Education as a Predictor of Antidepressant and Anxiolytic medication use after Bereavement: a population based record linkage study.

Purpose: Educational attainment has been shown to be positively associated with mental health and a potential buffer to stressful events. One stressful life event likely to affect everyone in their lifetime is bereavement. This paper assesses the effect of educational attainment on mental health post-bereavement. Methods: By utilising large administrative datasets, linking Census returns to death records and prescribed medication data, we analysed the bereavement exposure of 208,332 individuals aged 25–74 years. Two-level multi-level logistic regression models were constructed to determine the likelihood of antidepressant medication use (a proxy of mental ill health) post-bereavement given level of educational attainment. Results: Individuals who are bereaved have greater antidepressant use than those who are not bereaved, with over a quarter (26.5 %) of those bereaved by suicide in receipt of antidepressant medication compared to just 12.4 % of those not bereaved. Within individuals bereaved by a sudden death, those with a university degree or higher qualifications are 73 % less likely to be in receipt of antidepressant medication compared to those with no qualifications, after full adjustment for demographic, socio-economic and area factors (OR 0.27, 95 % CI 0.09,0.75). Higher educational attainment and no qualifications have an equivalent effect for those bereaved by suicide. Conclusions: Education may protect against poor mental health, as measured by the use of antidepressant medication, post-bereavement, except in those bereaved by suicide. This is likely due to the improved cognitive, personal and psychological skills gained from time spent in education

Impact of the COVID-19 pandemic on commencement of psychotropic medications in Northern Ireland: a population-wide, administrative data linkage study.

Objectives This study aimed to explore changes in commencement of psychotropic medications in first 20 months of the pandemic and associated restrictions in Northern Ireland (NI). Approach Antidepressant, anxiolytic, hypnotic and antipsychotic medications dispensed in all community pharmacies in NI (Jan-2012 to Oct-2021, Enhanced Prescribing Database) were linked to sociodemographic data (National Health Application and Infrastructure Services) for everyone alive and resident in NI aged ≥10years. Commencement of new medication was identified on a rolling monthly basis as a dispensation in a given month but not in the previous 24 months. Auto Regressive Integrated Moving Average (ARIMA) models were trained taking trends and seasonal effects into consideration. Monthly forecasts were compared to actual numbers, at population level and within sociodemographic groups (gender, age, rurality, living-alone, deprivation). Results There were consistent increased numbers of individuals commencing antipsychotic medications in the group aged ≥65years, with observed to expected ratio ranging from 1.12 to 2.1.  Commencement of hypnotics was decreased throughout the study in individuals aged <18years (OER ranged from 0.28 to 0.70) but remained as expected for other sociodemographic groups.  Across all sociodemographic groups, commencement of antidepressants decreased initially (Mar-May 2020 population-level OER ranged from 0.61 to 0.79) and in Jan 2021 (population-level OER 0.78) corresponding with stricter stay at home restrictions but resumed the expected trend outside of these periods.  There were no obvious deviations from expected trends in commencement of anxiolytics. Conclusion There was a clear impact on older people with regards commencement of antipsychotic medications throughout the pandemic. Hypnotic commencement in children was lower than expected throughout the pandemic, which may reflect reduced need or reduced access to specialist paediatric services. (NHS-REC:20/YH/0254; Data sourced from the Honest Broker Service

Childhood contact with social services and self-harm and suicidal ideation in young adulthood: A population-wide cohort study in Northern Ireland

