2/3 comparison years) and hospital admissions during April-May 2020 (μROR = 1.2, p<0.05 in 2/3 comparison years). Despite this, those who self-harmed in April 2020 were more likely to be seen in primary care than other settings compared to previous years (μROR = 1.2, p<0.05). A lower proportion of those with self-harm contacts in emergency departments were subsequently admitted to hospital in December 2020 compared to previous years (μROR = 0.5, p<0.05). CONCLUSIONS These findings suggest that those who self-harmed during the COVID-19 pandemic may have been less likely to seek help, and those who did so faced more stringent criteria for admission. Communications encouraging those who self-harm to seek help during pandemics may be beneficial. However, this needs to be supported by maintained provision of mental health services.
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Affiliation(s)
| | - S. C. Lee
- Swansea University Medical School, Wales, United Kingdom
| | - Y. Friedmann
- Swansea University Medical School, Wales, United Kingdom
| | - A. Akbari
- Population Data Science, Swansea University Medical School, Wales, United Kingdom
| | - F. Torabi
- Population Data Science, Swansea University Medical School, Wales, United Kingdom
| | - K. Lloyd
- Swansea University Medical School, Wales, United Kingdom
| | - R. A. Lyons
- Swansea University Medical School, Wales, United Kingdom
| | - A. John
- Swansea University Medical School, Wales, United Kingdom
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27
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Moore HE, Siriwardena AN, Gussy M, Hill B, Tanser F, Spaight R. Exploring the Impact of the COVID-19 Pandemic on Male Mental Health Emergencies Attended by Ambulances During the First National "Lockdown" in the East Midlands of the United Kingdom. Am J Mens Health 2022; 16:15579883221082428. [PMID: 35246002 PMCID: PMC8902032 DOI: 10.1177/15579883221082428] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic and associated mitigation strategies such as “lockdown” are having widespread adverse psychological effects, including increased levels of anxiety and depression. Most research using self-reported data highlights the pandemic’s impact on the psychological well-being of females, whereas data for mental health emergency presentations may reflect the impact on male mental health more accurately. We analyzed records of male mental health emergencies occurring in the East Midlands of the United Kingdom during the first national “lockdown.” We computed two binary logistic regression models to (a) compare male mental health emergencies occurring during “lockdown,” 2020 (5,779) with those occurring in the same period in 2019 (N = 4,744) and (b) compare male (N = 5,779) and female (N = 7,695) mental health emergencies occurring during “lockdown.” Comparisons considered the characteristics of mental health emergencies recorded by ambulance clinicians (Primary Impressions), and the socioeconomic characteristics of communities where emergencies use the Index of Multiple Deprivation. We found that during “lockdown,” male emergencies were more likely to involve acute anxiety (odds ratio [OR]: 1.42) and less likely to involve intentional drug overdose (OR: 0.86) or attempted suicide (OR: 0.71) compared with 2019. Compared with females, male emergencies were more likely to involve acute behavioral disturbance (OR: 1.99) and less likely to involve anxiety (OR: 0.67), attempted suicide (OR: 0.83), or intentional drug overdose (OR: 0.76). Compared with 2019, and compared with females, males experiencing mental health emergencies during “lockdown” were more likely to present in areas of high deprivation. Understanding the presentation of male mental health emergencies could inform improved patient care pathways.
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Affiliation(s)
| | | | - Mark Gussy
- Lincoln Institute of Rural Health, University of Lincoln, Lincoln, UK
| | | | - Frank Tanser
- Lincoln Institute of Rural Health, University of Lincoln, Lincoln, UK
| | - Robert Spaight
- East Midlands Ambulance Service NHS Trust, Nottingham, UK
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28
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Kirtley OJ, van Mens K, Hoogendoorn M, Kapur N, de Beurs D. Translating promise into practice: a review of machine learning in suicide research and prevention. Lancet Psychiatry 2022; 9:243-252. [PMID: 35183281 DOI: 10.1016/s2215-0366(21)00254-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023]
Abstract
In ever more pressured health-care systems, technological solutions offering scalability of care and better resource targeting are appealing. Research on machine learning as a technique for identifying individuals at risk of suicidal ideation, suicide attempts, and death has grown rapidly. This research often places great emphasis on the promise of machine learning for preventing suicide, but overlooks the practical, clinical implementation issues that might preclude delivering on such a promise. In this Review, we synthesise the broad empirical and review literature on electronic health record-based machine learning in suicide research, and focus on matters of crucial importance for implementation of machine learning in clinical practice. The challenge of preventing statistically rare outcomes is well known; progress requires tackling data quality, transparency, and ethical issues. In the future, machine learning models might be explored as methods to enable targeting of interventions to specific individuals depending upon their level of need-ie, for precision medicine. Primarily, however, the promise of machine learning for suicide prevention is limited by the scarcity of high-quality scalable interventions available to individuals identified by machine learning as being at risk of suicide.
