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DelPozo-Banos M, Stewart R, John A. Machine learning in mental health and its relationship with epidemiological practice. Front Psychiatry 2024; 15:1347100. [PMID: 38528983 PMCID: PMC10961376 DOI: 10.3389/fpsyt.2024.1347100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/22/2024] [Indexed: 03/27/2024] Open
Affiliation(s)
| | - Robert Stewart
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Ann John
- Swansea University Medical School, Swansea, United Kingdom
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2
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Hutchings HA, Rahman M, Carter K, Islam S, O'Neill C, Roberts S, John A, Fegan G, Dave U, Hawkes N, Ahmed F, Hasan M, Azad AK, Rahman MM, Kibria MG, Rahman MM, Mia T, Akhter M, Williams JG. Did the COVID-19 pandemic affect levels of burnout, anxiety and depression among doctors and nurses in Bangladesh? A cross-sectional survey study. BMJ Open 2024; 14:e079350. [PMID: 38453200 PMCID: PMC10921535 DOI: 10.1136/bmjopen-2023-079350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/14/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION COVID-19 has caused severe disruption to clinical services in Bangladesh but the extent of this, and the impact on healthcare professionals is unclear. We aimed to assess the perceived levels of anxiety, depression and burnout among doctors and nurses during COVID-19 pandemic. METHODS We undertook an online survey using RedCap, directed at doctors and nurses across four institutions in Bangladesh (The Sheikh Russel Gastro Liver Institute & Hospital (SRNGIH), Dhaka Medical College Hospital (DMCH), Mugda Medical College Hospital (MMCH) and M Abdur Rahim Medical College (MARMC) Hospital). We collected information on demographics, awareness of well-being services, COVID-19-related workload, as well as anxiety, depression and burnout using two validated questionnaires: the Hospital Anxiety and Depression Scale (HADS) and the Maslach Burnout Inventory (MBI). RESULTS Of the 3000 participants approached, we received responses from 2705 (90.2%). There was a statistically significant difference in anxiety, depression and burnout scores across institutions (p<0.01). Anxiety, depression and burnout scores were statistically worse in COVID-19 active staff compared with those not working on COVID-19 activities (p<0.01 for HADS anxiety and depression and MBI emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA)). Over half of the participants exhibited some level of anxiety (SRNGIH: 52.2%; DMCH: 53.9%; MMCH: 61.3%; MARMC: 68%) with a high proportion experiencing depression (SRNGIH: 39.5%; DMCH: 38.7%; MMCH: 53.7%; MARMC: 41.1%). Although mean burnout scores were within the normal range for each institution, a high proportion of staff (almost 20% in some instances) were shown to be classified as experiencing burnout by their EE, DP and PA scores. CONCLUSION We identified a high prevalence of perceived anxiety, depression and burnout among doctors and nurses during the COVID-19 pandemic. This was worse in staff engaged in COVID-19-related activities. These findings could help healthcare organisations to plan for future similar events.
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Affiliation(s)
| | - Mesbah Rahman
- Swansea Bay University Health Board, Port Talbot, UK
| | | | | | | | | | | | | | - Umakant Dave
- Swansea Bay University Health Board, Port Talbot, UK
| | - Neil Hawkes
- Cwm Taf Morgannwg University Health Board, Abercynon, UK
| | - Faruque Ahmed
- Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | | | | | | | - Md Golam Kibria
- Sheikh Russel National Gastroliver Institute, Dhaka, Bangladesh
| | | | - Titu Mia
- Mugda Medical College and Hospital, Dhaka, Bangladesh
| | | | - John G Williams
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
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Lee SC, DelPozo-Banos M, Friedmann Y, Akbari A, Lyons RA, John A. Widening Excess Mortality During the COVID-19 Pandemic in Individuals Who Self-Harmed. Crisis 2024; 45:154-158. [PMID: 36226352 PMCID: PMC10999850 DOI: 10.1027/0227-5910/a000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 11/07/2022]
Abstract
Background: Studies on COVID-19 pandemic-associated changes in mortality following self-harm remain scarce and inconclusive. Aims: To compare mortality risks in individuals who had self-harmed to those for individuals who had not, before and during the COVID-19 pandemic (Waves 1 and 2) in Wales, the United Kingdom, using population-based routinely collected data. Method: We linked whole population health data to all-cause mortality following an episode of self-harm between April 2016 and March 2021. Propensity score matching, Cox regression, and difference-in-differences were applied to compute changes in excess mortality (as ratios of hazard ratios, RHRs) before and during the pandemic for individuals who self-harmed. Results: The difference in mortality for individuals who self-harmed compared to those who did not widened during Wave 1 (RHR = 2.03, 95% CI: 1.04-4.03) and Wave 2 (RHR = 2.19, 95% CI: 1.12-4.29) from before the pandemic. Stratification by sex and age group produced no significant subgroup differences although risk for younger than 65 years group were higher. Limitations: Limitations include small sample size and incomplete data on cause-specific deaths during the pandemic. Conclusion: Our results underscore continuous monitoring of mortality of individuals who self-harm and effective interventions to address any increases in mortality.
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Affiliation(s)
- Sze Chim Lee
- Population Data Science, Swansea
University Medical School, Swansea, UK
| | | | - Yasmin Friedmann
- Population Data Science, Swansea
University Medical School, Swansea, UK
| | - Ashley Akbari
- Population Data Science, Swansea
University Medical School, Swansea, UK
| | - Ronan A. Lyons
- Population Data Science, Swansea
University Medical School, Swansea, UK
| | - Ann John
- Population Data Science, Swansea
University Medical School, Swansea, UK
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Iveson MH, Ball EL, Whalley HC, Deary IJ, Cox SR, Batty GD, John A, McIntosh AM. Childhood cognitive ability and self-harm and suicide in later life. SSM Popul Health 2024; 25:101592. [PMID: 38283541 PMCID: PMC10821139 DOI: 10.1016/j.ssmph.2023.101592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Background Self-harm and suicide remain prevalent in later life. For younger adults, higher early-life cognitive ability appears to predict lower self-harm and suicide risk. Comparatively little is known about these associations among middle-aged and older adults. Methods This study examined the association between childhood (age 11) cognitive ability and self-harm and suicide risk among a Scotland-wide cohort (N = 53037), using hospital admission and mortality records to follow individuals from age 34 to 85. Multistate models examined the association between childhood cognitive ability and transitions between unaffected, self-harm, and then suicide or non-suicide death. Results After adjusting for childhood and adulthood socioeconomic conditions, higher childhood cognitive ability was significantly associated with reduced risk of self-harm among both males (451 events; HR = 0.90, 95% CI [0.82, 0.99]) and females (516 events; HR = 0.89, 95% CI [0.81, 0.98]). Childhood cognitive ability was not significantly associated with suicide risk among those with (Male: 16 events, HR = 1.05, 95% CI [0.61, 1.80]; Female: 13 events, HR = 1.08, 95% CI [0.55, 2.15]) or without self-harm events (Male: 118 events, HR = 1.17, 95% CI [0.84, 1.63]; Female: 31 events, HR = 1.30, 95% CI [0.70, 2.41]). Limitations The study only includes self-harm events that result in a hospital admission and does not account for self-harm prior to follow-up. Conclusions This extends work on cognitive ability and mental health, demonstrating that these associations can span the life course and into middle and older age.
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Affiliation(s)
| | - Emily L. Ball
- Centre for Clinical Brain Sciences, The University of Edinburgh, UK
| | | | - Ian J. Deary
- Department of Psychology, The University of Edinburgh, UK
| | - Simon R. Cox
- Department of Psychology, The University of Edinburgh, UK
| | - G. David Batty
- Institute of Epidemiology and Health, University College London, London, UK
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, UK
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Delamain H, Buckman JEJ, Stott J, John A, Singh S, Pilling S, Saunders R. Measurement invariance and differential item functioning of the PHQ-9 and GAD-7 between working age and older adults seeking treatment for common mental disorders. J Affect Disord 2024; 347:15-22. [PMID: 37989437 DOI: 10.1016/j.jad.2023.11.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND The nine-item Patient Health Questionnaire (PHQ-9) and seven-item Generalised Anxiety Disorder (GAD-7) scale are widely used clinically and within research, and so it is important to determine how the measures, and individual items within the measures, are answered by adults of differing ages. This study sought to evaluate measurement invariance and differential item functioning (DIF) of the PHQ-9 and GAD-7 between working age and older adults seeking routine psychological treatment. METHODS Data of working age (18-64 years old) and older (≥65) adults in eight Improving Access to Psychological Therapies (IAPT) services were used. Confirmatory factor analysis (CFA) was used to establish unidimensionality of the PHQ-9 and GAD-7, with multiple-group CFA to test measurement invariance and The Multiple Indicators, Multiple Causes Models approach to assess DIF. The employed methods were applied to a propensity score matched (PSM) sample in sensitivity analyses to control for potential confounding. RESULTS Data from 166,816 patients (159,325 working age, 7491 older) were used to show measurement invariance for the PHQ-9 and GAD-7, with limited evidence of DIF and similar results found with a PSM sample (n = 5868). LIMITATIONS The localised sample creates an inability to detect geographical variance, and the potential effect of unmeasured confounders cannot be ruled out. CONCLUSIONS The findings support the use of the PHQ-9 and GAD-7 measures for working age and older adults, both clinically and in research settings. This study validates using the measures for these age groups to assess clinically significant symptom thresholds, and monitor treatment outcomes between them.
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Affiliation(s)
- H Delamain
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, United Kingdom.
| | - J E J Buckman
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, United Kingdom; iCope - Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, London, United Kingdom
| | - J Stott
- ADAPT Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, United Kingdom
| | - A John
- ADAPT Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, United Kingdom
| | - S Singh
- Waltham Forest Talking Therapies, North East London NHS Foundation Trust, London, United Kingdom
| | - S Pilling
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, United Kingdom; Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - R Saunders
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, United Kingdom
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Roberts SE, John A, Carter T, G Williams J. Suicide rates in the UK Armed Forces, compared with the general workforce and merchant shipping during peacetime years since 1900. BMJ Mil Health 2024:e002309. [PMID: 37028908 DOI: 10.1136/military-2022-002309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/02/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION The main objective was to compare suicide rates and their trends across the three UK Armed forces (Royal Navy, Army and Royal Air Force) from 1900 to 2020. Further objectives were to compare suicide rates with those in the corresponding general population and in UK merchant shipping and to discuss preventative measures. METHODS Examination of annual mortality reports and returns, death inquiry files and official statistics. The main outcome measure was the suicide rate per 100 000 population employed. RESULTS Since 1990, there have been significant reductions in suicide rates in each of the Armed Forces, although a non-significant increase in the Army since 2010. Compared with the corresponding general population, during the most recent decade from 2010 up to 2020, suicide rates were 73% lower in the Royal Air Force, 56% lower in the Royal Navy and 43% lower in the Army. Suicide rates have been significantly decreased in the Royal Air Force since the 1950s, in the Royal Navy since the 1970s and in the Army since the 1980s (comparisons for the Royal Navy and the Army were not available from the late 1940s to the 1960s).During the earliest decades from 1900 to the 1930s, suicide rates in the Armed Forces were mostly quite similar or moderately increased compared with the general population, but far lower than in merchant shipping. Following legislative changes in the last 30 years, suicide rates through poisoning by gases and through firearms or explosives have fallen sharply. CONCLUSIONS The study shows that suicide rates in the Armed Forces have been lower than in the general population over many decades. The sharp reductions in suicide rates over the last 30 years suggest the effectiveness of recent preventative measures, including reductions in access to a method of suicide and well-being initiatives.
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Affiliation(s)
| | - A John
- Medical School, Swansea University, Swansea, UK
| | - T Carter
- Norwegian Centre for Maritime and Diving Medicine, Haukeland Universitetssjukehus, Bergen, Norway
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Sewell B, Farr A, Akbari A, Carson-Stevens A, Dale J, Edwards A, Evans BA, John A, Torabi F, Jolles S, Kingston M, Lyons J, Lyons RA, Porter A, Watkins A, Williams V, Snooks H. The cost of implementing the COVID-19 shielding policy in Wales. BMC Public Health 2023; 23:2342. [PMID: 38008730 PMCID: PMC10680245 DOI: 10.1186/s12889-023-17169-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 11/06/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND The EVITE Immunity study investigated the effects of shielding Clinically Extremely Vulnerable (CEV) people during the COVID-19 pandemic on health outcomes and healthcare costs in Wales, United Kingdom, to help prepare for future pandemics. Shielding was intended to protect those at highest risk of serious harm from COVID-19. We report the cost of implementing shielding in Wales. METHODS The number of people shielding was extracted from the Secure Anonymised Information Linkage Databank. Resources supporting shielding between March and June 2020 were mapped using published reports, web pages, freedom of information requests to Welsh Government and personal communications (e.g. with the office of the Chief Medical Officer for Wales). RESULTS At the beginning of shielding, 117,415 people were on the shielding list. The total additional cost to support those advised to stay home during the initial 14 weeks of the pandemic was £13,307,654 (£113 per person shielded). This included the new resources required to compile the shielding list, inform CEV people of the shielding intervention and provide medicine and food deliveries. The list was adjusted weekly over the 3-month period (130,000 people identified by June 2020). Therefore the cost per person shielded lies between £102 and £113 per person. CONCLUSION This is the first evaluation of the cost of the measures put in place to support those identified to shield in Wales. However, no data on opportunity cost was available. The true costs of shielding including its budget impact and opportunity costs need to be investigated to decide whether shielding is a worthwhile policy for future health emergencies.
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Affiliation(s)
- Bernadette Sewell
- Swansea Centre for Health Economics, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
| | - Angela Farr
- Swansea Centre for Health Economics, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Ashley Akbari
- Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Andrew Carson-Stevens
- PRIME Centre Wales, Division of Population Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Adrian Edwards
- PRIME Centre Wales, Division of Population Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK
| | - Bridie Angela Evans
- Swansea University Medical School and PRIME Centre Wales, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Ann John
- Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Fatemeh Torabi
- Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Mark Kingston
- Swansea University Medical School and PRIME Centre Wales, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Jane Lyons
- Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Ronan A Lyons
- Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Alison Porter
- Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Alan Watkins
- Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Victoria Williams
- Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Helen Snooks
- Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
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Gibson JAG, Dobbs TD, Griffiths R, Song J, Akbari A, Bodger O, Hutchings HA, Lyons RA, John A, Whitaker IS. The association of anxiety disorders and depression with facial scarring: population-based, data linkage, matched cohort analysis of 358 158 patients. BJPsych Open 2023; 9:e212. [PMID: 37964568 PMCID: PMC10753955 DOI: 10.1192/bjo.2023.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 05/05/2023] [Accepted: 07/18/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Estimates suggest that 1 in 100 people in the UK live with facial scarring. Despite this incidence, psychological support is limited. AIMS The aim of this study was to strengthen the case for improving such support by determining the incidence and risk factors for anxiety and depression disorders in patients with facial scarring. METHOD A matched cohort study was performed. Patients were identified via secondary care data sources, using clinical codes for conditions resulting in facial scarring. A diagnosis of anxiety or depression was determined by linkage with the patient's primary care general practice data. Incidence was calculated per 1000 person-years at risk (PYAR). Logistic regression was used to determine risk factors. RESULTS Between 2009 and 2018, 179 079 patients met the study criteria and were identified as having a facial scar, and matched to 179 079 controls. The incidence of anxiety in the facial scarring group was 10.05 per 1000 PYAR compared with 7.48 per 1000 PYAR for controls. The incidence of depression in the facial scarring group was 16.28 per 1000 PYAR compared with 9.56 per 1000 PYAR for controls. Age at the time of scarring, previous history of anxiety or depression, female gender, socioeconomic status and classification of scarring increased the risk of both anxiety disorders and depression. CONCLUSIONS There is a high burden of anxiety disorders and depression in this patient group. Risk of these mental health disorders is very much determined by factors apparent at the time of injury, supporting the need for psychological support.
