Suchergebnisse

ABSTRACT
ObjectivesWe have conducted a feasibility study linking clinically rich survey data to routine data to create a platform for psychosis research in Wales: K Lloyd et al (2015), A national population-based e-cohort of people with psychosis (PsyCymru) linking prospectively ascertained phenotypically rich and genetic data to routinely collected records: overview, recruitment and linkage, Schizophrenia Research. Now we expand upon this through the linkage of large clinically rich cohorts with a range of mental health diagnoses along with genetic data to conduct validation exercises, develop novel methodologies, assess genetic and environment interactions and outcomes and address hypothesis-driven research questions.
ApproachThrough collaborations between the Farr Institute, Cardiff University based MRC centre for Neuropsychiatric Genetics and Genomics and the National Centre for Mental Health (NCMH) clinically rich data and genetic (CNVs, SNPs & polygenic scores) data from around 6000+ participants recruited from a variety of mental health research studies including 'PsyCymru', 'Genetic susceptibility to cognitive deficits study and NCMH amongst others will be loaded and linked to the datasets within SAIL. The analysis plan would firstly include validation exercises to compare the data between sources. Methodologies would be developed using this data to determine illness onset, relapse, chronicity, severity and response to treatment applied to large population-based mental health e-cohorts.
ResultsBy pooling together health service data, genetic variants, environmental and lifestyle factors, phenotypic and endo-phenotypic (cognitive scores) along with the ability to ascertain temporal relationships afforded by the longitudinal perspective available in SAIL we may be able to evaluate potential risk factors, assess the complex GxE interactions that lead to disease progression, and assess outcomes such as prognosis, remission, relapse and premature mortality. The on-going routine updates provide us with the opportunity to follow-up these individuals across multiple health care settings in a cost effective and in-obtrusive manner and to carry out health services utilization/benefit and treatment surveillance in a naturalistic setting. This resource will continue to expand over the coming years in size, breadth and depth of data, with continued recruitment and additional measures planned.
ConclusionTo advance mental health research by developing our understanding of the causes, course and outcomes of mental illness that may lead to the development of better diagnostic classification, predictive, preventative strategies and therapeutic approaches.

Looked after children (LAC) continue to be one of the most vulnerable groups in society with numbers and rates in care increasing year-on-year. The aim of this study was to explore the unique perspectives, perceptions and opinions of experienced social workers on the little explored subject of neurodevelopmental disorders (NDDs) in this population. Using purposeful sampling, 10 social work professionals with extensive experience of working with these children were interviewed using a semi-structured interview. A thematic analysis using NVivo software was utilised to analyse, code and identify themes that contributed to the aims of the study. Four overarching themes and sub-themes emerged from the findings: perceptions of NDDs, perceptions of diagnosis, access to service provision and the impact on care settings. Attention deficit hyperactivity disorder, autism spectrum disorder, dyslexia and dyspraxia were the more prominent conditions discussed. Even though these children are embedded in service provision, the findings raise important questions for both health and social care policy. There is a pressing need for research from a nationwide context to further explore areas of prevalence, training, resources, access to relevant specialist support services and the impacts on the already vulnerable LAC with an NDD.

BACKGROUND: Looked after children (LAC) that are placed in either a foster, kinship, residential care setting or transition to adoption continue to develop debilitating disorders that significantly impact their overall health and social well-being. The prevalence of these disorders is often depicted under broad categories such as mental, behavioural or neurodevelopmental disorders (NDDs). Limited in research is the prevalence of what specific disorders fall under these broad categories. NDDs such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) which fall under an umbrella group in the expert field of genetics and neuropsychiatry will be explored. Unsupported, these disorders can lead to suboptimal health and social outcomes for both the child and family. In the general population, the prevalence of these NDDs and impacts on health and social well-being are relatively well documented, but for minority groups such as LAC, research is extremely limited. This review aims to estimate the prevalence of NDDs among LAC and explore how they might impact the health and social well-being of these vulnerable children. If feasible, the review will compare the prevalence rates to those children who are not looked after, to illuminate any differences or similarities between populations. METHODS: PubMed, ASSIA, IBSS, Web of Science, PsychINFO, Scopus, Psych articles, Social Care Online, secondary, grey literature and government publications will be searched to identify any eligible studies. No restrictions will be placed on country, design or year of publication. Studies must provide primary data on the prevalence or incidence of NDDs for individuals < 25 years of age, supported by either a diagnostic code, standardised diagnostic assessment tool or survey response. The Joanna Briggs Institute (JBI) critical appraisal tools will be utilised to assess the quality and bias and the random-effects model used to estimate a pooled prevalence of NDDs. DISCUSSION: Attaining an estimated ...