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Affiliation(s)
| | | | - Mark Hoogendoorn
- Department of Computer Science, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Navneet Kapur
- Centre for Mental Health and Safety and Greater Manchester National Institute for Health Research Patient Safety Translational Research Centre, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Derek de Beurs
- Department of Epidemiology, Trimbos Institute, Utrecht, Netherlands
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29
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Steeg S, Carr M, Trefan L, Ashcroft D, Kapur N, Nielsen E, McMillan B, Webb R. Primary care clinical management following self-harm during the first wave of COVID-19 in the UK: population-based cohort study. BMJ Open 2022; 12:e052613. [PMID: 35165109 PMCID: PMC8844953 DOI: 10.1136/bmjopen-2021-052613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES A substantial reduction in self-harm recorded in primary care occurred during the first wave of COVID-19 but effects on primary care management of self-harm are unknown. Our objectives were to examine the impact of COVID-19 on clinical management within 3 months of an episode of self-harm. DESIGN Retrospective cohort study. SETTING UK primary care. PARTICIPANTS 4238 patients with an index episode of self-harm recorded in UK primary care during the COVID-19 first-wave period (10 March 2020-10 June 2020) compared with 48 739 patients in a prepandemic comparison period (10 March-10 June, 2010-2019). OUTCOME MEASURES Using data from the UK Clinical Practice Research Datalink, we compared cohorts of patients with an index self-harm episode recorded during the prepandemic period versus the COVID-19 first-wave period. Patients were followed up for 3 months to capture subsequent general practitioner (GP)/practice nurse consultation, referral to mental health services and psychotropic medication prescribing. We examined differences by gender, age group and Index of Multiple Deprivation quintile. RESULTS Likelihood of having at least one GP/practice nurse consultation was broadly similar (83.2% vs 80.3% in the COVID-19 cohort). The proportion of patients referred to mental health services in the COVID-19 cohort (4.2%) was around two-thirds of that in the prepandemic cohort (6.1%). Similar proportions were prescribed psychotropic medication within 3 months in the prepandemic (54.0%) and COVID-19 first-wave (54.9%) cohorts. CONCLUSIONS Despite the challenges experienced by primary healthcare teams during the initial COVID-19 wave, prescribing and consultation patterns following self-harm were broadly similar to prepandemic levels. We found no evidence of widening of digital exclusion in terms of access to remote consultations. However, the reduced likelihood of referral to mental health services warrants attention. Accessible outpatient and community services for people who have self-harmed are required as the COVID-19 crisis recedes and the population faces new challenges to mental health.
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Affiliation(s)
- Sarah Steeg
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Matthew Carr
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Laszlo Trefan
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Darren Ashcroft
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Navneet Kapur
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Emma Nielsen
- Self-harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Brian McMillan
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Roger Webb
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
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Chiang A, Paynter J, Edlin R, Exeter DJ. Suicide preceded by health services contact - A whole-of-population study in New Zealand 2013-2015. PLoS One 2021; 16:e0261163. [PMID: 34928994 PMCID: PMC8687551 DOI: 10.1371/journal.pone.0261163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/27/2021] [Indexed: 01/20/2023] Open
Abstract
New Zealand’s rate of suicide persistently exceeds the global average. The burden of suicide in New Zealand is disproportionately borne by youth, males and Māori (NZ indigenous people). While the demographic characteristics of suicide decedents are established, there is a need to identify potential points of contact with health services where preventative action could take place. This paper aims to determine if suicide deaths in New Zealand were likely to be preceded by contact with health services, and the type and time frame in which these contacts took place. This study utilised a whole-of-population-cohort of all individuals age 15 years and over, who were alive on March 5th 2013, followed up to December 2015. Associations between the odds of suicide, demographic factors, area-based deprivation, and the timing of last contact with primary, secondary, and tertiary services were analysed using univariate and multivariate logistic regression. Contact with a health service in the 6 Months prior to death was associated with the highest odds of suicide. Over half of the suicide decedent population (59.4%) had contacted primary health services during this period. Large proportions of the suicide decedent population contacted secondary and tertiary services in the 6 Months prior to death, 46.5% and 30.4% respectively. Contact with primary, secondary and tertiary services in the prior 6 Months, were associated with an increased odds of suicide of 2.51 times [95% CI 2.19–2.88], 4.45 times [95% CI 3.69–4.66] and 6.57 times [95% CI 5.84–7.38], respectively, compared to those who had no health services contact.