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Affiliation(s)
- John A. G. Gibson
- Reconstructive Surgery & Regenerative Medicine Research Centre,
Institute of Life Science, Swansea University Medical School,
UK; and The Welsh Centre for Burns and Plastic Surgery,
Morriston Hospital, UK
| | - Thomas D. Dobbs
- Reconstructive Surgery & Regenerative Medicine Research Centre,
Institute of Life Science, Swansea University Medical School,
UK; and The Welsh Centre for Burns and Plastic Surgery,
Morriston Hospital, UK
| | - Rowena Griffiths
- Population Data Science, Swansea University Medical School, Faculty of
Medicine, Health & Life Science, Swansea University,
UK
| | - Jiao Song
- Population Data Science, Swansea University Medical School, Faculty of
Medicine, Health & Life Science, Swansea University,
UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of
Medicine, Health & Life Science, Swansea University,
UK; and Patient and Population Health and Informatics Research, Swansea
University Medical School, Faculty of Medicine, Health & Life Science,
Swansea University, UK
| | - Owen Bodger
- Patient and Population Health and Informatics Research, Swansea University
Medical School, Faculty of Medicine, Health & Life Science, Swansea
University, UK
| | - Hayley A. Hutchings
- Patient and Population Health and Informatics Research, Swansea University
Medical School, Faculty of Medicine, Health & Life Science, Swansea
University, UK
| | - Ronan A. Lyons
- Population Data Science, Swansea University Medical School, Faculty of
Medicine, Health & Life Science, Swansea University,
UK; and Patient and Population Health and Informatics Research, Swansea
University Medical School, Faculty of Medicine, Health & Life Science,
Swansea University, UK
| | - Ann John
- Population Data Science, Swansea University Medical School, Faculty of
Medicine, Health & Life Science, Swansea University,
UK; and Patient and Population Health and Informatics Research, Swansea
University Medical School, Faculty of Medicine, Health & Life Science,
Swansea University, UK
| | - Iain S. Whitaker
- Reconstructive Surgery & Regenerative Medicine Research Centre,
Institute of Life Science, Swansea University Medical School,
UK; and The Welsh Centre for Burns and Plastic Surgery,
Morriston Hospital, UK
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Arya V, Page A, Vijayakumar L, Onie S, Tapp C, John A, Pirkis J, Armstrong G. Changing profile of suicide methods in India: 2014-2021. J Affect Disord 2023; 340:420-426. [PMID: 37573889 DOI: 10.1016/j.jad.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Restricting access to suicide methods is one of the most effective suicide prevention approaches. METHODS Trends in method specific suicide rates (2014-2021) in India were calculated using National Crime Records Bureau data (NCRB) by sex and geographical region. Joinpoint regression analysis was used to empirically identify any changes in suicide trends. RESULTS Suicide rates by hanging increased from 6.08 to 10.0 per 100,000 population among males and from 2.55 to 3.56 per 100,000 among females over the study period. Insecticide poisoning suicide rates also increased from 1.51 to 2.73 per 100,000 among males and from 0.74 to 1.14 per 100,000 among females. Suicide by self-immolation decreased over the study period among both sexes. In general, these national trends were mirrored among different regions. Joinpoint regression indicated an increase in suicide by hanging (annual percentage change (APC) of 12.3 among males between 2018 and 2021 and 4.9 among females between 2014 and 2021) and an increase in male suicide by insecticide poisoning between 2014 and 2021 (APC of 4.2) while a decrease in self-immolation rates was noted among males (APC of -12.7 between 2014 and 2021) and females (APC of -16.5 between 2016 and 2021). LIMITATION The NCRB data might underestimate true suicide rates. CONCLUSION Hanging suicides and insecticides poisoning suicides observed an increasing trend between 2014 and 2021. Self-immolation rates decreased during the study period which might be, in part, associated with the initiative to provide clean cooking fuel to households. Ban on lethal pesticides must be prioritised which might help lower insecticide poisoning suicide rates.
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Affiliation(s)
- Vikas Arya
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Australia
| | | | | | - Caley Tapp
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
| | - Ann John
- Swansea University Medical School, UK
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia
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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 2023. [PMID: 37904497 DOI: 10.1027/0227-5910/a000930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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John A, Popat S. Adjuvant immune checkpoint inhibitor therapy for resected non-small-cell lung cancer: dessert, starters, or a sandwich? Ann Oncol 2023; 34:829-830. [PMID: 37777306 DOI: 10.1016/j.annonc.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 10/02/2023] Open
Affiliation(s)
- A John
- Lung Unit, Royal Marsden Hospital, London. https://twitter.com/DrAlexiusJ
| | - S Popat
- Lung Unit, Royal Marsden Hospital, London; Section of Clinical Studies, Institute of Cancer Research, London, UK.
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12
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Lee SC, DelPozo-Banos M, Lloyd K, Jones I, Walters JTR, John A. Trends in socioeconomic inequalities in incidence of severe mental illness - A population-based linkage study using primary and secondary care routinely collected data between 2000 and 2017. Schizophr Res 2023; 260:113-122. [PMID: 37634386 DOI: 10.1016/j.schres.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/30/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE In 2008, the UK entered a period of economic recession followed by sustained austerity measures. We investigate changes in inequalities by area deprivation and urbanicity in incidence of severe mental illness (SMI, including schizophrenia-related disorders and bipolar disorder) between 2000 and 2017. METHODS We analysed 4.4 million individuals from primary and secondary care routinely collected datasets (2000-2017) in Wales and estimated the incidence of SMI by deprivation and urbanicity measured by the Welsh Index of Multiple Deprivation (WIMD) and urban/rural indicator respectively. Using linear modelling and joinpoint regression approaches, we examined time trends of the incidence and incidence rate ratios (IRR) of SMI by the WIMD and urban/rural indicator adjusted for available confounders. RESULTS We observed a turning point of time trends of incidence of SMI at 2008/2009 where slope changes of time trends were significantly increasing. IRRs by deprivation/urbanicity remained stable or significantly decreased over the study period except for those with bipolar disorder sourced from secondary care settings, with increasing trend of IRRs (increase in IRR by deprivation after 2010: 1.6 % per year, 95 % CI: 1.0 %-2.2 %; increase in IRR by urbanicity 1.0 % per year, 95 % CI: 0.6 %-1.3 %). CONCLUSIONS There was an association between recession/austerity and an increase in the incidence of SMI over time. There were variations in the effects of deprivation/urbanicity on incidence of SMI associated with short- and long-term socioeconomic change. These findings may support targeted interventions and social protection systems to reduce incidence of SMI.
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Affiliation(s)
- Sze Chim Lee
- DATAMIND at HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK,; National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Marcos DelPozo-Banos
- DATAMIND at HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK,; National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Keith Lloyd
- DATAMIND at HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK,; National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Ian Jones
- National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK; MRC Centre for Neuropsychiatric Genetics and Genomics. School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, UK
| | - James T R Walters
- DATAMIND at HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK,; National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK; MRC Centre for Neuropsychiatric Genetics and Genomics. School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, UK
| | - Ann John
- DATAMIND at HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK,; National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK.
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Lombardo C, Guo L, Solomon S, Crepaz-Keay D, McDaid S, Thorpe L, Martin S, John A, Morton A, Davidson G, Kousoulis AA, Van Bortel T. Inequalities and mental health during the Coronavirus pandemic in the UK: a mixed-methods exploration. BMC Public Health 2023; 23:1830. [PMID: 37730605 PMCID: PMC10510114 DOI: 10.1186/s12889-023-16523-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND The World Health Organisation declared the novel Coronavirus disease (COVID-19) a global pandemic on 11th March 2020. Since then, the world has been firmly in its grip. At the time of writing, there were more than 767,972,961 million confirmed cases and over 6,950,655 million deaths. While the main policy focus has been on controlling the virus and ensuring vaccine roll-out and uptake, the population mental health impacts of the pandemic are expected to be long-term, with certain population groups affected more than others. METHODS The overall objectives of our 'Coronavirus: Mental Health and the Pandemic' study were to explore UK adults' experiences of the Coronavirus pandemic and to gain insights into the mental health impacts, population-level changes over time, current and future mental health needs, and how these can best be addressed. The wider mixed-methods study consisted of repeated cross-sectional surveys and embedded qualitative sub-studies including in-depth interviews and focus group discussions with the wider UK adult population. For this particular inequalities and mental health sub-study, we used mixed methods data from our cross-sectional surveys and we carried out three Focus Group Discussions with a maximum variation sample from across the UK adult population. The discussions covered the broader topic of 'Inequalities and mental health during the Coronavirus pandemic in the UK' and took place online between April and August 2020. Focus Groups transcripts were analysed using thematic analysis in NVIVO. Cross-sectional survey data were analysed using STATA for descriptive statistics. RESULTS Three broad main themes emerged, each supporting a number of sub-themes: (1) Impacts of the pandemic; (2) Moving forward: needs and recommendations; (3) Coping mechanisms and resilience. Findings showed that participants described their experiences of the pandemic in relation to its impact on themselves and on different groups of people. Their experiences illustrated how the pandemic and subsequent measures had exacerbated existing inequalities and created new ones, and triggered various emotional responses. Participants also described their coping strategies and what worked and did not work for them, as well as support needs and recommendations for moving forward through, and out of, the pandemic; all of which are valuable learnings to be considered in policy making for improving mental health and for ensuring future preparedness. CONCLUSIONS The pandemic is taking a long-term toll on the nations' mental health which will continue to have impacts for years to come. It is therefore crucial to learn the vital lessons learned from this pandemic. Specific as well as whole-government policies need to respond to this, address inequalities and the different needs across the life-course and across society, and take a holistic approach to mental health improvement across the UK.
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Affiliation(s)
- Chiara Lombardo
- Cambridge Public Health Interdisciplinary Research Centre, Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Box 113, Cambridge, CB2 0SR, UK
- Mental Health Foundation, Studio 2, 197 Long Lane, London, SE1 4PD, UK
| | - Lijia Guo
- Cambridge Public Health Interdisciplinary Research Centre, Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Box 113, Cambridge, CB2 0SR, UK
| | - Susan Solomon
- Mental Health Foundation, Studio 2, 197 Long Lane, London, SE1 4PD, UK
| | - David Crepaz-Keay
- Mental Health Foundation, Studio 2, 197 Long Lane, London, SE1 4PD, UK
| | - Shari McDaid
- Mental Health Foundation, Studio 2, 197 Long Lane, London, SE1 4PD, UK
| | - Lucy Thorpe
- Mental Health Foundation, Studio 2, 197 Long Lane, London, SE1 4PD, UK
| | - Steven Martin
- Leicester School of Allied Health Sciences, Faculty of Health and Life Sciences, De Montfort University, Gateway House, Leicester, LE1 9BH, UK
| | - Ann John
- Health Data Research UK, Swansea University Medical School, Singleton Park, Swansea, SA2 8PP, UK
| | - Alec Morton
- Department of Management Science, Strathclyde Business School, University of Strathclyde, 199 Cathedral Street, Glasgow, G4 0QU, UK
| | - Gavin Davidson
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, BT7 1NN, UK
| | | | - Tine Van Bortel
- Cambridge Public Health Interdisciplinary Research Centre, Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Box 113, Cambridge, CB2 0SR, UK.
- Leicester School of Allied Health Sciences, Faculty of Health and Life Sciences, De Montfort University, Gateway House, Leicester, LE1 9BH, UK.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Schmidt L, Sinyor M, Webb RT, Marshall C, Knipe D, Eyles EC, John A, Gunnell D, Higgins JPT. A narrative review of recent tools and innovations toward automating living systematic reviews and evidence syntheses. Z Evid Fortbild Qual Gesundhwes 2023; 181:65-75. [PMID: 37596160 DOI: 10.1016/j.zefq.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/19/2023] [Accepted: 06/25/2023] [Indexed: 08/20/2023]
Abstract
Living reviews are an increasingly popular research paradigm. The purpose of a 'living' approach is to allow rapid collation, appraisal and synthesis of evolving evidence on an important research topic, enabling timely influence on patient care and public health policy. However, living reviews are time- and resource-intensive. The accumulation of new evidence and the possibility of developments within the review's research topic can introduce unique challenges into the living review workflow. To investigate the potential of software tools to support living systematic or rapid reviews, we present a narrative review informed by an examination of tools contained on the Systematic Review Toolbox website. We identified 11 tools with relevant functionalities and discuss the important features of these tools with respect to different steps of the living review workflow. Four tools (NestedKnowledge, SWIFT-ActiveScreener, DistillerSR, EPPI-Reviewer) covered multiple, successive steps of the review process, and the remaining tools addressed specific components of the workflow, including scoping and protocol formulation, reference retrieval, automated data extraction, write-up and dissemination of data. We identify several ways in which living reviews can be made more efficient and practical. Most of these focus on general workflow management, or automation through artificial intelligence and machine-learning, in the screening process. More sophisticated uses of automation mostly target living rapid reviews to increase the speed of production or evidence maps to broaden the scope of the map. We use a case study to highlight some of the barriers and challenges to incorporating tools into the living review workflow and processes. These include increased workload, the need for organisation, ensuring timely dissemination and challenges related to the development of bespoke automation tools to facilitate the review process. We describe how current end-user tools address these challenges, and which knowledge gaps remain that could be addressed by future tool development. Dedicated web presences for automatic dissemination of in-progress evidence updates, rather than solely relying on peer-reviewed journal publications, help to make the effort of a living evidence synthesis worthwhile. Despite offering basic living review functionalities, existing end-user tools could be further developed to be interoperable with other tools to support multiple workflow steps seamlessly, to address broader automatic evidence retrieval from a larger variety of sources, and to improve dissemination of evidence between review updates.
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Affiliation(s)
- Lena Schmidt
- National Institute for Health and Care Research Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle, UK; Sciome LLC, Research Triangle Park, North Carolina, USA.