IntroductionCommon mental health disorders (CMD) are significant contributors to impaired health and well-being, and drive greater health resource utilisation. Electronic health records (EHR) are increasingly used for case identification of CMD when ascertaining social determinants of mental health. We seek to compare self-reported well-being indicators in groups identified using EHR-based CMD methods.
Objectives and ApproachThe National Survey for Wales (NSW) contains self-reported well-being indicators (Warwick Edinburgh Mental Well-being Scale, WEMWBS) recorded annually on ~7,000 individuals. We combined data from two NSWs and linked well-being indicators with Welsh Longitudinal General Practice (WLGP) data within the Secure Anonymised Information Linkage (SAIL) Databank, using individual response dates. We then used WGLP data to algorithmically derive identifiers of CMD cases within survey respondents. This individual-level linkage enables a comparison of NSW responses in CMD and non-CMD cases, and to assess sensitivity and specificity of the current CMD algorithm.
ResultsSurvey participants comprised 18,450 adults aged 16+ and living in Wales during 16/17 or 18/19. WEMWBS responses indicate 2,338 (12.6%) participants could be considered possibly depressed, and 2,268 (12.3%) probably depressed with low mental well-being (LMW). For participants with LMW, a 42/58 percentage split is observed between male/female respondents, compared to a 45/55 respective split of those not identified with LMW. Participants with LMW recorded low measures for overall satisfaction with life, 998 (44%) reported a value of 5 or less (/10) compared to 1123 (7%) participants not identified with LMW. Similarly, 828 (37%) participants identified with LMW reported 5 or less (/10) on the life worthwhile index, compared to 800 (5%) of non-LMW participants.
Conclusion / ImplicationsLinkage to the NSW provides a rich data source to compare objective well-being to algorithmically derived CMD cases from routinely collected primary care data. The individual-level linkage involved will allow for the wider determinants of mental health disorders to be examined.

BackgroundUnderstanding how non-clinical patient factors (NCpF) such as gender, educational level and socioeconomic status impact clinical decisions regarding one's mental health is important for appropriate and equitable care.
Main AimThis research aims to i) investigate the feasibility of using administrative health data to investigate clinical decision making in mental health; ii) understand the impact of NCpF on mental health-related diagnosis, treatment, and referral decisions.
Methods/ApproachThree waves of the Welsh Health Survey, containing a five-item Mental Health Inventory (Short- Form SF36), and NCpF information were used to create our interest cohort.
The records with a low SF36, a 'gold standard' identifier of common mental health conditions, were then linked to the healthcare records datasets (Primary Care GP Dataset, Patient Episode Database for Wales, Emergency Department Dataset, Outpatient Referral Dataset, Annual District Death Extract) securely stored on the Secure Anonymised Information Linkage Databank.
ResultsWe will present the methodological challenges and benefits of using administrative data the study of decision making in mental health.
The differences in NCpF between those with a low SF36 and a mental health diagnosis, symptoms and treatment as well as those with a similar SF36 score but no diagnosis, symptoms or treatment recorded will be presented and discussed.
ConclusionAdministrative data can provide a unique opportunity to investigate issues related with clinical decision-making in mental health and improve health equity. Having a better understanding of the influence of NCpF on mental health decisions is necessary to prevent inequity in mental health care.