Objectives Childhood contact with social services is associated with adult suicide risk, but little is known about self-harm and suicidal ideation, which are recognised predictors of suicide. This study compares self-harm (SH) and suicidal ideation (SI) in young adults with childhood history of social services contact to unexposed peers. Method A longitudinal, population-wide study of all children born 1985-1993 in Northern Ireland (NI) linking primary care registrations to social services data (1985-2015) and a national registry capturing all SH and SI presentations to the 12 Emergency Departments in NI (2012-2015). Multilevel logistic regression models estimated the association between level of contact with social services in childhood (no contact; referred but assessed as not in need (NIN); child in need (CIN); and child in care (CIC)) and SH, SI and any SH/SI, accounting for confounders and the amount of variation attributable to clustering by Health and Social Care Trust. Results The cohort comprised 253,495 individuals (ages 18-30 years) alive and registered with a general practitioner during follow-up. Of the cohort, 4,026 presented with SH and 1,669 with SI. Individuals with a childhood history of social services contact comprised 10.8% of the cohort (2.9% NIN; 6.5% CIN; and 1.4% CIC) yet accounted for 40.9% of SH/SI cases. Likelihood of SH, SI, and any SH/SI increased stepwise with level of contact with social services. After full adjustment, young adults deemed NIN in childhood were three times more likely to present with SH/SI (OR 3.45 [95% CI 3.07-3.88]), former CIN five times more likely (OR 5.33 [95% CI 4.97-5.74]), and former CIC ten times more likely (OR 10.49 [95% CI 9.45-11.66]), relative to those with no contact. Conclusion Adults with a childhood history of social services contact, including those assessed as not in need, account for a disproportionate number of self-harm and suicidal ideation cases. Timely and targeted interventions aimed at this population have the potential to reduce the burden of self-harm and suicid

Are volunteering and caregiving associated with suicide risk? A Census-based longitudinal study

Background: Opposing risks have been identified between different prosocial activities, with volunteering having been linked to better mental health while caregiving has been associated with higher prevalence and incidence of depression. This study explored suicide risk of people engaged in prosocial activities of caregiving and/or volunteering. Methods: A Census-based record linkage study of 1,018,000 people aged 25–74 years (130,816 caregivers; 110,467 volunteers; and 42,099 engaged in both) was undertaken. Caregiving (light: 1–19; intense: ≥20 h/week), volunteering and mental health status were derived from 2011 Census records. Suicide risk (45 months follow-up) was assessed using Cox models adjusted for baseline mental health. Results: Intense caregiving was associated with worse mental health (ORadj = 1.15: 95%CI = 1.12, 1.18) and volunteering with better mental health (OR = 0.87: 95%CI = 0.84, 0.89). For those engaged in both activities, likelihood of poor mental health was determined by caregiving level. There were 528 suicides during follow-up, with those engaged in both activities having the lowest risk of suicide (HR = 0.34: 95%CI = 0.14, 0.84). Engaging in either volunteering or caregiving was associated with lower suicide risk for those with good mental health at baseline (HR = 0.66: 95%CI = 0.49, 0.88) but not for their peers with baseline poor mental health (HR = 1.02: 95%CI = 0.69, 1.51). Conclusions: Although an increased risk of poor mental health was identified amongst caregivers, there was no evidence of an increased risk of suicide

Parental mental health and risk of poor mental health and death by suicide in offspring

Background Suicide is a major public health concern. Identifying those most at risk is vital for effective targeting of interventions. Mental health (MH) has a genetic component and parental MH is associated with child’s MH. However, little is known on the effect of parental MH on a child’s risk of death by suicide. Methods Data from 2011 Northern Ireland Census was linked to 5 years’ death records (2011-2015) to construct multi-level regression models to determine if children living with parents with poor self-rated MH are at an increased risk of poor MH themselves and an increased risk of death by suicide. Results 618,970 individuals live with their parents; with almost 1 in 7 (13.7%) living with parents with poor MH and 225 (0.1%) dying by suicide during follow-up. Interim results suggest after full adjustment, children with 2 parents with poor MH were 5 times more likely to have poor MH themselves (OR=5.30, 95% CI 4.62,6.09), and children with 1 parent with poor MH were 67% more likely to die by suicide compared to children of parents with good MH (OR=1.67, 95%CI 1.19, 2.33). Conclusions Parental MH is associated with child suicide risk even after adjustment for their own MH status

Data-driven research with historically excluded groups: Towards a model for co-production and democratisation