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Roger T Webb
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK; National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC), Manchester, UK
| | | | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily C Eyles
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; The National Institute of Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Ann John
- Population Data Science, Swansea University, Swansea, UK; Public Health Wales NHS Trust, Wales, UK
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; The National Institute of Health and Care Research Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Julian P T Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; The National Institute of Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK; The National Institute of Health and Care Research Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
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16
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Lyons J, Akbari A, Abrams KR, Azcoaga Lorenzo A, Ba Dhafari T, Chess J, Denaxas S, Fry R, Gale CP, Gallacher J, Griffiths LJ, Guthrie B, Hall M, Jalali-najafabadi F, John A, MacRae C, McCowan C, Peek N, O’Reilly D, Rafferty J, Lyons RA, Owen RK. Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005-2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individuals. Lancet Reg Health Eur 2023; 32:100687. [PMID: 37520147 PMCID: PMC10372901 DOI: 10.1016/j.lanepe.2023.100687] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023]
Abstract
Background Understanding and quantifying the differences in disease development in different socioeconomic groups of people across the lifespan is important for planning healthcare and preventive services. The study aimed to measure chronic disease accrual, and examine the differences in time to individual morbidities, multimorbidity, and mortality between socioeconomic groups in Wales, UK. Methods Population-wide electronic linked cohort study, following Welsh residents for up to 20 years (2000-2019). Chronic disease diagnoses were obtained from general practice and hospitalisation records using the CALIBER disease phenotype register. Multi-state models were used to examine trajectories of accrual of 132 diseases and mortality, adjusted for sex, age and area-level deprivation. Restricted mean survival time was calculated to measure time spent free of chronic disease(s) or mortality between socioeconomic groups. Findings In total, 965,905 individuals aged 5-104 were included, from a possible 2.9 m individuals following a 5-year clearance period, with an average follow-up of 13.2 years (12.7 million person-years). Some 673,189 (69.7%) individuals developed at least one chronic disease or died within the study period. From ages 10 years upwards, the individuals living in the most deprived areas consistently experienced reduced time between health states, demonstrating accelerated transitions to first and subsequent morbidities and death compared to their demographic equivalent living in the least deprived areas. The largest difference were observed in 10 and 20 year old males developing multimorbidity (-0.45 years (99% CI: -0.45, -0.44)) and in 70 year old males dying after developing multimorbidity (-1.98 years (99% CI: -2.01, -1.95)). Interpretation This study adds to the existing literature on health inequalities by demonstrating that individuals living in more deprived areas consistently experience accelerated time to diagnosis of chronic disease and death across all ages, accounting for competing risks. Funding UK Medical Research Council, Health Data Research UK, and Administrative Data Research Wales.
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Affiliation(s)
- Jane Lyons
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
| | - Keith R. Abrams
- Department of Statistics, University of Warwick, Coventry, UK
- Centre for Health Economics, University of York, York, UK
| | - Amaya Azcoaga Lorenzo
- Instituto Investigación Sanitaria Fundación Jimenez Diaz, Madrid, Spain
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Thamer Ba Dhafari
- Division of Informatics, Imaging and Data Science, School of Health Sciences, University of Manchester, Manchester, UK
| | - James Chess
- Swansea Bay Health Board, Morriston Hospital, Swansea, Wales, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
| | - Richard Fry
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
| | | | - John Gallacher
- Dementias Platform UK, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Lucy J. Griffiths
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Marlous Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Farideh Jalali-najafabadi
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Ann John
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
| | - Clare MacRae
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Niels Peek
- Division of Informatics, Imaging and Data Science, School of Health Sciences, University of Manchester, Manchester, UK
| | - Dermot O’Reilly
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - James Rafferty
- Swansea Trials Unit, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
| | - Ronan A. Lyons
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
| | - Rhiannon K. Owen
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
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Snooks H, Watkins A, Lyons J, Akbari A, Bailey R, Bethell L, Carson-Stevens A, Dale J, Edwards A, Emery H, Evans BA, Jolles S, John A, Kingston M, Porter A, Sewell B, Williams V, Lyons RA. Corrigendum to "Did the UK's public health shielding policy protect the clinically extremely vulnerable during the COVID-19 pandemic in wales? Results of EVITE immunity, a linked data retrospective study" [Public Health 218 (2023) 12-20]. Public Health 2023; 222:229. [PMID: 37463828 PMCID: PMC11021201 DOI: 10.1016/j.puhe.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- H Snooks
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK.
| | - A Watkins
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - J Lyons
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
| | - A Akbari
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
| | - R Bailey
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
| | - L Bethell
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - A Carson-Stevens
- Cardiff University, Division of Population Medicine, University Hospital of Wales, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - J Dale
- The University of Warwick, Medical School, Coventry CV4 7AL, UK
| | - A Edwards
- Cardiff University, Division of Population Medicine, University Hospital of Wales, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - H Emery
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - B A Evans
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - S Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - A John
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
| | - M Kingston
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - A Porter
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - B Sewell
- Swansea University, School of Health and Social Care, Vivian Tower, Singleton Park, SA2 8PP, Swansea, UK
| | - V Williams
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - R A Lyons
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Porter A, Akbari A, Carson-Stevens A, Dale J, Dixon L, Edwards A, Evans B, Griffiths L, John A, Jolles S, Kingston MR, Lyons R, Morgan J, Sewell B, Whiffen A, Williams VA, Snooks H. Rationale for the shielding policy for clinically vulnerable people in the UK during the COVID-19 pandemic: a qualitative study. BMJ Open 2023; 13:e073464. [PMID: 37541747 PMCID: PMC10407356 DOI: 10.1136/bmjopen-2023-073464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/19/2023] [Indexed: 08/06/2023] Open
Abstract
INTRODUCTION Shielding aimed to protect those predicted to be at highest risk from COVID-19 and was uniquely implemented in the UK during the first year of the pandemic from March 2020. As the first stage in the EVITE Immunity evaluation (Effects of shielding for vulnerable people during COVID-19 pandemic on health outcomes, costs and immunity, including those with cancer:quasi-experimental evaluation), we generated a logic model to describe the programme theory underlying the shielding intervention. DESIGN AND PARTICIPANTS We reviewed published documentation on shielding to develop an initial draft of the logic model. We then discussed this draft during interviews with 13 key stakeholders involved in putting shielding into effect in Wales and England. Interviews were recorded, transcribed and analysed thematically to inform a final draft of the logic model. RESULTS The shielding intervention was a complex one, introduced at pace by multiple agencies working together. We identified three core components: agreement on clinical criteria; development of the list of people appropriate for shielding; and communication of shielding advice. In addition, there was a support programme, available as required to shielding people, including food parcels, financial support and social support. The predicted mechanism of change was that people would isolate themselves and so avoid infection, with the primary intended outcome being reduction in mortality in the shielding group. Unintended impacts included negative impact on mental and physical health and well-being. Details of the intervention varied slightly across the home nations of the UK and were subject to minor revisions during the time the intervention was in place. CONCLUSIONS Shielding was a largely untested strategy, aiming to mitigate risk by placing a responsibility on individuals to protect themselves. The model of its rationale, components and outcomes (intended and unintended) will inform evaluation of the impact of shielding and help us to understand its effect and limitations.
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Affiliation(s)
- Alison Porter
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Ashley Akbari
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Lucy Dixon
- Public Contributor, SUPER group, Swansea, UK
| | | | - Bridie Evans
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Ann John
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | | | - Ronan Lyons
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Bernadette Sewell
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Anthony Whiffen
- Administrative Data Research Unit, Welsh Government, Cardiff, UK
| | | | - Helen Snooks
- Swansea University Medical School, Swansea University, Swansea, UK
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20
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Bernard A, de Ossorno Garcia S, Salhi L, John A, DelPozo-Banos M. Patterns of engagement in a digital mental health service during COVID-19: a cohort study for children and young people. Front Psychiatry 2023; 14:1143272. [PMID: 37575580 PMCID: PMC10415812 DOI: 10.3389/fpsyt.2023.1143272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/27/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction The COVID-19 pandemic increased public use of digital mental health technologies. However, little is known about changes in user engagement with these platforms during the pandemic. This study aims to assess engagement changes with a digital mental healthcare service during COVID-19. Methods A cohort study based on routinely collected service usage data from a digital mental health support service in the United Kingdom. Returning users aged 14-25 years that interacted for a maximum of two months were included. The study population was divided into pre-COVID and COVID cohorts. Demographic and usage information between cohorts were compared and usage clusters were identified within each cohort. Differences were tested using Chi-squared, two-sample Kolmogorov-Smirnov tests and logit regressions. Results Of the 624,103 users who joined the service between May 1, 2019, and October 1, 2021, 18,889 (32.81%) met the inclusion criteria: 5,048 in the pre-COVID cohort and 13,841 in the COVID cohort. The COVID cohort wrote more journals; maintained the same focus on messaging practitioners, posting discussions, commenting on posts, and having booked chats; and engaged less in writing journals, setting personal goals, posting articles, and having ad-hoc chats. Four usage profiles were identified in both cohorts: one relatively disengaged, one focused on contacting practitioners through chats/messages, and two broadly interested in writing discussions and comments within the digital community. Despite their broad similarities, usage patterns also exhibited differences between cohorts. For example, all four clusters had over 70% of users attempting to have ad-hoc chats with practitioners in the pre-COVID cohort, compared to one out of four clusters in the COVID cohort. Overall, engagement change patterns during the COVID-19 pandemic were not equal across clusters. Sensitivity analysis revealed varying strength of these defined clusters. Discussion Our study identified changes in user activity and engagement behavior within a digital mental healthcare service during the COVID-19 pandemic. These findings suggest that usage patterns within digital mental health services may be susceptible to change in response to external events such as a pandemic. Continuous monitoring of engagement patterns is important for informed design and personalized interventions.
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Affiliation(s)
| | | | | | - Ann John
- Swansea University Medical School, Swansea, United Kingdom
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21
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Cowley LE, Hodgson K, Song J, Whiffen T, Tan J, John A, Bandyopadhyay A, Davies AR. Effects of the COVID-19 pandemic on the mental health of clinically extremely vulnerable children and children living with clinically extremely vulnerable people in Wales: a data linkage study. BMJ Open 2023; 13:e067882. [PMID: 37328187 PMCID: PMC10276955 DOI: 10.1136/bmjopen-2022-067882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 06/02/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVES To determine whether clinically extremely vulnerable (CEV) children or children living with a CEV person in Wales were at greater risk of presenting with anxiety or depression in primary or secondary care during the COVID-19 pandemic compared with children in the general population and to compare patterns of anxiety and depression during the pandemic (23 March 2020-31 January 2021, referred to as 2020/2021) and before the pandemic (23 March 2019-31 January 2020, referred to as 2019/2020), between CEV children and the general population. DESIGN Population-based cross-sectional cohort study using anonymised, linked, routinely collected health and administrative data held in the Secure Anonymised Information Linkage Databank. CEV individuals were identified using the COVID-19 shielded patient list. SETTING Primary and secondary healthcare settings covering 80% of the population of Wales. PARTICIPANTS Children aged 2-17 in Wales: CEV (3769); living with a CEV person (20 033); or neither (415 009). PRIMARY OUTCOME MEASURE First record of anxiety or depression in primary or secondary healthcare in 2019/2020 and 2020/2021, identified using Read and International Classification of Diseases V.10 codes. RESULTS A Cox regression model adjusted for demographics and history of anxiety or depression revealed that only CEV children were at greater risk of presenting with anxiety or depression during the pandemic compared with the general population (HR=2.27, 95% CI=1.94 to 2.66, p<0.001). Compared with the general population, the risk among CEV children was higher in 2020/2021 (risk ratio 3.04) compared with 2019/2020 (risk ratio 1.90). In 2020/2021, the period prevalence of anxiety or depression increased slightly among CEV children, but declined among the general population. CONCLUSIONS Differences in the period prevalence of recorded anxiety or depression in healthcare between CEV children and the general population were largely driven by a reduction in presentations to healthcare services by children in the general population during the pandemic.
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Affiliation(s)
| | - Karen Hodgson
- Research and Evaluation Division, Public Health Wales, Cardiff, UK
| | - Jiao Song
- Health Protection Division, Public Health Wales, Cardiff, UK
| | - Tony Whiffen
- Administrative Data Research Unit, Welsh Government, Cardiff, UK
| | - Jacinta Tan
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ann John
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Amrita Bandyopadhyay
- National Centre for Population Health and Wellbeing Research, Swansea University, Swansea, UK
| | - Alisha R Davies
- Research and Evaluation Division, Public Health Wales, Cardiff, UK
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22
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Cannings-John R, Schoenbuchner S, Jones H, Lugg-Widger FV, Akbari A, Brookes-Howell L, Hood K, John A, Thomas DR, Prout H, Robling M. Impact of the COVID-19 pandemic on domiciliary care workers in Wales, UK: a data linkage cohort study using the SAIL Databank. BMJ Open 2023; 13:e070637. [PMID: 37263685 DOI: 10.1136/bmjopen-2022-070637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES To quantify population health risks for domiciliary care workers (DCWs) in Wales, UK, working during the COVID-19 pandemic. DESIGN A population-level retrospective study linking occupational registration data to anonymised electronic health records maintained by the Secure Anonymised Information Linkage Databank in a privacy-protecting trusted research environment. SETTING Registered DCW population in Wales. PARTICIPANTS Records for all linked DCWs from 1 March 2020 to 30 November 2021. PRIMARY AND SECONDARY OUTCOME MEASURES Our primary outcome was confirmed COVID-19 infection; secondary outcomes included contacts for suspected COVID-19, mental health including self-harm, fit notes, respiratory infections not necessarily recorded as COVID-19, deaths involving COVID-19 and all-cause mortality. RESULTS Confirmed and suspected COVID-19 infection rates increased over the study period to 24% by 30 November 2021. Confirmed COVID-19 varied by sex (males: 19% vs females: 24%) and age (>55 years: 19% vs <35 years: 26%) and were higher for care workers employed by local authority social services departments compared with the private sector (27% and 23%, respectively). 34% of DCWs required support for a mental health condition, with mental health-related prescribing increasing in frequency when compared with the prepandemic period. Events for self-harm increased from 0.2% to 0.4% over the study period as did the issuing of fit notes. There was no evidence to suggest a miscoding of COVID-19 infection with non-COVID-19 respiratory conditions. COVID-19-related and all-cause mortality were no greater than for the general population aged 15-64 years in Wales (0.1% and 0.034%, respectively). A comparable DCW workforce in Scotland and England would result in a comparable rate of COVID-19 infection, while the younger workforce in Northern Ireland may result in a greater infection rate. CONCLUSIONS While initial concerns about excess mortality are alleviated, the substantial pre-existing and increased mental health burden for DCWs will require investment to provide long-term support to the sector's workforce.