IntroductionThe World Health Organization recognizes suicide as a public health priority. Recent studies have focused on health care contacts for those who complete suicide to highlight opportunities for intervention. In Wales, electronic health records (EHR) are routinely collected, providing an invaluable opportunity for researching suicide risk factors.
Objectives and ApproachWe aim at linking primary and secondary EHRs to identify suicide risk factors for those between 10 and 24 years of age. We linked 7 different demographic and health datasets from the Secure Anonymised Information Linkage Databank UK, and identified a total of 471 cases between 2001 and 2015, 10 matched controls of same gender and age (±1 year), as well as cases' and controls' mothers. We measured a number of factors from primary and secondary care including self-harm, mental health issues and drugs and alcohol misuse. We used conditional logistic regression to conduct our analyses.
ResultsPreliminary results suggest that environmental factors extracted from cohabitants and mothers have a statistically significant effect even after adjusting for deprivation. Self-harm, possible maltreatment and alcohol and drugs misuse seem to be strongest factors of those studied. Factors related to mental health have smaller and more complex effects when adjusting for deprivation.
Conclusion/ImplicationsOur preliminary analysis indicate that EHR can be linked to study the effect of the environment on suicide risk. Once completed, we hope this study will help to identify other suicide risk factors, improve our knowledge of the mechanisms underlying suicide and help to identify opportunities for intervention and improve care.

Background: The 2020 Coronavirus pandemic is a major international public health challenge. Governments have taken public health protection measures to reduce the spread of the virus through non-pharmalogical measures. The impact of the pandemic and the public health response on individual and population mental health is unknown. Methods: We used Google Trends data (1 Jan 2020 - 30 Mar 2020) to investigate the impact of the pandemic and government measures to curb it on people's concerns, as indexed by changes in search frequency for topics indicating mental distress, social and economic stressors and mental health treatment-seeking. We explored the changes of key topics in Google trends in Italy, Spain, USA, UK, and Worldwide in relation to sentinel events during the pandemic. Results: Globally there appears to be significant concerns over the financial and work-related consequences of the pandemic, with some evidence that levels of fear are rising. Conversely relative searching for topics related to depression and suicide fell after the pandemic was announced, with some evidence that searches for the latter have risen recently. Concerns over education and access to medication appear to be particular social stressors. Whilst searches for face-to-face treatments have declined, those for self-care have risen. Conclusions: Monitoring Google trends shows promise as a means of tracking changing public concerns. In weeks to come it may enable policy makers to assess the impact of their interventions including those aiming to limit negative consequences, such as government funded financial safety nets.

ABSTRACT
ObjectivesRates of common mental disorders may be increasing among children and adolescents, though evidence of this is mixed. Symptom questionnaires in population surveys may overestimate clinical disease. Conversely, lower participation of individuals with mental disorders may lead to underestimates in surveys. Clinical databases may have greater population coverage and contain information of more obvious clinical validity; however, several factors, including the help-seeking behaviour of individuals and the recording practices of clinicians, may influence burden-of-disease estimates based on these databases. The aim of the current investigation was to compare case definitions of common mental disorders (CMD) using linked electronic primary care data to definitions derived from self-reported data obtained in an observational study.
ApproachWe studied 1,562 adolescents who had completed the Revised Clinical Interview Schedule (CIS-R) in the Avon Longitudinal Study of Parents and Children (ALSPAC) at age 17-18 years and had linkage established to their electronic primary care records for at least 6 months after the time they completed the CIS-R. We used lists of Read codes corresponding to diagnoses, symptoms and treatment to create twelve definitions of CMD and also of depression alone. We calculated sensitivities and specificities of these, using CIS-R case definitions as the reference standard. All analyses were carried in Stata 13.0.
ResultsSensitivities ranged from 5.2% to 24.3% for depression and from 3.8% to 19.2% for CMD. The specificities of all definitions were above 98% for depression and above 96% for CMD. For both depression and CMD, the definition that included current diagnosis, treatment or symptoms identified the highest proportion of cases.
ConclusionsMost individuals meeting case definitions for CMD based on information in clinical records also met CMD case definitions based on symptoms reported in a contemporaneous survey. Conversely, many individuals identified as CMD cases based on reported symptoms had no evidence of CMD in their clinical records. A small number of individuals with CMD recorded in their clinical records had not reported symptoms of this in the survey. Overall, these data suggest that clinical databases are likely to yield underestimates of the burden of CMD in the population. Clinical records appear to yield highly valid diagnoses of common mental disorders which may be useful for studying risk factors and outcomes of these conditions. The greatest epidemiological value is likely to be obtained when the combination of information from both survey and clinical records is possible.