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Affiliation(s)
- Annie Chiang
- Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
- * E-mail:
| | - Janine Paynter
- General Practice and Primary Healthcare, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Richard Edlin
- Health Systems, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Daniel J. Exeter
- Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
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31
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Renemane L, Kivite-Urtane A, Rancans E. Suicidality and Its Relation with Physical and Mental Conditions: Results from a Cross-Sectional Study of the Nationwide Primary Care Population Sample in Latvia. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:970. [PMID: 34577893 PMCID: PMC8472357 DOI: 10.3390/medicina57090970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Physical and mental conditions are important risk factors for suicidality. However, there is no clear understanding of these relationships and the effect of co-occurrence on suicidality. We aimed to investigate the associations between current suicidality and mental disorders, physical conditions, and health-related factors in the nationwide primary care population in Latvia. Materials and Methods: A cross-sectional study was performed within the framework of the National Research Program BIOMEDICINE 2014-2017 at 24 primary care settings across Latvia in 2015. Adult patients were evaluated over one week at each facility. Socio-demographic variables, physical condition, and health-related factors were assessed on-site by trained psychiatrists. Mental disorders and suicidality were determined using the Mini International Neuropsychiatric Interview, and assessments were conducted over the telephone within two weeks after the visit to the general practitioner. Results: Of the 1485 cases, 18.6% reported suicidality. Only current depression, any anxiety disorder, any alcohol use disorder, and physical-mental multimorbidity were significantly associated with suicidality in the multivariate logistic regression analysis. Gastrointestinal diseases were associated with current depression alone (odds ratio (OR) 10.36; 95% confidence interval (CI) 2.34-45.76) and comorbid depression with any anxiety disorder (OR 7.55; 95% CI 2.15-26.49) among persons with current suicidality. Conclusions: Screening for depression, anxiety, and alcohol use disorders regularly among patients with physical illness may be important to help recognise suicidality in primary care that could improve the quality of life of patients and prevent suicides.
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Affiliation(s)
- Lubova Renemane
- Department of Psychiatry and Narcology, Riga Stradins University, Tvaika Street 2, LV-1005 Riga, Latvia;
| | - Anda Kivite-Urtane
- Department of Public Health and Epidemiology, Institute of Public Health, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia;
| | - Elmars Rancans
- Department of Psychiatry and Narcology, Riga Stradins University, Tvaika Street 2, LV-1005 Riga, Latvia;
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32
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Stallman HM, Allen A. Acute suicide prevention: A systematic review of the evidence and implications for clinical practice. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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33
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Mughal F, Gorton HC, Michail M, Robinson J, Saini P. Suicide Prevention in Primary Care. CRISIS 2021; 42:241-246. [PMID: 34184574 DOI: 10.1027/0227-5910/a000817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Faraz Mughal
- School of Medicine, Keele University, Staffordshire, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, UK.,Unit of Academic Primary Care, University of Warwick, Coventry, UK
| | | | - Maria Michail
- Institute for Mental Health, School of Psychology, University of Birmingham, UK
| | - Jo Robinson
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Pooja Saini
- Faculty of Health, School of Psychology, Liverpool John Moores University, UK
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34
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Seidler ZE, Wilson MJ, Kealy D, Oliffe JL, Ogrodniczuk JS, Rice SM. Men's Dropout From Mental Health Services: Results From a Survey of Australian Men Across the Life Span. Am J Mens Health 2021; 15:15579883211014776. [PMID: 34041980 PMCID: PMC8165839 DOI: 10.1177/15579883211014776] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
While increasing numbers of Australian men are accessing mental health services, the sustainability of their therapy engagement varies significantly, with many men being lost to follow-up. The current study investigated dropout rates in a large community-based male sample to highlight the reasons for, and potential predictors of, men dropping out of mental health care services. Data were drawn from an online survey of 1907 Australian men (aged 16–85; M = 44.1 years) reflecting on their broad experiences in mental health therapy. Participants responded to bespoke items assessing their past dropout experience and reasons for dropping out, the odds of which were modeled in relation to demographics and predictors (e.g., therapist engagement strategies, alignment to traditional masculinity and pre-therapy feelings of optimism, shame, and emasculation). The overall dropout rate from therapy was 44.8% (n = 855), of which 26.6% (n = 120) accessed therapy once and did not return. The most common reasons for dropout were lack of connection with the therapist (54.9%) and the sense that therapy lacked progress (20.2%). Younger age, unemployment, self-reported identification with traditional masculinity, the presence of specific therapist engagement strategies, and whether therapy made participants feel emasculated all predicted dropout. Current depressive symptoms and suicidality were also higher amongst dropouts. Therapists should aim to have an honest discussion with all clients about the importance of therapy fit, including the real likelihood of dropout, in order to ensure this does not deter future engagement with professional services.