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Affiliation(s)
| | | | - Hywel Jones
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | | | - Ashley Akbari
- Faculty of Medicine, Health & Life Science, Swansea University Medical School, Swansea, UK
| | | | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ann John
- Health Data Research UK | Administrative Data Research Wales, Swansea University, Swansea, UK
- DECIPHer-Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Daniel Rh Thomas
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, UK
- Cardiff Metropolitan University, Cardiff, UK
| | - Hayley Prout
- Centre for Trials Research, Cardiff University, Cardiff, UK
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23
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O'Connor RC, Worthman CM, Abanga M, Athanassopoulou N, Boyce N, Chan LF, Christensen H, Das-Munshi J, Downs J, Koenen KC, Moutier CY, Templeton P, Batterham P, Brakspear K, Frank RG, Gilbody S, Gureje O, Henderson D, John A, Kabagambe W, Khan M, Kessler D, Kirtley OJ, Kline S, Kohrt B, Lincoln AK, Lund C, Mendenhall E, Miranda R, Mondelli V, Niederkrotenthaler T, Osborn D, Pirkis J, Pisani AR, Prawira B, Rachidi H, Seedat S, Siskind D, Vijayakumar L, Yip PSF. Gone Too Soon: priorities for action to prevent premature mortality associated with mental illness and mental distress. Lancet Psychiatry 2023; 10:452-464. [PMID: 37182526 DOI: 10.1016/s2215-0366(23)00058-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 05/16/2023]
Abstract
Globally, too many people die prematurely from suicide and the physical comorbidities associated with mental illness and mental distress. The purpose of this Review is to mobilise the translation of evidence into prioritised actions that reduce this inequity. The mental health research charity, MQ Mental Health Research, convened an international panel that used roadmapping methods and review evidence to identify key factors, mechanisms, and solutions for premature mortality across the social-ecological system. We identified 12 key overarching risk factors and mechanisms, with more commonalities than differences across the suicide and physical comorbidities domains. We also identified 18 actionable solutions across three organising principles: the integration of mental and physical health care; the prioritisation of prevention while strengthening treatment; and the optimisation of intervention synergies across social-ecological levels and the intervention cycle. These solutions included accessible, integrated high-quality primary care; early life, workplace, and community-based interventions co-designed by the people they should serve; decriminalisation of suicide and restriction of access to lethal means; stigma reduction; reduction of income, gender, and racial inequality; and increased investment. The time to act is now, to rebuild health-care systems, leverage changes in funding landscapes, and address the effects of stigma, discrimination, marginalisation, gender violence, and victimisation.
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Affiliation(s)
- Rory C O'Connor
- Suicidal Behaviour Research Laboratory, School of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
| | | | - Marie Abanga
- Hope for the Abused and Battered, Douala, Cameroon
| | | | | | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Helen Christensen
- Faculty of Medicine & Health, University of New South Wales, Sydney and the Black Dog Institute, Sydney, NSW, Australia
| | - Jayati Das-Munshi
- Department of Psychological Medicine, King's College London, London, UK; Institute of Psychiatry, Psychology, and Neuroscience, and Centre for Society and Mental Health, King's College London, London, UK; South London and Maudsley NHS Trust, London, UK
| | - James Downs
- Royal College of Psychiatrists, UK and Faculty of Wellbeing, Education, and Language Studies, Open University, Milton Keynes, UK
| | | | | | - Peter Templeton
- The William Templeton Foundation for Young People's Mental Health, Cambridge, UK
| | - Philip Batterham
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | | | | | - Simon Gilbody
- York Mental Health and Addictions Research Group, University of York, York, UK
| | - Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neuroscience, Drug and Alcohol Abuse, University of Ibadan, Ibadan, Nigeria
| | - David Henderson
- Department of Psychiatry, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Murad Khan
- Brain & Mind Institute, Aga Khan University, Karachi, Pakistan
| | - David Kessler
- Bristol Population Health Science Institute, Centre for Academic Mental Health, Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Olivia J Kirtley
- Center for Contextual Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Brandon Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Alisa K Lincoln
- Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA, USA
| | - Crick Lund
- Health Services and Population Research Department, King's College London, London, UK; Centre for Global Mental Health, King's College London, London, UK
| | - Emily Mendenhall
- Edmund A Walsh School of Foreign Service, Georgetown University, Washington, DC, USA
| | - Regina Miranda
- Hunter College, Department of Psychology, The Graduate Center, City University of New York, New York, NY, USA
| | - Valeria Mondelli
- Department of Psychological Medicine, King's College London, London, UK
| | - Thomas Niederkrotenthaler
- Department of Social and Preventive Medicine, Suicide Research & Mental Health Promotion Unit, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - David Osborn
- Division of Psychiatry, University College London and Camden and Islington NHS Foundation Trust, London, UK
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Anthony R Pisani
- University of Rochester Center for the Study and Prevention of Suicide, SafeSide Prevention, Rochester, NY, USA
| | | | | | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, SAMRC Genomics of Brain Disorders Unit, Stellenbosch University, Cape Town, South Africa
| | - Dan Siskind
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
| | | | - Paul S F Yip
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong Special Administrative Region, China
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24
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John A, McGregor J, Marchant A, DelPozo-Baños M, Farr I, Nurmatov U, Kemp A, Naughton A. An external validation of coding for childhood maltreatment in routinely collected primary and secondary care data. Sci Rep 2023; 13:8138. [PMID: 37208469 PMCID: PMC10199091 DOI: 10.1038/s41598-023-34011-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/22/2023] [Indexed: 05/21/2023] Open
Abstract
Validated methods of identifying childhood maltreatment (CM) in primary and secondary care data are needed. We aimed to create the first externally validated algorithm for identifying maltreatment using routinely collected healthcare data. Comprehensive code lists were created for use within GP and hospital admissions datasets in the SAIL Databank at Swansea University working with safeguarding clinicians and academics. These code lists build on and refine those previously published to include an exhaustive set of codes. Sensitivity, specificity and positive predictive value of previously published lists and the new algorithm were estimated against a clinically assessed cohort of CM cases from a child protection service secondary care-based setting-'the gold standard'. We conducted sensitivity analyses to examine the utility of wider codes indicating Possible CM. Trends over time from 2004 to 2020 were calculated using Poisson regression modelling. Our algorithm outperformed previously published lists identifying 43-72% of cases in primary care with a specificity ≥ 85%. Sensitivity of algorithms for identifying maltreatment in hospital admissions data was lower identifying between 9 and 28% of cases with high specificity (> 96%). Manual searching of records for those cases identified by the external dataset but not recorded in primary care suggest that this code list is exhaustive. Exploration of missed cases shows that hospital admissions data is often focused on the injury being treated rather than recording the presence of maltreatment. The absence of child protection or social care codes in hospital admissions data poses a limitation for identifying maltreatment in admissions data. Linking across GP and hospital admissions maximises the number of cases of maltreatment that can be accurately identified. Incidence of maltreatment in primary care using these code lists has increased over time. The updated algorithm has improved our ability to detect CM in routinely collected healthcare data. It is important to recognize the limitations of identifying maltreatment in individual healthcare datasets. The inclusion of child protection codes in primary care data makes this an important setting for identifying CM, whereas hospital admissions data is often focused on injuries with CM codes often absent. Implications and utility of algorithms for future research are discussed.
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Affiliation(s)
- Ann John
- Population Data Science, Data Science Building, Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
| | - Joanna McGregor
- Population Data Science, Data Science Building, Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Amanda Marchant
- Population Data Science, Data Science Building, Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Marcos DelPozo-Baños
- Population Data Science, Data Science Building, Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Ian Farr
- Population Data Science, Data Science Building, Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Ulugbek Nurmatov
- School of Medicine, Cardiff University, Neuadd Meirionnydd, Cardiff, CF14 4YS, UK
| | - Alison Kemp
- School of Medicine, Cardiff University, Neuadd Meirionnydd, Cardiff, CF14 4YS, UK
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25
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Snooks H, Watkins A, Lyons J, Akbari A, Bailey R, Bethell L, Carson-Stevens A, Edwards A, Emery H, Evans BA, Jolles S, John A, Kingston M, Porter A, Sewell B, Williams V, Lyons RA. Did the UK's public health shielding policy protect the clinically extremely vulnerable during the COVID-19 pandemic in Wales? Results of EVITE Immunity, a linked data retrospective study. Public Health 2023; 218:12-20. [PMID: 36933354 PMCID: PMC9928733 DOI: 10.1016/j.puhe.2023.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION The UK shielding policy intended to protect people at the highest risk of harm from COVID-19 infection. We aimed to describe intervention effects in Wales at 1 year. METHODS Retrospective comparison of linked demographic and clinical data for cohorts comprising people identified for shielding from 23 March to 21 May 2020; and the rest of the population. Health records were extracted with event dates between 23 March 2020 and 22 March 2021 for the comparator cohort and from the date of inclusion until 1 year later for the shielded cohort. RESULTS The shielded cohort included 117,415 people, with 3,086,385 in the comparator cohort. The largest clinical categories in the shielded cohort were severe respiratory condition (35.5%), immunosuppressive therapy (25.9%) and cancer (18.6%). People in the shielded cohort were more likely to be female, aged ≥50 years, living in relatively deprived areas, care home residents and frail. The proportion of people tested for COVID-19 was higher in the shielded cohort (odds ratio [OR] 1.616; 95% confidence interval [CI] 1.597-1.637), with lower positivity rate incident rate ratios 0.716 (95% CI 0.697-0.736). The known infection rate was higher in the shielded cohort (5.9% vs 5.7%). People in the shielded cohort were more likely to die (OR 3.683; 95% CI: 3.583-3.786), have a critical care admission (OR 3.339; 95% CI: 3.111-3.583), hospital emergency admission (OR 2.883; 95% CI: 2.837-2.930), emergency department attendance (OR 1.893; 95% CI: 1.867-1.919) and common mental disorder (OR 1.762; 95% CI: 1.735-1.789). CONCLUSION Deaths and healthcare utilisation were higher amongst shielded people than the general population, as would be expected in the sicker population. Differences in testing rates, deprivation and pre-existing health are potential confounders; however, lack of clear impact on infection rates raises questions about the success of shielding and indicates that further research is required to fully evaluate this national policy intervention.
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Affiliation(s)
- H Snooks
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Watkins
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - J Lyons
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Akbari
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
| | - R Bailey
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
| | - L Bethell
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Carson-Stevens
- Cardiff University, Division of Population Medicine, Neuadd Meirionnydd, University Hospital of Wales, Heath Park, Cardiff, CF14 4YS, UK.
| | - A Edwards
- Cardiff University, Division of Population Medicine, Neuadd Meirionnydd, University Hospital of Wales, Heath Park, Cardiff, CF14 4YS, UK.
| | - H Emery
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - B A Evans
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - S Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
| | - A John
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
| | - M Kingston
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Porter
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - B Sewell
- Swansea University, School of Health and Social Care, Vivian Tower, Singleton Park, Swansea, SA2 8PP, UK.
| | - V Williams
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - R A Lyons
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
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Baghdadi F, Evans BA, Goodacre S, John PA, Hettiarachchi T, John A, Lyons RA, Porter A, Safari S, Siriwardena AN, Snooks H, Watkins A, Williams J, Khanom A. Building an understanding of Ethnic minority people's Service Use Relating to Emergency care for injuries: the BE SURE study protocol. BMJ Open 2023; 13:e069596. [PMID: 37185177 PMCID: PMC10151843 DOI: 10.1136/bmjopen-2022-069596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Injuries are a major public health problem which can lead to disability or death. However, little is known about the incidence, presentation, management and outcomes of emergency care for patients with injuries among people from ethnic minorities in the UK. The aim of this study is to investigate what may differ for people from ethnic minorities compared with white British people when presenting with injury to ambulance and Emergency Departments (EDs). METHODS AND ANALYSIS This mixed methods study covers eight services, four ambulance services (three in England and one in Scotland) and four hospital EDs, located within each ambulance service. The study has five Work Packages (WP): (WP1) scoping review comparing mortality by ethnicity of people presenting with injury to emergency services; (WP2) retrospective analysis of linked NHS routine data from patients who present to ambulances or EDs with injury over 5 years (2016-2021); (WP3) postal questionnaire survey of 2000 patients (1000 patients from ethnic minorities and 1000 white British patients) who present with injury to ambulances or EDs including self-reported outcomes (measured by Quality of Care Monitor and Health Related Quality of Life measured by SF-12); (WP4) qualitative interviews with patients from ethnic minorities (n=40) and focus groups-four with asylum seekers and refugees and four with care providers and (WP5) a synthesis of quantitative and qualitative findings. ETHICS AND DISSEMINATION This study received a favourable opinion by the Wales Research Ethics Committee (305391). The Health Research Authority has approved the study and, on advice from the Confidentiality Advisory Group, has supported the use of confidential patient information without consent for anonymised data. Results will be shared with ambulance and ED services, government bodies and third-sector organisations through direct communications summarising scientific conference proceedings and publications.
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Affiliation(s)
| | | | - Steve Goodacre
- School of Health and Health Related Research, University of Sheffield, Sheffield, UK
| | - Paul Anthony John
- Research and Innovation Hub, Scottish Ambulance Service, Edinburgh, UK
| | | | - Ann John
- Medical School, Swansea University, Swansea, UK
| | | | | | - Solmaz Safari
- Public Contributor, c/o Medical School, Swansea University, Swansea, UK
| | | | | | | | - Julia Williams
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
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Brown M, Lord E, John A. Adaptation of ACTivate Your Wellbeing, a Digital Health and Well-being Program for Young Persons: Co-design Approach. JMIR Form Res 2023; 7:e39913. [PMID: 37052994 PMCID: PMC10141270 DOI: 10.2196/39913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/09/2022] [Accepted: 10/06/2022] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND ACTivate your wellbeing is a digital health and well-being program designed to support and encourage positive lifestyle behavior change. The website includes 5 lifestyle behavior change modules and a 12-week well-being intervention based on acceptance and commitment therapy. It was timely to adapt the resource for a new audience in the wake of the COVID-19 pandemic. Young persons' mental health needs have increased substantially, and lifestyle behaviors play a critical role in both mental and physical health statuses. OBJECTIVE This study aimed to adapt an existing health and well-being website for use by young persons aged 16 to 24 years. METHODS A 3-staged participatory, co-design approach was adopted. The participants reviewed the existing program and provided feedback (stage 1) before cocreating new content (stage 2). Finally, the updated program underwent formative evaluation (stage 3). Two groups were created: one had access for 3 weeks and the other could self-select their study duration. The options were 3 weeks, 60 days, or 90 days. Outcome measures were the Warwick and Edinburgh Mental Well-being Scale, 4-item Patient Health Questionnaire, and Acceptance and Action Questionnaire version 2. RESULTS Stage 1 identified that the website was appealing to the new audience (19/24, 79%), and the 3 web-based focus group discussions explored data from the written review in more depth to identify and clarify the main areas for update and adaptation. Overall, 3 themes were developed, and the data informed the creation of 6 tasks for use in 5 web-based co-design workshops. Stage 2 led to the cocreation of 36 outputs, including a new name, new content, scenarios, images, and a new user dashboard, which included streaks and an updated color scheme. After the website update program was completed, 40 participants registered to use the website for formative evaluation (stage 3). Data analysis revealed differences in engagement, completion, and mean well-being after intervention between the 2 groups. The completion rate was 68% in the 3-week duration group, and well-being scores improved after intervention. CONCLUSIONS Young persons engaged actively with the participatory design process. The participants discussed the updates they desired during the web-based discussions, which worked well via Zoom (Zoom Video Communications Inc) when small groups were used. The participants easily cocreated new content during the web-based co-design workshops. The web-based format enabled a range of participants to take part, share their ideas, search for images, and design digital content creatively together. The Zoom software enabled screen sharing and collaborative whiteboard use, which helped the cocreation process. The formative evaluation suggested that younger users who engage more with the website for a shorter duration may benefit more.
