Suicide in post agreement Northern Ireland: A Study of the Role of Paramilitary Intimidation 2007-2009

Since the end of the ‘Troubles’ in Northern Ireland, there has been a rise in the number of acts of intimidation and Paramilitary Punishment Attacks (PPA). Anecdotally, some suicides have been linked to such incidents. To date, there has been a lack of research examining this association. This article details a case series study exploring how individual deaths by suicide in Northern Ireland were connected to intimidation. Data from Coroners, GP records and interviews with family members were examined to identify experiences of intimidation among a two-year cohort who died by suicide. Further case based analysis was conducted using a modified version of the psychological autopsy method. Our results indicate that in 19 male suicides there were incidents of intimidation in the twelve months prior to death. The suicides of these men are discussed in relation to the suicide model of entrapment. Our findings highlight the continuing problem of intimidation in Northern Ireland and suggest further research into the connection between these incidents and suicide is warranted

Does Place Matter When Understanding Loneliness and Social Isolation?

Physical distancing and restriction of movements as measures to prevent the spread of Covid-19 required people to change their work, home and social lives. Loneliness and social isolation have emerged as key public health issues during the pandemic. Traditionally when considering loneliness the focus is often on individual factors rather than within the context of structural and environmental dimensions. This paper will utilise data from the Coping with Loneliness, Isolation and Covid-19 global online survey which had over 20, 000 global responses from people aged 18+ in 2020. Analysis will use the lens of ‘place’ and the 5-item UCLA scale and 6-item Lubben social network scale to understand the social and demographic characteristics and structural and environmental factors associated with those experiencing loneliness and/or social isolation in rural and urban areas both before and during the pandemic. The paper will conclude with key messages from a public health perspective

When health services are powerless to prevent suicide: results from a linkage study of suicide among men with no service contact in the year prior to death

Aims: To investigate cases of suicide in which there was no healthcare contact, by looking at history of help-seeking and evidence of previous mental health vulnerability. To identify any life events associated with suicide for which individuals did not seek help. Background: Previous research has suggested that non-consultation is the main barrier to suicide prevention among men. Estimates suggest approximately 22% of men who die by suicide have not consulted their GP in the year before their death. Little is known about the lifetime pattern of engagement with services among these individuals and whether or not this may influence their help-seeking behaviour before death. Methods: Coroner records of suicide deaths in Northern Ireland over 2 years were linked to general practice (GP) records. This identified 63 individuals who had not attended health services in the 12 months before death. Coroner’s data were used to categorise life events associated with the male deaths. Lifetime mental health help-seeking at the GP was assessed. Findings: The vast majority of individuals who did not seek help were males (n=60, 15% of all suicide deaths). Lack of consultation in the year before suicide was consistent with behaviour over the lifespan; over two-thirds had no previous consultations for mental health. In Coroner’s records, suicides with no prior consultation were primarily linked to relationship breakdown and job loss. These findings highlight the limitations of primary care in suicide prevention as most had never attended GP for mental health issues and there was a high rate of supported consultation among those who had previously sought help. Public health campaigns that promote service use among vulnerable groups at times of crisis might usefully be targeted at those likely to be experiencing financial and relationship issues

Social-determinants of self-reported multi-morbidity among adults in Northern Ireland: a census-based administrative data study

Background A combination of increased life expectancy and improvements in childhood survival rates has resulted in a persistent increase in the population at risk of chronic conditions and multimorbidity (WHO, 2016). Relatively little is known about levels of multi-morbidity, combinations of multi-morbid disorders or risk factors among the Northern Ireland (NI) population. Objectives This study aims to estimate rates of multi-morbidity among adults aged 25 and over in the NI population and examine the association of multi-morbidity and combinations of multimorbid conditions with a range of social determinants. Methods Analyses are based on 1,123,604 individuals enumerated in the 2011 NI census, aged 25-64 and 65 plus. Descriptive statistics report prevalence rates and logistic regression examined the association between social determinants and multi-morbidity. Results Overall, 40.08% reported at least one health condition, while 19.23% reported multi-morbidity. Results confirm a clear social gradient and association between age and multi-morbidity. Multi-morbidity was more likely among females aged 25- 64 (OR=1.09), but less likely among females aged 65 plus (OR=0.93). Marriage was protective among those aged 25- 64, while those who were never married had lower risk among those aged 65 plus (OR=0.64). Further analyses exploring social determinants of morbidity profiles present a complex array of associations. Among 25-64 year olds, while females were more likely to report single mental and less likely to report single physical problems, they were less likely to report multiple mental conditions and more likely to report combined physical/mental conditions. Conclusions Results suggest that multi-morbidity is common among the NI adult population and is a public health issue across the lifespan. While studies assessing the validity of self-reported health conditions within census are required, findings provide tentative evidence of the complex nature of associations between social determinants and multi-morbidity and how these vary among younger and older adults