Objectives It is widely recognised that involving “experts by experience” from historically excluded groups (e.g. those with experience of care) is necessary to maximise research impact, ensure mutual benefit, and is central to the democratisation of data for research. We aim to develop a model of co-production in data-driven research. Method Public engagement in research generally, and data-driven research specifically, has increased significantly in the last decade. However, the co-production of data-driven research with the people behind the data is still rare. This pilot project was designed and delivered in partnership between Administrative Data Research Centre Northern Ireland (ADRC NI), Voice of Young People in Care (VOYPIC) and a group of care experienced young people. Through a range of methods (including meetings, a series of workshops and an internship for a care experienced young person at ADRC NI) we explored and tested opportunities for the co-production of research. Results Led by the group of care experienced young people, we identified a range of entry points for the co-production of data-driven research. While some stages of the research process remained challenging for those with lived experience to penetrate, most notably the analysis of quantitative data in a secure environment, other stages of the research process were meaningfully co-produced. These include the prioritisation of research topics, the development of research questions, the interpretation of findings and the creation of lay language dissemination materials. Formal evaluation of the pilot is pending, but early benefits for all project partners include the development of new skills and knowledge, re-focused research priorities, and more accessible research outputs. Conclusion Co-production of data-driven research with experts by experience is feasible and necessary for the democratisation of data. It delivers tangible benefits which amplify the positive impact of data-driven research. This session will share innovative practice, key learnings, and practical guidance for the co-production of data research with historically excluded groups

Are disability-related social security benefits modified by demographic, social and area-level factors?

Background In the UK Disability Living Allowance (DLA) provides non means-tested contribution towards the disability-related costs of living for disabled people. Although eligibility is based on mobility/personal care needs, other factors may be important. Methodology Three 2011 census-based measures of self-reported health (number of chronic disabilities; activity limitation (a little; a lot); and chronic poor mental health) were linked to 2011 DLA records for people aged <65. Census returns provided individual demographic, socio-economic, social and area-level characteristics. Overall, 92.5% of DLA records were matched to 1.4 million Census records. Interim Results Analyses confirms health as the main determinant of DLA Claims uptake, but that for a given level of health uptake was: higher amongst non-married and those of lower socioeconomic status ( OR 1.76; (95%CI 1.68, 1.84) most deprived vs. least deprived), lower amongst ethnic minorities (OR 0.87 (95%CIs 0.78, 0.97) non-white vs. white), migrants (OR 0.37; (95%CI 0.34, 0.39) migrants vs. non migrants) and slightly lower in rural communities (OR 0.95; (95%CI 0.93, 0.97) rural vs. urban). Conclusions Poor health is the predominant determinant of disability benefits but other social and socioeconomic factors are influential. Results of these analyses might assist in enabling resources to be targeted appropriately

Which best predicts suicides in Northern Ireland - self-rated mental health or medication record? (Abstract)

Background Over 800,000 suicides occur annually worldwide, and approximately 300 suicides in Northern Ireland (NI) each year. Studies from elsewhere have highlighted the role of mental health in the risk of death by suicide, but such studies are scarce in NI. Objectives This project seeks to: (1) examine the association between mental health and death by suicide during 2011–2015, and (2) assess if self-rated mental health, medication record, or both better predict risk of death by suicide. Methods De-identified information will be drawn from 2011 Census on NI’s 1.8 million residents, linked to the Business Service Organisation’s Health Card Registration data, the Enhanced Prescribing Database (EPD) and death registrations. Subjects’ mental health will be ascertained through single-item self-rated mental health question from the Census and/or record of psychotropic medication in the EPD. Data captures over 1,100 suicides over 5 years (main causes of death defined as ICD- 10 codes X60–X84, Y10–Y34, Y87). Cox proportional hazard models will be used to examine the association between mental health and death by suicide (adjusting for age, gender, comorbid physical disorders, socio-economic status). The performance of prediction models of death by suicide, including self-rated mental health or prescribed medication record or both, will be compared. Data are with the Administrative Data Research Centre – NI, with data analysis underway. Findings This study will yield information beneficial for policy-making regarding suicide prevention and identifying “at risk” groups. Understanding which measures of mental health (self-rated versus medication record) best predict risk of death by suicide could be used to inform future studies on suicide risk and to identify groups for targeted interventions