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Affiliation(s)
- Menna Brown
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Emily Lord
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
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Astle DE, Moore A, Marryat L, Viding E, Mansfield KL, Fazel M, Pierce M, Abel KM, Green J, John A, Broome MR, Upthegrove R, Bould H, Minnis H, Gajwani R, Groom MJ, Hollis C, Liddle E, Sayal K, Berry V, Collishaw S, Dawes H, Cortese S, Violato M, Pollard J, MacCabe JH, Blakemore SJ, Simonoff E, Watkins E, Hiller RM, Townsend E, Armour C, Geddes JR, Thompson L, Schwannauer M, Nicholls D, Hotopf M, Downs J, Rahman A, Sharma AN, Ford TJ. We need timely access to mental health data: implications of the Goldacre review. Lancet Psychiatry 2023; 10:242-244. [PMID: 36931773 DOI: 10.1016/s2215-0366(23)00030-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 03/17/2023]
Affiliation(s)
- Duncan E Astle
- Department of Psychiatry, University of Cambridge, Cambridge CB2 1TN, UK; MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 1TN, UK.
| | - Anna Moore
- Department of Psychiatry, University of Cambridge, Cambridge CB2 1TN, UK
| | - Louise Marryat
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Essi Viding
- Division of Psychology and Language Sciences, University College London, London, UK
| | | | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Matthias Pierce
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Kathryn M Abel
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jonathan Green
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Ann John
- Population Data Science, Swansea University, Swansea, UK
| | - Matthew R Broome
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Helen Bould
- Population Health Science, Centre for Academic Mental Health and Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Helen Minnis
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ruchika Gajwani
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Madeleine J Groom
- Academic Unit of Mental Health & Clinical Neurosciences School of Medicine, University of Nottingham, Nottingham, UK; Centre for ADHD & Neurodevelopmental Disorders Across the Lifespan, University of Nottingham, Nottingham, UK
| | - Chris Hollis
- NIHR MindTech MIC & NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Elizabeth Liddle
- Centre for ADHD & Neurodevelopmental Disorders Across the Lifespan, University of Nottingham, Nottingham, UK
| | - Kapil Sayal
- Academic Unit of Mental Health & Clinical Neurosciences School of Medicine, University of Nottingham, Nottingham, UK; Centre for ADHD & Neurodevelopmental Disorders Across the Lifespan, University of Nottingham, Nottingham, UK
| | - Vashti Berry
- Children & Young People's Mental Health Research Collaboration, University of Exeter, Exeter, UK
| | - Stephan Collishaw
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Helen Dawes
- NIHR Exeter Biomedical Research Centre, University of Exeter, Exeter, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jack Pollard
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - James H MacCabe
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - Emily Simonoff
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - Rachel M Hiller
- Division of Psychology and Language Sciences, University College London, London, UK; Anna Freud National Centre for Children and Families, University College London, London, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Cherie Armour
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - John R Geddes
- NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Lucy Thompson
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Matthias Schwannauer
- Centre for Applied Developmental Psychology, University of Edinburgh, Edinburgh, UK
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Johnny Downs
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Atif Rahman
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Aditya Narain Sharma
- Translational and Clinical Research Institute, University of Newcastle, Newcastle, UK; Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Tamsin J Ford
- Department of Psychiatry, University of Cambridge, Cambridge CB2 1TN, UK
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Bertolini F, Witteveen AB, Young S, Cuijpers P, Ayuso-Mateos JL, Barbui C, Cabello M, Cadorin C, Downes N, Franzoi D, Gasior ME, Gray B, John A, Melchior M, van Ommeren M, Palantza C, Purgato M, Van der Waerden J, Wang S, Sijbrandij M. Risk of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 mortality in people with pre-existing mental disorders: an umbrella review. BMC Psychiatry 2023; 23:181. [PMID: 36941591 PMCID: PMC10026202 DOI: 10.1186/s12888-023-04641-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/28/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has posed a serious health risk, especially in vulnerable populations. Even before the pandemic, people with mental disorders had worse physical health outcomes compared to the general population. This umbrella review investigated whether having a pre-pandemic mental disorder was associated with worse physical health outcomes due to the COVID-19 pandemic. METHODS Following a pre-registered protocol available on the Open Science Framework platform, we searched Ovid MEDLINE All, Embase (Ovid), PsycINFO (Ovid), CINAHL, and Web of Science up to the 6th of October 2021 for systematic reviews on the impact of COVID-19 on people with pre-existing mental disorders. The following outcomes were considered: risk of contracting the SARS-CoV-2 infection, risk of severe illness, COVID-19 related mortality risk, risk of long-term physical symptoms after COVID-19. For meta-analyses, we considered adjusted odds ratio (OR) as effect size measure. Screening, data extraction and quality assessment with the AMSTAR 2 tool have been done in parallel and duplicate. RESULTS We included five meta-analyses and four narrative reviews. The meta-analyses reported that people with any mental disorder had an increased risk of SARS-CoV-2 infection (OR: 1.71, 95% CI 1.09-2.69), severe illness course (OR from 1.32 to 1.77, 95%CI between 1.19-1.46 and 1.29-2.42, respectively) and COVID-19 related mortality (OR from 1.38 to 1.52, 95%CI between 1.15-1.65 and 1.20-1.93, respectively) as compared to the general population. People with anxiety disorders had an increased risk of SAR-CoV-2 infection, but not increased mortality. People with mood and schizophrenia spectrum disorders had an increased COVID-19 related mortality but without evidence of increased risk of severe COVID-19 illness. Narrative reviews were consistent with findings from the meta-analyses. DISCUSSION AND CONCLUSIONS As compared to the general population, there is strong evidence showing that people with pre-existing mental disorders suffered from worse physical health outcomes due to the COVID-19 pandemic and may therefore be considered a risk group similar to people with underlying physical conditions. Factors likely involved include living accommodations with barriers to social distancing, cardiovascular comorbidities, psychotropic medications and difficulties in accessing high-intensity medical care.
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Affiliation(s)
- Federico Bertolini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Anke B Witteveen
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Susanne Young
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Pim Cuijpers
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
- International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Jose Luis Ayuso-Mateos
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - María Cabello
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Camilla Cadorin
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Naomi Downes
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Social Epidemiology Research Team (ERES), Paris, F75012, France
| | - Daniele Franzoi
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Michael Elizabeth Gasior
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Brandon Gray
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Ann John
- Population Psychiatry, Suicide and Informatics, Medical School, Swansea University, Swansea, UK
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Social Epidemiology Research Team (ERES), Paris, F75012, France
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Christina Palantza
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Judith Van der Waerden
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Social Epidemiology Research Team (ERES), Paris, F75012, France
| | - Siyuan Wang
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Marit Sijbrandij
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
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Rees S, Fry R, Davies J, John A, Condon L. Can routine data be used to estimate the mental health service use of children and young people living on Gypsy and Traveller sites in Wales? A feasibility study. PLoS One 2023; 18:e0281504. [PMID: 36800353 PMCID: PMC9937479 DOI: 10.1371/journal.pone.0281504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/11/2023] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION Gypsies and Travellers have poorer physical and mental health than the general population, but little is known about mental health service use by Gypsy and Traveller children and young people. Finding this group in routine electronic health data is challenging, due to limited recording of ethnicity. We assessed the feasibility of using geographical markers combined with linked routine datasets to estimate the mental health service use of children and young people living on Traveller sites. METHODS Welsh Government supplied a list of Traveller site postcodes included in Caravan Counts between 2012 and 2020. Using spatial filtering with data from the Adolescent Mental Health Data Platform (ADP) at Swansea University's SAIL Databank, we created a cohort of Traveller site residents aged 11-25 years old, 2010-2019. ADP algorithms were used to describe health service use, and to estimate incidence and prevalence of common mental disorders (CMD) and self-harm. RESULTS Our study found a subgroup of young Gypsies and Travellers (n = 802). We found no significant differences between our cohort and the general population for rates of CMD or self-harm. The rate of non-attendance for psychiatric outpatient follow-up appointments was significantly higher in our cohort. Rates were higher (but not statistically significant) among Gypsies and Travellers for measures suggesting less well-managed care, including emergency department attendance and prescribed CMD medication without follow-up. The small size of the cohort resulted in imprecise estimates with wide confidence intervals, compared with those for the general population. CONCLUSIONS Gypsies and Travellers are under-represented in routine health datasets, even using geographical markers, which find only those resident in authorised traveller sites. Routine data is increasingly relied upon for needs assessment and service planning, which has policy and practice implications for this underserved group. To address health inequalities effort is required to ensure that health datasets accurately capture ethnicity.
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Affiliation(s)
- Sarah Rees
- Population Data Science, Swansea University Medical School, Swansea, United Kingdom
| | - Richard Fry
- Population Data Science, Swansea University Medical School, Swansea, United Kingdom
| | - Jason Davies
- School of Psychology, Swansea University, Swansea, United Kingdom
| | - Ann John
- Population Data Science, Swansea University Medical School, Swansea, United Kingdom
| | - Louise Condon
- School of Health and Social Care, Swansea University, Swansea, United Kingdom
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Iveson MH, Ball EL, Whalley HC, Deary IJ, Cox SR, Batty GD, John A, McIntosh AM. Childhood cognitive ability and self-harm and suicide in later life. medRxiv 2023:2023.02.10.23285747. [PMID: 36798203 PMCID: PMC9934796 DOI: 10.1101/2023.02.10.23285747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Self-harm and suicide remain prevalent in later life. For younger adults, work has highlighted an association between higher early-life cognitive ability and lower self-harm and suicide risk. Comparatively little is known about its association with self-harm and suicide among older adults. Furthermore, most work has measured cognitive ability in early adulthood, raising issues of potential confounding by emerging psychiatric conditions. The present study examined the association between childhood (age 11) cognitive ability and self-harm and suicide risk among a Scotland-wide cohort of older adults (N = 53037), using health data linkage to follow individuals from age 34 to 85. Self-harm events were extracted from hospital admissions and suicide deaths were extracted from national mortality records. Multistate models were used to model transitions between unaffected, self-harm, and then suicide or non-suicide death, and to examine the association between childhood cognitive ability and each transition. After adjusting for childhood and adulthood socioeconomic conditions, higher childhood cognitive ability was significantly associated with reduced risk of self-harm among older females (N events = 516; HR = 0.90, 95% CI = [0.81, 0.99]). A similar, though non-significant, association was observed among older males (N events = 451; HR = 0.90, 95% CI = [0.82, 1.00]). Although suicide risk was higher among older adults experiencing self-harm, childhood cognitive ability was not significantly associated with suicide risk among either older adults experiencing no self-harm events (Male: N events = 118, HR = 1.17, 95% CI = [0.84, 1.63]; Female: N events = 31, HR = 1.30, 95% CI = [0.70, 2.41]) or those experiencing a self-harm event during follow-up (Male: N events = 16, HR = 1.05, 95% CI = [0.61, 1.80]; Female: N events = 13, HR = 1.08, 95% CI = [0.55, 2.14]). Higher suicide risk was significantly associated with covariates including higher adulthood deprivation and longer time in the self-harm state. These results extend work on cognitive ability and mental health, demonstrating that these associations can span across the life course and into older age.
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Affiliation(s)
- Matthew H Iveson
- Centre for Clinical Brain Sciences, The University of Edinburgh, UK
| | - Emily L Ball
- Centre for Clinical Brain Sciences, The University of Edinburgh, UK
| | | | - Ian J Deary
- Department of Psychology, The University of Edinburgh, UK
| | - Simon R Cox
- Department of Psychology, The University of Edinburgh, UK
| | - G David Batty
- Institute of Epidemiology and Health, University College London, London, UK
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Witteveen A, Young S, Cuijpers P, Ayuso-Mateos J, Barbui C, Bertolini F, Cabello M, Cadorin C, Downes N, Franzoi D, Gasior M, John A, Melchior M, McDaid D, Palantza C, Purgato M, Van der Waerden J, Wang S, Sijbrandij M. Remote mental health care interventions during the COVID-19 pandemic: An umbrella review. Behav Res Ther 2022; 159:104226. [PMID: 36410111 PMCID: PMC9661449 DOI: 10.1016/j.brat.2022.104226] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 10/13/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
Mitigating the COVID-19 related disruptions in mental health care services is crucial in a time of increased mental health disorders. Numerous reviews have been conducted on the process of implementing technology-based mental health care during the pandemic. The research question of this umbrella review was to examine what the impact of COVID-19 was on access and delivery of mental health services and how mental health services have changed during the pandemic. A systematic search for systematic reviews and meta-analyses was conducted up to August 12, 2022, and 38 systematic reviews were identified. Main disruptions during COVID-19 were reduced access to outpatient mental health care and reduced admissions and earlier discharge from inpatient care. In response, synchronous telemental health tools such as videoconferencing were used to provide remote care similar to pre-COVID care, and to a lesser extent asynchronous virtual mental health tools such as apps. Implementation of synchronous tools were facilitated by time-efficiency and flexibility during the pandemic but there was a lack of accessibility for specific vulnerable populations. Main barriers among practitioners and patients to use digital mental health tools were poor technological literacy, particularly when preexisting inequalities existed, and beliefs about reduced therapeutic alliance particularly in case of severe mental disorders. Absence of organizational support for technological implementation of digital mental health interventions due to inadequate IT infrastructure, lack of funding, as well as lack of privacy and safety, challenged implementation during COVID-19. Reviews were of low to moderate quality, covered heterogeneously designed primary studies and lacked findings of implementation in low- and middle-income countries. These gaps in the evidence were particularly prevalent in studies conducted early in the pandemic. This umbrella review shows that during the COVID-19 pandemic, practitioners and mental health care institutions mainly used synchronous telemental health tools, and to a lesser degree asynchronous tools to enable continued access to mental health care for patients. Numerous barriers to these tools were identified, and call for further improvements. In addition, more high quality research into comparative effectiveness and working mechanisms may improve scalability of mental health care in general and in future infectious disease outbreaks.