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Affiliation(s)
- Zac E Seidler
- Orygen, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Michael J Wilson
- Orygen, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - John L Oliffe
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.,Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia
| | - John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Simon M Rice
- Orygen, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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35
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Suicide prevention and COVID-19: the role of primary care during the pandemic and beyond. Br J Gen Pract 2021; 71:200-201. [PMID: 33926869 DOI: 10.3399/bjgp21x715637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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36
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Carr MJ, Steeg S, Webb RT, Kapur N, Chew-Graham CA, Abel KM, Hope H, Pierce M, Ashcroft DM. Effects of the COVID-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: a population-based cohort study. Lancet Public Health 2021; 6:e124-e135. [PMID: 33444560 PMCID: PMC7843955 DOI: 10.1016/s2468-2667(20)30288-7] [Citation(s) in RCA: 168] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The COVID-19 pandemic has adversely affected population mental health. We aimed to assess temporal trends in primary care-recorded common mental illness, episodes of self-harm, psychotropic medication prescribing, and general practitioner (GP) referrals to mental health services during the COVID-19 emergency in the UK. METHODS We did a population-based cohort study using primary care electronic health records from general practices registered on the UK Clinical Practice Research Datalink (CPRD). We included patient records from Jan 1, 2010, to Sept 10, 2020, to establish long-term trends and patterns of seasonality, but focused primarily on the period January, 2019-September, 2020. We extracted data on clinical codes entered into patient records to estimate the incidence of depression and anxiety disorders, self-harm, prescriptions for antidepressants and benzodiazepines, and GP referrals to mental health services, and assessed event rates of all psychotropic prescriptions and self-harm. We used mean-dispersion negative binomial regression models to predict expected monthly incidence and overall event rates, which were then compared with observed rates to assess the percentage reduction in incidence and event rates after March, 2020. We also stratified analyses by sex, age group, and practice-level Index of Multiple Deprivation quintiles. FINDINGS We identified 14 210 507 patients from 1697 UK general practices registered in the CPRD databases. In April, 2020, compared with expected rates, the incidence of primary care-recorded depression had reduced by 43·0% (95% CI 38·3-47·4), anxiety disorders by 47·8% (44·3-51·2), and first antidepressant prescribing by 36·4% (33·9-38·8) in English general practices. Reductions in first diagnoses of depression and anxiety disorders were largest for adults of working age (18-44 and 45-64 years) and for patients registered at practices in more deprived areas. The incidence of self-harm was 37·6% (34·8-40·3%) lower than expected in April, 2020, and the reduction was greatest for women and individuals aged younger than 45 years. By September, 2020, rates of incident depression, anxiety disorder, and self-harm were similar to expected levels. In Northern Ireland, Scotland, and Wales, rates of incident depression and anxiety disorder remained around a third lower than expected to September, 2020. In April, 2020, the rate of referral to mental health services was less than a quarter of the expected rate for the time of year (75·3% reduction [74·0-76·4]). INTERPRETATION Consequences of the considerable reductions in primary care-recorded mental illness and self-harm could include more patients subsequently presenting with greater severity of mental illness and increasing incidence of non-fatal self-harm and suicide. Addressing the effects of future lockdowns and longer-term impacts of economic instability on mental health should be prioritised. FUNDING National Institute for Health Research and Medical Research Council.