ABSTRACT
ObjectivesTo use routinely collected datasets and data linkage to identify patterns of healthcare utilisation by children and young people (CYP) with adolescent mental health (AMH) disorders across the four UK Nations, with a particular focus on self-harm, anxiety and depression and eating disorders. The analysis will focus on healthcare utilisation during transition from child to adult services and, where possible, on the interface between different care settings e.g. primary and secondary care and health and social care.
In addition we will determine the extent to which routinely collected datasets can contribute to an assessment of the health needs and the quality of care that CYP with AMH disorders receive.
ApproachData has been requested from the national data providers in each country:

The Health and Social Care Information Centre - England
The Secure Anonymised Information Linkage (SAIL) databank - Wales
Information Services Division – Scotland
The Honest Broker Service- Northern Ireland

As well as other sources:

The Clinical Practice Research Datalink
The Paediatric Intensive Care Audit Network.

A number of restrictions and information governance regulations have had to be negotiated and put in place in order to access and store the data in the SAIL Databank, Swansea University. Descriptive cross sectional analysis is underway to address the key questions.
RationalThe project has arisen from the report 'Overview of Child Deaths in Four UK Countries' which found that 30-40% of 13-18 year olds were affected by mental health, learning difficulties or behavioural conditions. The diagnosis, management and services available for mental disorders in CYP are of growing concern and a source of controversy in the UK. Transitional care between child and adult services and the interface between primary and secondary/ specialist services, as well as, that between the NHS and other sectors is often disjointed. Thresholds for referral to Child and Adolescent Mental Health Services (CAMHS) are high and many adolescents are treated, at least initially, in primary health care systems.
ImplicationsAnalysis of routinely collected health datasets has the potential to describe the nature and extent of health needs and health care utilisation for CYP with AMH disorders (self-harm, depression/anxiety, eating disorders). Furthermore the knowledge obtained from using routinely collected healthcare data, will inform future routine data collection across the UK for CYP with AMH disorders.

Abstract
Air pollution (AP) is a significant environmental risk to human health. Historically, the impact of AP exposure has focused upon the physical health effects, yet the implications of AP on mental health have received limited attention. Despite this, recent research has highlighted emerging evidence supporting a possible aetiological link. The purpose of this study, therefore, was to investigate the potential consequences of AP upon mental health and well-being. In a PRISMA based systematic review multiple databases were searched from January 2012 to 2022 for peer-reviewed, English-language, human based primary research. Of the 2,224 studies identified in the literature search, 94 met the inclusion criteria. The mental health and wellbeing issues explored were psychosis, anxiety, suicide, mania, overall diagnosed conditions, and self-reported wellbeing symptoms. Depression was omitted due to the volume of attention the condition has received in the literature. Key air pollutants, particulate matter (PM10 and PM2.5), sulphur oxides (SOx), carbon monoxide (CO) and nitrogen oxides (NOx) were investigated. Data revealed a positive association between psychotic disorders and NOx exposure in ten studies with only one contradictory finding. Whereas the other conditions received multiple contradictory findings. To compare these results to real-life situations, currently a pilot study is exploring associations between psychotic disorder diagnoses and AP, specifically NOx, in Wales using the Secure Anonymised Information Linkage (SAIL) database. There is a large body of evidence showing associations between mental health and AP. However, due to research complexities and some contradictory findings more high-quality research is required to elucidate these relationships.