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Affiliation(s)
- A.B. Witteveen
- Clinical, Neuro and Developmental Psychology, and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands,Corresponding author
| | - S. Young
- Clinical, Neuro and Developmental Psychology, and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - P. Cuijpers
- Clinical, Neuro and Developmental Psychology, and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - J.L. Ayuso-Mateos
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - C. Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - F. Bertolini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - M. Cabello
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - C. Cadorin
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - N. Downes
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Faculté de Médecine St Antoine, Paris, France
| | - D. Franzoi
- Clinical, Neuro and Developmental Psychology, and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - M. Gasior
- Clinical, Neuro and Developmental Psychology, and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - A. John
- Health Data Science, Swansea University Medical School, Swansea, UK
| | - M. Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Faculté de Médecine St Antoine, Paris, France
| | - D. McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - C. Palantza
- Clinical, Neuro and Developmental Psychology, and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - M. Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - J. Van der Waerden
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Faculté de Médecine St Antoine, Paris, France
| | - S. Wang
- Clinical, Neuro and Developmental Psychology, and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - M. Sijbrandij
- Clinical, Neuro and Developmental Psychology, and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
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Lewis C, Lewis K, Edwards B, Evison C, John A, Pearce H, Raisanen L, Richards N, Roberts A, Jones I, Bisson JI. Posttraumatic growth related to the COVID-19 pandemic among individuals with lived experience of psychiatric disorder. J Trauma Stress 2022; 35:1756-1768. [PMID: 36322379 PMCID: PMC9877956 DOI: 10.1002/jts.22884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 12/03/2022]
Abstract
Although the COVID-19 pandemic has been shown to be detrimental to mental health, it may hold a parallel potential for positive change. Little is known about posttraumatic growth (PTG) as a potential outcome for individuals with lived experience of psychiatric disorders following trauma exposure, especially in the context of the COVID-19 pandemic. Participants were 1,424 adults with lived experience of a psychiatric disorder who took part in a longitudinal study of mental health during the COVID-19 pandemic conducted by the National Centre for Mental Health. PTG was measured using the Posttraumatic Growth Inventory-Short Form (PTGI-SF). Factors hypothesized to be associated with PTG were investigated using linear regression. The mean participant PTGI score was 12.64 (SD = 11.01). On average, participants reported the highest scores on items related to appreciation of life and lowest on those related to spiritual change subscale. We found the strongest evidence of associations between higher levels of PTG and higher scores on assessment items related to perceived social support, B = 2.86; perceptions of the pandemic as traumatic, B = 4.89; and higher psychological well-being, B = 0.40. Taken together, we did not observe evidence of widespread PTG related to the COVID-19 pandemic among individuals with lived experiences of psychiatric disorders.
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Affiliation(s)
- Catrin Lewis
- National Centre for Mental Health, Division of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUnited Kingdom
| | - Katie Lewis
- National Centre for Mental Health, Division of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUnited Kingdom
| | - Bethan Edwards
- National Centre for Mental Health, PÂRCardiff University School of MedicineCardiffUnited Kingdom
| | - Claudia Evison
- National Centre for Mental Health, Division of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUnited Kingdom
| | - Ann John
- National Centre for Mental Health, Population Data ScienceSwansea University Medical SchoolSwanseaUnited Kingdom
| | - Holly Pearce
- National Centre for Mental Health, Division of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUnited Kingdom
| | - Lawrence Raisanen
- National Centre for Mental Health, Division of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUnited Kingdom
| | - Natalie Richards
- National Centre for Mental Health, Division of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUnited Kingdom
| | - Alice Roberts
- National Centre for Mental Health, Division of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUnited Kingdom
| | - Ian Jones
- National Centre for Mental Health, Division of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUnited Kingdom
| | - Jonathan I. Bisson
- National Centre for Mental Health, Division of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUnited Kingdom
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Prout H, Lugg‐Widger FV, Brookes‐Howell L, Cannings‐John R, Akbari A, John A, Thomas DR, Robling M. "I don't mean to be rude, but could you put a mask on while I'm here?" A qualitative study of risks experienced by domiciliary care workers in Wales during the COVID-19 pandemic. Health Soc Care Community 2022; 30:e6601-e6612. [PMID: 36426419 PMCID: PMC10100139 DOI: 10.1111/hsc.14109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/05/2022] [Accepted: 10/01/2022] [Indexed: 06/03/2023]
Abstract
Domiciliary care workers (DCWs) continued to provide care to adults in their own homes throughout the COVID-19 pandemic. The evidence of the impact of COVID-19 on health outcomes of DCWs is currently mixed. The OSCAR study will quantify the impact of COVID-19 upon health outcomes of DCWs in Wales, explore causes of variation and extrapolate to the rest of the UK DCW population. An embedded qualitative study aimed to explore DCW experiences during the pandemic, including factors that may have varied risk of exposure to COVID-19 and adverse health and wellbeing outcomes. Registered DCWs working throughout Wales were invited to participate in a semi-structured telephone interview. 24 DCWs were interviewed between February and July 2021. Themes were identified through inductive analysis using thematic coding. Several themes emerged relating to risk of exposure to COVID-19. First, general changes to the role of the DCW during the pandemic were identified. Second, practical challenges for DCWs in the workplace were reported, including staff shortages, clients and families not following safety procedures, initial shortages of personal protective equipment (PPE), DCW criticism of standard use PPE, client difficulty with PPE and management of rapid antigen testing. Third, lack of government/employer preparation for a pandemic was described, including the reorganisation of staff clients and services, inadequate or confusing information for many DCWs, COVID-19 training and the need for improved practical instruction and limited official standard risk assessments for DCWs. Pressure to attend work and perceptions of COVID-19 risk and vaccination was also reported. In summary, this paper describes the risk factors associated with working during the pandemic. We have mapped recommendations for each problem using these qualitative findings including tailored training and better support for isolated team members and identified the required changes at several socio-ecological levels.
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Affiliation(s)
- Hayley Prout
- Centre for Trials Research, Heath Park CampusCardiff UniversityCardiffUK
| | | | | | | | - Ashley Akbari
- Population Data Science, Health Data Research UK (HDR UK)Swansea UniversitySwanseaUK
- Population Data Science, Administrative Data Research WalesSwansea UniversitySwanseaUK
| | - Ann John
- Population Data Science, Health Data Research UK (HDR UK)Swansea UniversitySwanseaUK
- Population Data Science, Administrative Data Research WalesSwansea UniversitySwanseaUK
| | - Daniel Rh. Thomas
- Public Health Wales, Communicable Disease Surveillance CentreCardiffUK
- Cardiff Metropolitan University School of Health SciencesCardiffUK
| | - Michael Robling
- Centre for Trials Research, Heath Park CampusCardiff UniversityCardiffUK
- DECIPHer – Centre for Development, Evaluation, Complexity and Implementation in Public Health ImprovementCardiff UniversityCardiffUK
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Sinyor M, Zaheer R, Webb RT, Knipe D, Eyles E, Higgins JP, McGuinness L, Schmidt L, Macleod-Hall C, Dekel D, Gunnell D, John A. SARS-CoV-2 Infection and the Risk of Suicidal and Self-Harm Thoughts and Behaviour: A Systematic Review. Can J Psychiatry 2022; 67:812-827. [PMID: 35532916 PMCID: PMC9096003 DOI: 10.1177/07067437221094552] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has had a complex impact on risks of suicide and non-fatal self-harm worldwide with some evidence of increased risk in specific populations including women, young people, and people from ethnic minority backgrounds. This review aims to systematically address whether SARS-CoV-2 infection and/or COVID-19 disease confer elevated risk directly. METHOD As part of a larger Living Systematic Review examining self-harm and suicide during the pandemic, automated daily searches using a broad list of keywords were performed on a comprehensive set of databases with data from relevant articles published between January 1, 2020 and July 18, 2021. Eligibility criteria for our present review included studies investigating suicide and/or self-harm in people infected with SARS-CoV-2 with or without manifestations of COVID-19 disease with a comparator group who did not have infection or disease. Suicidal and self-harm thoughts and behaviour (STBs) were outcomes of interest. Studies were excluded if they reported data for people who only had potential infection/disease without a confirmed exposure, clinical/molecular diagnosis or self-report of a positive SARS-CoV-2 test result. Studies of news reports, treatment studies, and ecological studies examining rates of both SARS-CoV-2 infections and suicide/self-harm rates across a region were also excluded. RESULTS We identified 12 studies examining STBs in nine distinct samples of people with SARS-CoV-2. These studies, which investigated STBs in the general population and in subpopulations, including healthcare workers, generally found positive associations between SARS-CoV-2 infection and/or COVID-19 disease and subsequent suicidal/self-harm thoughts and suicidal/self-harm behaviour. CONCLUSIONS This review identified some evidence that infection with SARS-CoV-2 and/or COVID-19 disease may be associated with increased risks for suicidal and self-harm thoughts and behaviours but a causal link cannot be inferred. Further research with longer follow-up periods is required to confirm these findings and to establish whether these associations are causal.
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Affiliation(s)
- Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre,
Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Rabia Zaheer
- Department of Psychiatry, Sunnybrook Health Sciences Centre,
Toronto, Canada
- Department of Education Services, Centre for Addiction and Mental
Health, Toronto, Canada
| | - Roger T. Webb
- Division of Psychology and Mental Health, University of Manchester,
Manchester, UK
- National Institute for Health Research Greater Manchester Patient
Safety Translational Research Centre, Manchester, UK
| | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily Eyles
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute of Health and Care Research Applied Research
Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation
Trust, Bristol, UK
| | - Julian P.T. Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute of Health and Care Research Applied Research
Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation
Trust, Bristol, UK
- The National Institute of Health and Care Research Biomedical
Research Centre, University Hospitals Bristol NHS Foundation Trust and the
University of Bristol, Bristol, UK
| | - Luke McGuinness
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lena Schmidt
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Sciome LLC, Research Triangle Park, NC, USA
| | | | - Dana Dekel
- Population Data Science, Swansea University, Swansea, UK
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute of Health and Care Research Biomedical
Research Centre, University Hospitals Bristol NHS Foundation Trust and the
University of Bristol, Bristol, UK
| | - Ann John
- Population Data Science, Swansea University, Swansea, UK
- Public Health Wales NHS Trust, Wales, UK
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Bernard A, Salhi L, de Ossorno Garcia S, John A, Del Pozo-Baños M. Engagement of individuals aged 14-25 years with a digital mental health service during the COVID-19 pandemic in the UK: a cohort study of service usage data. Lancet 2022; 400 Suppl 1:S20. [PMID: 36929963 PMCID: PMC9691046 DOI: 10.1016/s0140-6736(22)02230-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Public use of digital mental health technologies has informed several studies focusing on patterns of engagement within user-led digital support systems. General engagement with these services has increased since the start of the COVID-19 pandemic. However, to the best of our knowledge, this is the first study to explore how user engagement patterns with these platforms changed during the pandemic. METHODS In this cohort study, we included individuals aged 14-25 years who signed up to the online mental health platform Kooth in the UK before the pandemic (May 1, 2019 to March 10, 2020) and during the pandemic (March 11, 2020 to Oct 31, 2021). Routinely collected usage data were assessed for consenting users who returned to Kooth at least once after sign-up. We used logistic regression to compare service component usage and overall engagement across cohorts. FINDINGS 5048 individuals (mean sign-ups per day 9·0 [12·0]) were included in the pre-pandemic cohort and 13 841 (mean sign-ups per day 11·5 [13·9]) in the pandemic cohort, representing a significant increase in sign-ups per day during the pandemic compared with the pre-pandemic period (Welch's t-test p=0·0001). Compared with users pre-pandemic, users during the pandemic were less likely to have a drop-in chat with a practitioner (odds ratio [OR] 0·50 [95% CI 0·47-0·54], p<0·0001) but were more likely to journal (1·92 [1·77-2·07], p<0·0001) and comment on existing content (1·10 [1·03-1·18], p=0·008). Users who signed up to Kooth during the pandemic and requested a chat with a practitioner (7816 [56·5%] of 13 841 users) were also less likely to receive a chat than users who requested a chat pre-pandemic (3791 [75·1%] of 5048 users; OR 0·68 [0·63-0·74], p<0·0001). INTERPRETATION During the COVID-19 pandemic, people with the ability and resources to access digital mental health support were diverted from face-to-face services to digital mental health services. This change might have resulted in an unmet need for drop-in practitioner chats, with users probably resorting to asynchronous support through community interaction or journaling. FUNDING Kooth Digital Health.
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Affiliation(s)
| | | | | | - Ann John
- Swansea University Medical School, Swansea University, Swansea, UK
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John A, Pirkis J, Gunnell D, Spittal M, Del Pozo Banos M, Arya V, Shin S. Suicide Trends during the COVID-19 pandemic and the International COVID-19 Suicide Prevention Research Collaboration. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
There was and still is much speculation about the COVID-19 pandemic impact on suicide rates. We aimed to assess the effect of the COVID-19 pandemic on suicide rates around the world.
Methods
We sourced real-time suicide data from countries or countries areas through a systematic internet search (official websites of Ministries of health, police agencies, and government-run statistics agencies or equivalents), recourse to our networks (e.g. ICSPRC) and the published literature (a living systematic review). We used an interrupted time-series analysis to model the trend in monthly suicides before COVID-19 in each country or country area, comparing the expected number of suicides derived from the model with the observed number of suicides in the early months of the pandemic (from April 1 to July 31, 2020, in the primary analysis). We have now updated this work to cover the first 15 months of the pandemic and stratified analyses by age and sex and method. We will present findings from the new updated data (35 countries) at the conference.
Results
Initially we sourced data from 21 countries (16 high-income and five upper-middle-income countries). Rate ratios (RRs) and 95% CIs based on the observed versus expected numbers of suicides showed no evidence of a significant increase in risk of suicide since the pandemic began in any country or area. There was statistical evidence of a decrease in suicide compared with the expected number in 12 countries or areas.
Conclusions
This was the first study to examine suicides occurring in the context of the COVID-19 pandemic in multiple countries. Early on high-income and upper-middle-income countries, suicide numbers remained largely unchanged or declined compared with the expected levels based on the pre-pandemic period. We need to remain vigilant and be poised to respond as the longer-term mental health and economic effects of the pandemic unfold. We will present updated findings with more recent data.
