Exploring the potential of online self-reported and routinely collected electronic healthcare record data in self-harm research

Background:Self-harm is a major public health concern and is a leading cause of death from injury. Reaching participants for self-harm research raises a number of challenges, however an opportunity exists in the use of both the internet for data collection and in the use of routinely collected healthcare data.Aims and objectives:The aim of this project was to explore the potential of both online and routinely collected healthcare data for self-harm research and the way in which these data sources can be brought together.Methods:This thesis represents a series of projects exploring the use of various data sources for self-harm research. The first was the development and piloting of an online platform (SHARE UK) for self-harm research. This website incorporated multiple functions: hosting questionnaires; sign-up for a research register; sign-up for linkage with routinely collected data and uploads to a media databank. Next a national survey was conducted to explore young people’s perspectives on the use of both online and healthcare data for self-harm research. Lastly a population level electronic health record cohort study analysing trends over time and contacts across healthcare services was conducted.Results:Participants engaged well with research online: 498 participants signed up to the SHARE UK platform; of whom 85% signed up for the research register. Sixty-two participants uploaded 95 items to the media databank. Alternative formats are discussed. Only 15% of participants consented for linkage with healthcare data. A total of 2,733 young people aged 10-24 who self-harm completed the national survey. Results demonstrated that the necessity for participants to give their address for linkage poses a significant barrier. Opinions around the use of Big Data, encompassing social media, marketing and health data are explored.A total of 937,697 individuals aged 10-24 provided 5,269,794 person years of data from 01.01.2003 to 20.09.2015 to the electronic health record cohort study. Self-harm incidence was highest in primary care. Males preferentially present to emergency departments. Male are less likely than females to be admitted following attendance. This difference persists in the youngest age groups and for self-poisoning. Analysis supports the importance of non-specialist services.Conclusions:This thesis has explored both online and routinely collected healthcare data and their utility for self-harm research, exploring participant views and issues via a national survey. An online platform for self-harm research was successfully piloted and issues identified. This series of projects explores possibilities for future self-harm research. The use of multiple data sources allows research to represent both those in the community and those presenting to healthcare settings, lowering many of the barriers to participating in self-harm research. The future utility of the SHARE UK platform through its collaboration with the Adolescent Mental Health Data Platform (ADP) is discussed. Results of this series of projects will be used to inform the development of this platform with lessons learnt from the pilot addressed and findings from both the national survey and the electronic health record cohort study informing and shaping future research

Has the COVID-19 pandemic influenced suicide rates differentially according to socioeconomic indices and ethnicity? More evidence is needed globally

The COVID-19 pandemic has harmed many people's mental health globally. Whilst the evidence generated thus far from high-income countries regarding the pandemic's impact on suicide rates is generally reassuring, we know little about its influence on this outcome in lower- and middle-income countries or among marginalised and disadvantaged people. There are some signals for concern regarding the pandemic's potentially unequal impact on suicide rates, with some of the affected demographic subgroups and regions being at elevated risk before the pandemic began. However, the evidence-base for this topic is currently sparse, and studies conducted to date have generally not taken account of pre-pandemic temporal trends. The collection of accurate, complete and comparable data on suicide rate trends in ethnic minority and low-income groups should be prioritised. The vulnerability of low-income groups will likely be exacerbated further by the current energy supply and cost-of-living crises in many countries. It is therefore crucial that reassuring messaging highlighting the stability of suicide rates during the pandemic does not lead to complacency among policymakers

Understanding suicide clusters through exploring self-harm: Semi-structured interviews with individuals presenting with near-fatal self-harm during a suicide cluster

There was a highly publicised cluster of at least ten suicides in South Wales, United Kingdom, in 2007–2008. We carried out a qualitative descriptive study using cross-case thematic analysis to investigate the experiences and narratives of eight individuals who lived in the area where the cluster occurred and who survived an episode of near-fatal self-harm at the time of the cluster. Interviews were conducted from 01.01.2015 to 31.12.2015. All interviewees denied that the other deaths in the area had affected their own suicidal behaviour. However, in other sections of the interviews they spoke about the cluster contributing to difficulties they were experiencing at the time, including damage to social relationships, feelings of loss and being out of control. When asked about support, the interviewees emphasized the importance of counselling, which they would have found helpful but in most cases did not receive, even in the case of close contacts of individuals who had died. The findings suggest that effective prevention messaging must be subtle, since those affected may not be explicitly aware of or acknowledge the imitative aspects of their behaviour. This could be related to stigma attached to suicidal behaviour in a cluster context. Lessons for prevention include changing the message from asking if people ‘have been affected by’ the suicide deaths to emphasising the preventability of suicide, and directly reaching out to individuals rather than relying on people to come forward

A Content Analysis and Comparison of Two Peaks of Newspaper Reporting During a Suicide Cluster to Examine Implications for Imitation, Suggestion, and Prevention

Background: During 2007–2008, media attention focused on a cluster of youth suicides in the UK. There were two peaks (P1, P2) in the volume of newspaper reporting of the deaths. The number of possible suicides was greater than expected at the time of the first peak but not at the time of the second. Aims: To explore any differences in the content of the reporting peaks and to consider implications for imitation and prevention. Method: A content analysis of two peaks of newspaper reporting was conducted. Results: There were 204 articles in P1 (December 27, 2007 to February 19, 2008) and 157 in P2 (February 20, 2008 to March 15, 2008). Four main themes were identified: individual stories; possible causes; features of reporting of the cluster; and educating and informing the public. P1 articles more frequently contained: explicit details of method; photographs of the deceased, and contained more characterization of individuals. Limitations: The focus was on print media, future studies should incorporate online and social media content. Conclusion: The findings provide some support for the hypothesis of a process of suggestion initiated by sensationalist reporting in P1. This contributes to the evidence base of the role of the press in suicide imitation and prevention, highlighting the importance of care when reporting suicides