IntroductionThe diagnosis, management and services available for mental disorders are of growing concern and controversy in the UK. Transitional care between child and adult services and the interface between primary and secondary/ specialist services is often disjointed and thresholds for referral to Child and Adolescent Mental Health Services are high.
Objectives and ApproachRoutinely collected healthcare datasets and data linkage were used to identify patterns of healthcare utilisation by young people and young adults with mental health disorders across the four UK Nations. We explored the extent to which routinely collected datasets can contribute to an assessment of the health needs and the quality of care that children and young people with mental health disorders receive.
Data was requested from the national data providers in each country. A series of descriptive analyses were performed and methods were developed for cross- national comparisons to be made (e.g. Four Nation Person Spell).
ResultsIt is feasible to explore healthcare utilisation across the four countries of the UK using routine data. However the recording, availability and access varied considerably between countries, making meaningful comparisons challenging.
Descriptive analyses showed strong deprivation gradients in the diagnoses and care provided for young people and young adults with mental health disorders. Depression and anxiety were the most commonly recorded mental health conditions in primary care. In secondary care drug/alcohol disorders and self-harm were the most commonly recorded. Re-admissions to emergency departments were higher for those admitted for self-harm or psychiatric conditions.
Conclusion/ImplicationsRoutine data has the potential to make a difference to care. However collection and access needs to be standardised in order to improve efficiency and effectiveness in improving the care for children and young people with mental health disorders. MQ has funded an Adolescent Data Platform to facilitate this.

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.

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.

ABSTRACTObjectivesIn Wales suicide accounts for 20% of deaths among men aged 15-24 years and almost 10% of deaths among women of that age. Up to 2% of suicides in young people are thought to occur in clusters. Yet, our understanding of the social and psychological determinants of suicide clusters is limited, with none of the cross-discipline theories proposed having been tested via in-depth research on an actual cluster. This HCRW funded mixed methods study had qualitative and quantitative data linkage work packages to explore here the factors that trigger a suicide cluster, cause it to continue and then eventually subside.
ApproachThe data of 1866 individuals' who attended the Princes of Wales Hospital emergency department (ED) with self harm between 1st January 2006 and 31st December 2013 was anonymously linked within the Secure Anonymised Information Linkage (SAIL) databank. We had a matching rate of 99.7. We performed both time-trend analysis on this data around the apparant suicide cluster in 2007-08, and a comparison across three defined populations: those attending ED at the time of the cluster; those attending during the same period, one year before; and those attending one year after.
ResultsWe are able to present the characteristics of those who attend ED during a cluster with self harm compared to those who attend at other times and their long term outcomes.
ConclusionTo inform the development of appropriate policy to respond to suicide clusters at an early stage.

ABSTRACTObjectivesTo examine the characteristics of children who are prescribed antipsychotic medication.
ApproachA cohort study using routine data from general practitioner and hospital records linked with education records. All children in Wales between the years 1999 to 2014 were included in the analysis, demographic characteristics and outcomes of children were stratified by intellectual disability/autism (identified using education records and GP records) and antipsychotic use. All data were linked and held in the Secure Anonymised Information Linkage (SAIL) Databank in Wales
ResultsOf children with intellectual disability 2.4 % (360/14428) have been prescribed an antipsychotic and 75 % of these have a diagnosis of autism. This compares with 0.19% (1126/602320) of children without intellectual disability who are prescribed an antipsychotic. Children, predominantly boys (78.1% (281/360) of those with intellectual disability prescribed an antipsychotic were boys compared to 67.12% (9442/14068) of those not prescribed antipsychotics), with aggression codes (17.5% of those on an antipsychotic had aggression codes compared to 1.36% of those without antipsychotic) were more likely to be prescribed antipsychotics. Those with intellectual disabilities were prescribed antipsychotics at a younger age (58 % of those with intellectual disability started the drug before the age of 14 compared to 29 % of those without intellectual disability) but were less likely to be from a deprived area compared to those prescribed antipsychotics but without intellectual disability/autism (22.5 % and 28.4 %, were in the lowest fifth of deprivation, intellectual disability and non- intellectual disability, respectively). Antipsychotic use was associated with more visits to the GP for epilepsy, diabetes and injury (post drug compared to prior to drug) and higher deaths in childhood (compared to those not give antipsychotics).
ConclusionsThe linkage of the education records allowed intellectual disability to be used as an explanatory factor in analysis looking at drug prescriptions. The majority of children prescribed antipsychotics do not have psychotic or mental disorder diagnosis codes but have a diagnosis of behavioural problems, attend special schools and have intellectual difficulties. In the group with intellectual disability/autism there is evidence that the use of antipsychotics may be associated with more visits to the GP for epilepsy, diabetes, injury (post drug compared to prior to drug) and is associated with more deaths in childhood. These findings support concerns that antipsychotics may be over used for managing predominately behavioural problems.