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Affiliation(s)
- A John
- Swansea University Medical School, Swansea University , Swansea, UK
| | - J Pirkis
- Centre for Mental Health, University of Melbourne , Melbourne, Australia
| | - D Gunnell
- National Institute for Health and Care Research Bristol Biomedical Research Centre, University of Bristol , Bristol, UK
| | - M Spittal
- Centre for Mental Health, University of Melbourne , Melbourne, Australia
| | - M Del Pozo Banos
- Swansea University Medical School, Swansea University , Swansea, UK
| | - V Arya
- Centre for Mental Health, University of Melbourne , Melbourne, Australia
| | - S Shin
- Centre for Mental Health, University of Melbourne , Melbourne, Australia
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Van Bortel T, Lombardo C, Guo L, Solomon S, Martin S, Hughes K, Weeks L, Crepaz-Keay D, McDaid S, Chantler O, Thorpe L, Morton A, Davidson G, John A, Kousoulis AA. The mental health experiences of ethnic minorities in the UK during the Coronavirus pandemic: A qualitative exploration. Front Public Health 2022; 10:875198. [PMID: 36276403 PMCID: PMC9582845 DOI: 10.3389/fpubh.2022.875198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 08/15/2022] [Indexed: 12/04/2022] Open
Abstract
Background Worldwide, the Coronavirus pandemic has had a major impact on people's health, lives, and livelihoods. However, this impact has not been felt equally across various population groups. People from ethnic minority backgrounds in the UK have been more adversely affected by the pandemic, especially in terms of their physical health. Their mental health, on the other hand, has received less attention. This study aimed to explore the mental health experiences of UK adults from ethnic minorities during the Coronavirus pandemic. This work forms part of our wider long-term UK population study "Mental Health in the Pandemic." Methods We conducted an exploratory qualitative study with people from ethnic minority communities across the UK. A series of in-depth interviews were conducted with 15 women, 14 men and 1 non-binary person from ethnic minority backgrounds, aged between 18 and 65 years old (mean age = 40). We utilized purposefully selected maximum variation sampling in order to capture as wide a variety of views, perceptions and experiences as possible. Inclusion criteria: adults (18+) from ethnic minorities across the UK; able to provide full consent to participate; able to participate in a video- or phone-call interview. All interviews took place via MS Teams or Zoom. The gathered data were transcribed verbatim and underwent thematic analysis following Braun and Clarke carried out using NVivo 12 software. Results The qualitative data analysis yielded seven overarching themes: (1) pandemic-specific mental health and wellbeing experiences; (2) issues relating to the media; (3) coping mechanisms; (4) worries around and attitudes toward vaccination; (5) suggestions for support in moving forward; (6) best and worst experiences during pandemic and lockdowns; (7) biggest areas of change in personal life. Generally, participants' mental health experiences varied with some not being affected by the pandemic in a way related to their ethnicity, some sharing positive experiences and coping strategies (exercising more, spending more time with family, community cohesion), and some expressing negative experiences (eating or drinking more, feeling more isolated, or even racism and abuse, especially toward Asian communities). Concerns were raised around trust issues in relation to the media, the inadequate representation of ethnic minorities, and the spread of fake news especially on social media. Attitudes toward vaccinations varied too, with some people more willing to have the vaccine than others. Conclusion This study's findings highlight the diversity in the pandemic mental health experiences of ethnic minorities in the UK and has implications for policy, practice and further research. To enable moving forward beyond the pandemic, our study surfaced the need for culturally appropriate mental health support, financial support (as a key mental health determinant), accurate media representation, and clear communication messaging from the Governments of the UK.
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Affiliation(s)
- Tine Van Bortel
- Faculty of Health and Life Sciences, Leicester School of Allied Health Sciences, Gateway House, De Montfort University, Leicester, United Kingdom,Cambridge Public Health, Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom,*Correspondence: Tine Van Bortel ;
| | - Chiara Lombardo
- Cambridge Public Health, Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom,Mental Health Foundation, London, United Kingdom
| | - Lijia Guo
- Cambridge Public Health, Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom,Department of Sociology, School of Humanities and Social Sciences, University of Cambridge, Cambridge, United Kingdom
| | | | - Steven Martin
- Faculty of Health and Life Sciences, Leicester School of Allied Health Sciences, Gateway House, De Montfort University, Leicester, United Kingdom
| | - Kate Hughes
- Mental Health Foundation, London, United Kingdom
| | - Lauren Weeks
- Mental Health Foundation, London, United Kingdom
| | | | - Shari McDaid
- Mental Health Foundation, London, United Kingdom
| | | | - Lucy Thorpe
- Mental Health Foundation, London, United Kingdom
| | - Alec Morton
- Department of Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, United Kingdom
| | - Gavin Davidson
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, United Kingdom
| | - Ann John
- Health Data Research UK, Swansea University Medical School, Swansea, United Kingdom
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40
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Steeg S, John A, Gunnell DJ, Kapur N, Dekel D, Schmidt L, Knipe D, Arensman E, Hawton K, Higgins JPT, Eyles E, Macleod-Hall C, McGuiness LA, Webb RT. The impact of the COVID-19 pandemic on presentations to health services following self-harm: systematic review. Br J Psychiatry 2022; 221:603-612. [PMID: 35816104 DOI: 10.1192/bjp.2022.79] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Evidence on the impact of the pandemic on healthcare presentations for self-harm has accumulated rapidly. However, existing reviews do not include studies published beyond 2020. AIMS To systematically review evidence on presentations to health services following self-harm during the COVID-19 pandemic. METHOD A comprehensive search of databases (WHO COVID-19 database; Medline; medRxiv; Scopus; PsyRxiv; SocArXiv; bioRxiv; COVID-19 Open Research Dataset, PubMed) was conducted. Studies published from 1 January 2020 to 7 September 2021 were included. Study quality was assessed with a critical appraisal tool. RESULTS Fifty-one studies were included: 57% (29/51) were rated as 'low' quality, 31% (16/51) as 'moderate' and 12% (6/51) as 'high-moderate'. Most evidence (84%, 43/51) was from high-income countries. A total of 47% (24/51) of studies reported reductions in presentation frequency, including all six rated as high-moderate quality, which reported reductions of 17-56%. Settings treating higher lethality self-harm were overrepresented among studies reporting increased demand. Two of the three higher-quality studies including study observation months from 2021 reported reductions in self-harm presentations. Evidence from 2021 suggests increased numbers of presentations among adolescents, particularly girls. CONCLUSIONS Sustained reductions in numbers of self-harm presentations were seen into the first half of 2021, although this evidence is based on a relatively small number of higher-quality studies. Evidence from low- and middle-income countries is lacking. Increased numbers of presentations among adolescents, particularly girls, into 2021 is concerning. Findings may reflect changes in thresholds for help-seeking, use of alternative sources of support and variable effects of the pandemic across groups.
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Affiliation(s)
- Sarah Steeg
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, UK; and Manchester Academic Health Science Centre, UK
| | - Ann John
- Medical School, Swansea University, UK; and Public Health Wales NHS Trust, UK
| | - David J Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, UK; and National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, UK
| | - Nav Kapur
- Division of Psychology and Mental Health, University of Manchester, UK;NIHR Greater Manchester Patient Safety Translational Research Centre, UK; and Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Dana Dekel
- Department of Population Psychiatry, Suicide and Informatics, Swansea University, UK
| | - Lena Schmidt
- Sciome LLC, North Carolina, USA; Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Ella Arensman
- School of Public Health and National Suicide Research Foundation, University College Cork, Ireland; and Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK; and Warneford Hospital, Oxford Health NHS Foundation Trust, UK
| | - Julian P T Higgins
- National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, UK; National Institute for Health Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, UK; and Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Emily Eyles
- National Institute for Health Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, UK; and Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | | | - Luke A McGuiness
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Roger T Webb
- Division of Psychology and Mental Health, University of Manchester, UK; and NIHR Greater Manchester Patient Safety Translational Research Centre, UK
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Abstract
BACKGROUND Perinatal self-harm is of concern but poorly understood. AIMS To determine if women's risk of self-harm changes in pregnancy and the first postpartum year, and if risk varies by mental illness, age and birth outcome. METHOD This was a retrospective cohort study of 2 666 088 women aged 15-45 years from the 1 January 1990 to 31 December 2017 linked to 1 102 040 pregnancies and their outcomes, utilising the Clinical Practice Research Datalink and Pregnancy Register. We identified self-harm events and mental illness (depression/anxiety/addiction/affective/non-affective psychosis/eating/personality disorders) from clinical records and grouped women's age into 5-year bands. They calculated the rate of self-harm during discrete non-perinatal, pregnant and postpartum periods. We used a gap-time, stratified Cox model to manage multiple self-harm events, and calculated the unadjusted and adjusted hazard ratios (adjHR) of self-harm associated with pregnancy and the postpartum compared with non-perinatal periods. Pre-planned interactions tested if risk varied by mental illness, age and birth outcome. RESULTS The analysis included 57 791 self-harm events and 14 712 319 person-years of follow-up. The risk of self-harm shrank in pregnancy (2.07 v. 4.01 events/1000 person-years, adjHR = 0.53, 95% CI 0.49-0.58) for all women except for 15- to 19-year-olds (adjHR = 0.95, 95% CI 0.84-1.07) and the risk reduced most for women with mental illness (adjHR = 0.40, 95% CI 0.36-0.44). Postpartum, self-harm risk peaked at 6-12 months (adjHR = 1.08, 95% CI 1.02-1.15), at-risk groups included young women and women with a pregnancy loss or termination. CONCLUSIONS Maternity and perinatal mental health services are valuable. Family planning services might have psychological benefit, particularly for young women.
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Affiliation(s)
- Holly Hope
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Matthias Pierce
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Cemre Su Osam
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Catharine Morgan
- Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Ann John
- Swansea University Medical School, Swansea University, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK and Greater Manchester Mental Health NHS Foundation Trust, UK
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Evans BA, Akbari A, Bailey R, Bethell L, Bufton S, Carson-Stevens A, Dixon L, Edwards A, John A, Jolles S, Kingston MR, Lyons J, Lyons R, Porter A, Sewell B, Thornton CA, Watkins A, Whiffen T, Snooks H. Evaluation of the shielding initiative in Wales (EVITE Immunity): protocol for a quasiexperimental study. BMJ Open 2022; 12:e059813. [PMID: 36691218 PMCID: PMC9461087 DOI: 10.1136/bmjopen-2021-059813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/23/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Shielding aimed to protect those predicted to be at highest risk from COVID-19 and was uniquely implemented in the UK during the COVID-19 pandemic. Clinically extremely vulnerable people identified through algorithms and screening of routine National Health Service (NHS) data were individually and strongly advised to stay at home and strictly self-isolate even from others in their household. This study will generate a logic model of the intervention and evaluate the effects and costs of shielding to inform policy development and delivery during future pandemics. METHODS AND ANALYSIS This is a quasiexperimental study undertaken in Wales where records for people who were identified for shielding were already anonymously linked into integrated data systems for public health decision-making. We will: interview policy-makers to understand rationale for shielding advice to inform analysis and interpretation of results; use anonymised individual-level data to select people identified for shielding advice in March 2020 and a matched cohort, from routine electronic health data sources, to compare outcomes; survey a stratified random sample of each group about activities and quality of life at 12 months; use routine and newly collected blood data to assess immunity; interview people who were identified for shielding and their carers and NHS staff who delivered healthcare during shielding, to explore compliance and experiences; collect healthcare resource use data to calculate implementation costs and cost-consequences. Our team includes people who were shielding, who used their experience to help design and deliver this study. ETHICS AND DISSEMINATION The study has received approval from the Newcastle North Tyneside 2 Research Ethics Committee (IRAS 295050). We will disseminate results directly to UK government policy-makers, publish in peer-reviewed journals, present at scientific and policy conferences and share accessible summaries of results online and through public and patient networks.
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Affiliation(s)
- Bridie Angela Evans
- Swansea University Medical School, Swansea, UK
- PRIME Centre Wales, Swansea University Medical School, Swansea, UK
| | | | | | | | - Samantha Bufton
- Knowledge and Analytical Services, Welsh Government, Cardiff, UK
| | | | - Lucy Dixon
- Swansea University Medical School, Swansea, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Ann John
- Swansea University Medical School, Swansea, UK
| | | | - Mark Rhys Kingston
- Swansea University Medical School, Swansea, UK
- PRIME Centre Wales, Swansea University Medical School, Swansea, UK
| | - Jane Lyons
- Swansea University Medical School, Swansea, UK
| | - Ronan Lyons
- Swansea University Medical School, Swansea, UK
| | - Alison Porter
- Swansea University Medical School, Swansea, UK
- PRIME Centre Wales, Swansea University Medical School, Swansea, UK
| | - Bernadette Sewell
- Swansea Centre for Health Economics, Swansea University, Swansea, West Glamorgan, UK
| | | | | | - Tony Whiffen
- Knowledge and Analytical Services, Welsh Government, Cardiff, UK
| | - Helen Snooks
- Swansea University Medical School, Swansea, UK
- PRIME Centre Wales, Swansea University Medical School, Swansea, UK
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Lewis C, Lewis K, Roberts A, Edwards B, Evison C, John A, Meudell A, Parry P, Pearce H, Richards N, Jones I, Bisson JI. Trauma exposure and co-occurring ICD-11 post-traumatic stress disorder and complex post-traumatic stress disorder in adults with lived experience of psychiatric disorder. Acta Psychiatr Scand 2022; 146:258-271. [PMID: 35752949 PMCID: PMC9543812 DOI: 10.1111/acps.13467] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To establish factors associated with ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) in a large sample of adults with lived experience of psychiatric disorder and examine the psychiatric burden associated with the two disorders. METHODS One thousand three hundred and five adults were recruited from the National Centre for Mental Health (NCMH) cohort. ICD-11 PTSD/CPTSD were assessed with the International Trauma Questionnaire (ITQ). Binary logistic regression was used to determine factors associated with both PTSD and CPTSD. One-way between-groups analysis of variance was conducted to examine the burden associated with the two disorders in terms of symptoms of anxiety, depression, and psychological wellbeing. For post-hoc pairwise comparisons, the Tukey HSD test was used, and the magnitude of between-group differences assessed using Cohen's d. RESULTS Probable ICD-11 CPTSD was more common than PTSD within the sample (PTSD 2.68%; CPTSD 12.72%). We found evidence that PTSD was associated with interpersonal trauma and household income under £20,000 a year. CPTSD was also associated with interpersonal trauma, higher rates of personality disorder, and lower rates of bipolar disorder. Those with probable-CPTSD had higher levels of current anxiety and depressive symptoms and lower psychological wellbeing in comparison to those with probable-PTSD and those with neither disorder. CONCLUSIONS CPTSD was more prevalent than PTSD in our sample of people with lived experience of psychiatric disorder. Our findings indicate a need for routine screening for trauma histories and PTSD/CPTSD in clinical settings and a greater focus on the need for interventions to treat CPTSD.