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Affiliation(s)
- Matthew J Carr
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK; National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK
| | - Sarah Steeg
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK.
| | - Roger T Webb
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK; Centre for Mental Health and Safety, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK
| | - Nav Kapur
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK; Centre for Mental Health and Safety, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Kathryn M Abel
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Holly Hope
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK
| | - Matthias Pierce
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK; National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK
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37
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Lyons J, Akbari A, Agrawal U, Harper G, Azcoaga-Lorenzo A, Bailey R, Rafferty J, Watkins A, Fry R, McCowan C, Dezateux C, Robson JP, Peek N, Holmes C, Denaxas S, Owen R, Abrams KR, John A, O'Reilly D, Richardson S, Hall M, Gale CP, Davies J, Davies C, Cross L, Gallacher J, Chess J, Brookes AJ, Lyons RA. Protocol for the development of the Wales Multimorbidity e-Cohort (WMC): data sources and methods to construct a population-based research platform to investigate multimorbidity. BMJ Open 2021; 11:e047101. [PMID: 33468531 PMCID: PMC7817800 DOI: 10.1136/bmjopen-2020-047101] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Multimorbidity is widely recognised as the presence of two or more concurrent long-term conditions, yet remains a poorly understood global issue despite increasing in prevalence.We have created the Wales Multimorbidity e-Cohort (WMC) to provide an accessible research ready data asset to further the understanding of multimorbidity. Our objectives are to create a platform to support research which would help to understand prevalence, trajectories and determinants in multimorbidity, characterise clusters that lead to highest burden on individuals and healthcare services, and evaluate and provide new multimorbidity phenotypes and algorithms to the National Health Service and research communities to support prevention, healthcare planning and the management of individuals with multimorbidity. METHODS AND ANALYSIS The WMC has been created and derived from multisourced demographic, administrative and electronic health record data relating to the Welsh population in the Secure Anonymised Information Linkage (SAIL) Databank. The WMC consists of 2.9 million people alive and living in Wales on the 1 January 2000 with follow-up until 31 December 2019, Welsh residency break or death. Published comorbidity indices and phenotype code lists will be used to measure and conceptualise multimorbidity.Study outcomes will include: (1) a description of multimorbidity using published data phenotype algorithms/ontologies, (2) investigation of the associations between baseline demographic factors and multimorbidity, (3) identification of temporal trajectories of clusters of conditions and multimorbidity and (4) investigation of multimorbidity clusters with poor outcomes such as mortality and high healthcare service utilisation. ETHICS AND DISSEMINATION The SAIL Databank independent Information Governance Review Panel has approved this study (SAIL Project: 0911). Study findings will be presented to policy groups, public meetings, national and international conferences, and published in peer-reviewed journals.
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Affiliation(s)
- Jane Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Gill Harper
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Rowena Bailey
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - James Rafferty
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Alan Watkins
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Richard Fry
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Carol Dezateux
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - John P Robson
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Niels Peek
- Health e-Research Centre, Institute of Population Health, University of Manchester, Manchester, UK
| | - Chris Holmes
- Department of Statistics, Oxford University, Oxford, Oxfordshire, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, London, UK
| | - Rhiannon Owen
- Department of Health Sciences, University of Leicester, Leicester, Leicestershire, UK
| | - Keith R Abrams
- Department of Health Sciences, University of Leicester, Leicester, Leicestershire, UK
| | - Ann John
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Dermot O'Reilly
- Epidemiology and Public Health, Queens University Belfast, Belfast, UK
| | - Sylvia Richardson
- Department of Epidemiology and Public Health, MRC Biostatistics Unit, Cambridge, UK
| | - Marlous Hall
- School of Medicine, University of Leeds, Leeds, UK
| | - Chris P Gale
- School of Medicine, University of Leeds, Leeds, UK
| | | | | | - Lynsey Cross
- Population Data Science, Swansea University Medical School, Swansea, UK
| | | | - James Chess
- Renal Unit, Swansea Bay University Health Board, Swansea, UK
| | | | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
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