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Affiliation(s)
- Catrin Lewis
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Katie Lewis
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Alice Roberts
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Bethan Edwards
- National Centre for Mental Health, PÂR, Cardiff University School of Medicine, Cardiff, UK
| | - Claudia Evison
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Ann John
- National Centre for Mental Health, Population Data Science, Swansea University Medical School, Swansea, UK
| | - Alan Meudell
- National Centre for Mental Health, PÂR, Cardiff University School of Medicine, Cardiff, UK
| | - Patrick Parry
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Holly Pearce
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Natalie Richards
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Ian Jones
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Jonathan I Bisson
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
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Pirkis J, Gunnell D, Shin S, Del Pozo-Banos M, Arya V, Aguilar PA, Appleby L, Arafat SMY, Arensman E, Ayuso-Mateos JL, Balhara YPS, Bantjes J, Baran A, Behera C, Bertolote J, Borges G, Bray M, Brečić P, Caine E, Calati R, Carli V, Castelpietra G, Chan LF, Chang SS, Colchester D, Coss-Guzmán M, Crompton D, Ćurković M, Dandona R, De Jaegere E, De Leo D, Deisenhammer EA, Dwyer J, Erlangsen A, Faust JS, Fornaro M, Fortune S, Garrett A, Gentile G, Gerstner R, Gilissen R, Gould M, Gupta SK, Hawton K, Holz F, Kamenshchikov I, Kapur N, Kasal A, Khan M, Kirtley OJ, Knipe D, Kõlves K, Kölzer SC, Krivda H, Leske S, Madeddu F, Marshall A, Memon A, Mittendorfer-Rutz E, Nestadt P, Neznanov N, Niederkrotenthaler T, Nielsen E, Nordentoft M, Oberlerchner H, O'Connor RC, Papsdorf R, Partonen T, Phillips MR, Platt S, Portzky G, Psota G, Qin P, Radeloff D, Reif A, Reif-Leonhard C, Rezaeian M, Román-Vázquez N, Roskar S, Rozanov V, Sara G, Scavacini K, Schneider B, Semenova N, Sinyor M, Tambuzzi S, Townsend E, Ueda M, Wasserman D, Webb RT, Winkler P, Yip PS, Zalsman G, Zoja R, John A, Spittal MJ. Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries. EClinicalMedicine 2022; 51:101573. [PMID: 35935344 PMCID: PMC9344880 DOI: 10.1016/j.eclinm.2022.101573] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. METHODS We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation. FINDINGS We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries' COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries' income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well. INTERPRETATION Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue. FUNDING None.
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Affiliation(s)
- Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Corresponding author at: Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Victoria, 3010, Australia.
| | - David Gunnell
- National Institute of Health and care Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, United Kingdom
| | - Sangsoo Shin
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Vikas Arya
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health, University of Manchester, Manchester, United Kingdom
| | - S. M. Yasir Arafat
- Department of Psychiatry, Enam Medical College and Hospital, Dhaka, Bangladesh
| | - Ella Arensman
- School of Public Health, National Suicide Research Foundation, University College Cork, Cork, Ireland
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Jose Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autonoma de Madrid, Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Yatan Pal Singh Balhara
- National Drug Dependence Treatment Center and Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Jason Bantjes
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Anna Baran
- Working Group on Prevention of Suicide and Depression at Public Health Council, Ministry of Health, Warsaw, Poland
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
- Department of Psychiatry, Blekinge Hospital, Karlshamn, Sweden
| | - Chittaranjan Behera
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi, India
| | - Jose Bertolote
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, Brazil
| | - Guilherme Borges
- Department of Global Mental Health, Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Michael Bray
- Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Petrana Brečić
- Department for Psychiatry, University Psychiatric Hospital Vrapče; School of Medicine University of Zagreb, Zagreb, Croatia
| | - Eric Caine
- University of Rochester Medical Center, Rochester, NY, United States
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
- Department of Psychiatry, Nimes University Hospital, Nimes, France
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Giulio Castelpietra
- Region Friuli Venezia Giulia, Central Health Directorate, Outpatient and Inpatient Care Service, Trieste, Italy
| | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | - Maria Coss-Guzmán
- Puerto Rico Department of Health's Commission on Suicide Prevention, San Juan, Puerto Rico
| | - David Crompton
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Marko Ćurković
- Department for Medical Ethics, University Psychiatric Hospital Vrapče; School of Medicine University of Zagreb, Zagreb, Croatia
| | - Rakhi Dandona
- Public Health Foundation of India, Gurugram, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States
| | - Eva De Jaegere
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium
| | | | - Eberhard A. Deisenhammer
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology; University Hospital for Psychiatry 2, Medical University of Innsbruck, Innsbruck, Austria
| | - Jeremy Dwyer
- Coroners Court of Victoria, Melbourne, Australia
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Copenhagen Research Centre for Mental Health, Copenhagen, Denmark
- Centre for Mental Health Research, Australian National University, Canberra, Australia
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jeremy S. Faust
- Brigham and Women's Hospital Department of Emergency Medicine, Harvard Medical School, Boston, United States
| | - Michele Fornaro
- Department of Psychiatry, Neuroscience Institute, Federico II University of Naples, Naples, Italy
| | - Sarah Fortune
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Andrew Garrett
- Coronial Division, Tasmanian Magistrates Court, Hobart, Australia
| | - Guendalina Gentile
- Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Rebekka Gerstner
- Undersecretary of Health Services, Ministry of Public Health, Quito, Ecuador
- Monitoring and Evaluation, German Institute for Medical Mission, Tübingen, Germany
| | - Renske Gilissen
- 113 Suicide Prevention, Research Department, Amsterdam, the Netherlands
| | - Madelyn Gould
- Departments of Psychiatry and Epidemiology, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY, United States
| | - Sudhir Kumar Gupta
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi, India
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Franziska Holz
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Iurii Kamenshchikov
- Udmurtia Republican Clinical Psychiatric Hospital, Izhevsk, Russian Federation
| | - Navneet Kapur
- Centre for Mental Health and Safety and National Institute for Health Research (NIHR) Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Alexandr Kasal
- National Institute of Mental Health, Klecany, Czechia
- Faculty of Social Sciences, Charles University, Prague, Czechia
| | - Murad Khan
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan
| | | | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Sarah C. Kölzer
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Hryhorii Krivda
- Department of Forensic Medicine, Odessa National Medical University, Odessa, Ukraine
| | - Stuart Leske
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Fabio Madeddu
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Andrew Marshall
- Brigham and Women's Hospital, Harvard Medical School, MA, United States
| | - Anjum Memon
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Paul Nestadt
- Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nikolay Neznanov
- Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russian Federation
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
| | - Thomas Niederkrotenthaler
- Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Emma Nielsen
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Herwig Oberlerchner
- Department of Psychiatry and Psychotherapy; Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Rory C. O'Connor
- Suicidal Behaviour Research Lab, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Rainer Papsdorf
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany
| | - Timo Partonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Michael R. Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Departments of Psychiatry and Epidemiology, Columbia University, New York, United States
| | - Steve Platt
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Gwendolyn Portzky
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Georg Psota
- Psychosocial Services in Vienna, Vienna, Austria
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Daniel Radeloff
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany
| | - Christine Reif-Leonhard
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany
| | - Mohsen Rezaeian
- Department of Epidemiology and Biostatistics, Occupational Environment Research Center, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Nayda Román-Vázquez
- Puerto Rico Department of Health's Commission on Suicide Prevention, San Juan, Puerto Rico
| | - Saska Roskar
- National Institute of Public Health, Ljubljana, Slovenia
| | - Vsevolod Rozanov
- Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russian Federation
- Saint Petersburg State University, Saint Petersburg, Russian Federation
| | - Grant Sara
- System Information and Analytics Branch, NSW Ministry of Health, Sydney, Australia
| | | | - Barbara Schneider
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany
- LVR Klinik Köln, Department of Addictive Disorders, Psychiatry and Psychotherapy, Cologne, Germany
| | - Natalia Semenova
- Organizational-Scientific Department, Bekhterev National Medical Research Center of Psychiatry and Neurology, Saint Petersburg, Russian Federation
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Stefano Tambuzzi
- Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Michiko Ueda
- Waseda University, Faculty of Political Science and Economics, Tokyo, Japan
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Roger T. Webb
- Centre for Mental Health and Safety and National Institute for Health Research (NIHR) Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| | - Petr Winkler
- National Institute of Mental Health, Klecany, Czechia
| | - Paul S.F. Yip
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Gil Zalsman
- Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Riccardo Zoja
- Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Ann John
- Swansea University Medical School, Swansea, United Kingdom
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Johnson R, North L, Alrouh B, John A, Jones K, Akbari A, Smart J, Thompson S, Hargreaves C, Doebler S, Cusworth L, Broadhurst K, Ford D, Griffiths L. A population-level study into health vulnerabilities of mothers and fathers involved in public law care proceedings in Wales, UK. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.2003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
ObjectivesUnder section 31 (s.31) of the UK Children Act 1989, public law care proceedings can be issued if there is concern a child is subject to, or at risk of significant harm. We examined health vulnerabilities of parents involved in public law care proceedings in the two-year period prior to involvement.
ApproachOur study created an anonymised individual-level population-based cohort, with a matched comparison group of parents in Wales who were not subject to care proceedings, matched on age, sex and deprivation. Family court data provided by Cafcass Cymru were linked to population-level healthcare records held within the Secure Anonymised Information Linkage (SAIL) Databank. Demographic characteristics, overall health service use and health profiles of parents of children subject to s.31 care proceedings between 2011 and 2019 were examined.
ResultsData were available for 8,821 parents involved in care proceedings between 2011 and 2019, with a comparison group of 32,006 parents. Nearly half (47.6%) of cohort parents resided in the most deprived quintile. Higher levels of healthcare use were found for cohort mothers and fathers compared to the comparison group across multiple healthcare settings, with the most pronounced differences for emergency department attendances (59.3% vs 37.0%). Health conditions with the largest variation between groups were related to mental health (43.6% vs 16.0%), substance use (19.4% vs 1.6%) and injuries (41.5% vs 23.6%).
ConclusionThis study highlights the heightened socioeconomic and health vulnerabilities of parents who experience care proceedings concerning a child. Better understanding of the needs and vulnerabilities of this population may provide opportunities to improve a range of support and preventative interventions that respond to crises in the community.
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Mizen A, Rafferty J, Lowthian E, Bailey R, John A, Fry R, Griffiths L. Associations between viewable greenspace and adolescent wellbeing in Wales. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.1979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
ObjectivesMental wellbeing can deteriorate throughout adolescence; females and children from low-income families more likely to experience mental health conditions. Views of greenspace from home positively impact cognition, but links with wellbeing has not been explored in children. We linked environment and survey data for 14 year olds in Wales, UK.
ApproachOur cross-sectional study examined the relationship between views of greenspace and wellbeing for >1000 children aged 14 years living in Wales between 2015-2016. We linked data on views of greenspace from the home location with individual-level wellbeing and socio-demographic data in the SAIL Databank; a secure research environment. Our health outcome was derived from self-reported wellbeing measures in the Millennium Cohort Study. Views of greenspace were derived from LiDAR data and quantified on a continuous scale (0-1). We used Generalised Additive Models to investigate associations between views of greenspace and wellbeing; adjusting for factors such as parent wellbeing and deprivation.
ResultsHomes in coastal areas had larger views of greenspace than non-coastal residences. Individuals living in the most deprived areas had smaller views of greenspace (mean = 0.03) than least deprived (mean = 0.12). Overall, individuals living in detached homes had the greatest views of greenspace (0.4) and flats had the poorest views of greenspace (mean = 0.02). We will report our final regression analyses at the conference investigating the association between views of greenspace and adolescent wellbeing. Our models will be fully adjusted and sub-analyses will be stratified by gender and urban/rural status. We will also report findings on whether deprivation mediates for any relationships.
ConclusionOur study is the first to link objectively measured views of greenspace with wellbeing data for a national cohort. Our results can be used to develop interventions to support good wellbeing in adolescents. Further longitudinal research is required to investigate the causal pathways between views of greenspace and adolescent wellbeing.
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Cusworth L, Hargreaves C, Alrouh B, Broadhurst K, Griffiths L, Akbari A, John A, Johnson R. Adults in private family law proceedings in Wales: characteristics and vulnerabilities. Int J Popul Data Sci 2022. [PMCID: PMC9644910 DOI: 10.23889/ijpds.v7i3.1910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Savinc J, Dougall N, Maxwell M, Karatzias T, O'Connor R, Williams B, John A, Cheyne H, Fyvie C, Bisson J, Hibberd C, Abbott-Smith S, Nolan L. Childhood adversity, mental health and suicide (CHASE): a longitudinal case-control linked data study of lifetime inpatient records associated with suicide. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.1878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
ObjectivesChildhood adversity (CA) carries an increased risk of developing later mental health (MH) problems and suicidal behaviour. This study aimed to summarise lifetime hospital attendances for CA and MH in young people who later died by suicide.
ApproachThis study is a retrospective longitudinal case control study. Lifetime Scottish inpatient acute and psychiatric records were linked to death records and summarised for individuals born since 1981 who died by suicide in the period 1991-2017 (cases), and controls (1:10) matched on sex, age, and postcode. Relevant records were coded MH (including self-harm) and/or CA. Descriptive statistics and odds ratios (OR) were computed.
ResultsData for 2,477 and 24,777 ‘cases’ and ‘controls’ were extracted, of whom 2,106 cases (85%) and 13,589 controls (55%) had lifespan hospital records. Mean age at death for cases was 23.7 (SD=4.9) and 75.9% were male. Psychiatric records represented 11.6% and 1.4% of records for cases and controls, respectively.
For the age range 10-18, Maltreatment & violence-related codes were recorded for 160 (7.6%) cases and 371 (2.7%) controls, corresponding to OR=2.9 (95%CI: 2.4-3.6). This was compared with MH at 458 (21.7%) cases and 560 (4.1%) controls and OR=6.5 (95%CI: 5.7-7.4). The highest adjusted ORs were for self-harm episodes recorded in general hospital with aORmale=6.56 (95%CI: 4.96-8.68) and aORfemale=6.87 (95%CI: 4.99-9.48).
ConclusionAll CA and MH presentations in inpatient hospital records were associated with greater risk of subsequent suicide, with the strongest association for self-harm.
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Maria Manuel Vianny D, John A, Kumar Mohan S, Sarlan A, Adimoolam, Ahmadian A. Water optimization technique for precision irrigation system using IoT and machine learning. Sustainable Energy Technologies and Assessments 2022; 52:102307. [DOI: 10.1016/j.seta.2022.102307] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
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Abstract
LAY ABSTRACT Autism spectrum disorders (autism) are thought to be relatively common, with analyses estimating 1% in the population could meet diagnostic criteria. New services for adult diagnosis have been set up in Wales, UK; however, no studies have examined for the proportion of adults with autism in Wales. In this study, we take anonymised healthcare record data from more than 3.6 million people to produce a national estimate of recorded autism diagnoses. We found the overall prevalence rate of autism in healthcare records was 0.51%. The number of new-recorded cases of autism increased from 0.188 per 1000 person-years in 2001 to 0.644 per 1000 person-years in 2016. The estimate of 0.51% prevalence in the population is lower than suggested by population survey and cohort studies, but comparable to other administrative records. From 2001 to 2016, the number of autism services for adults has increased, and autism is more widely known in society, while concurrently in healthcare records, there was a >150% increase autism diagnoses in the years 2008-2016. An increasing number of diagnoses were among women and those aged over 35 years. This study suggests that while the number of people being diagnosed with autism is increasing, many are still unrecognised by healthcare services.
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