A Multilingual Digital Mental Health and Well-Being Chatbot (ChatPal): Pre-Post Multicenter Intervention Study.

BACKGROUND: In recent years, advances in technology have led to an influx of mental health apps, in particular the development of mental health and well-being chatbots, which have already shown promise in terms of their efficacy, availability, and accessibility. The ChatPal chatbot was developed to promote positive mental well-being among citizens living in rural areas. ChatPal is a multilingual chatbot, available in English, Scottish Gaelic, Swedish, and Finnish, containing psychoeducational content and exercises such as mindfulness and breathing, mood logging, gratitude, and thought diaries. OBJECTIVE: The primary objective of this study is to evaluate a multilingual mental health and well-being chatbot (ChatPal) to establish if it has an effect on mental well-being. Secondary objectives include investigating the characteristics of individuals that showed improvements in well-being along with those with worsening well-being and applying thematic analysis to user feedback. METHODS: A pre-post intervention study was conducted where participants were recruited to use the intervention (ChatPal) for a 12-week period. Recruitment took place across 5 regions: Northern Ireland, Scotland, the Republic of Ireland, Sweden, and Finland. Outcome measures included the Short Warwick-Edinburgh Mental Well-Being Scale, the World Health Organization-Five Well-Being Index, and the Satisfaction with Life Scale, which were evaluated at baseline, midpoint, and end point. Written feedback was collected from participants and subjected to qualitative analysis to identify themes. RESULTS: A total of 348 people were recruited to the study (n=254, 73% female; n=94, 27% male) aged between 18 and 73 (mean 30) years. The well-being scores of participants improved from baseline to midpoint and from baseline to end point; however, improvement in scores was not statistically significant on the Short Warwick-Edinburgh Mental Well-Being Scale (P=.42), the World Health Organization-Five Well-Being Index (P=.52), or the Satisfaction With Life Scale (P=.81). Individuals that had improved well-being scores (n=16) interacted more with the chatbot and were significantly younger compared to those whose well-being declined over the study (P=.03). Three themes were identified from user feedback, including "positive experiences," "mixed or neutral experiences," and "negative experiences." Positive experiences included enjoying exercises provided by the chatbot, while most of the mixed, neutral, or negative experiences mentioned liking the chatbot overall, but there were some barriers, such as technical or performance errors, that needed to be overcome. CONCLUSIONS: Marginal improvements in mental well-being were seen in those who used ChatPal, albeit nonsignificant. We propose that the chatbot could be used along with other service offerings to complement different digital or face-to-face services, although further research should be carried out to confirm the effectiveness of this approach. Nonetheless, this paper highlights the need for blended service offerings in mental health care.

A Mental Health and Well-Being Chatbot: User Event Log Analysis.

BACKGROUND: Conversational user interfaces, or chatbots, are becoming more popular in the realm of digital health and well-being. While many studies focus on measuring the cause or effect of a digital intervention on people's health and well-being (outcomes), there is a need to understand how users really engage and use a digital intervention in the real world. OBJECTIVE: In this study, we examine the user logs of a mental well-being chatbot called ChatPal, which is based on the concept of positive psychology. The aim of this research is to analyze the log data from the chatbot to provide insight into usage patterns, the different types of users using clustering, and associations between the usage of the app's features. METHODS: Log data from ChatPal was analyzed to explore usage. A number of user characteristics including user tenure, unique days, mood logs recorded, conversations accessed, and total number of interactions were used with k-means clustering to identify user archetypes. Association rule mining was used to explore links between conversations. RESULTS: ChatPal log data revealed 579 individuals older than 18 years used the app with most users being female (n=387, 67%). User interactions peaked around breakfast, lunchtime, and early evening. Clustering revealed 3 groups including "abandoning users" (n=473), "sporadic users" (n=93), and "frequent transient users" (n=13). Each cluster had distinct usage characteristics, and the features were significantly different (P<.001) across each group. While all conversations within the chatbot were accessed at least once by users, the "treat yourself like a friend" conversation was the most popular, which was accessed by 29% (n=168) of users. However, only 11.7% (n=68) of users repeated this exercise more than once. Analysis of transitions between conversations revealed strong links between "treat yourself like a friend," "soothing touch," and "thoughts diary" among others. Association rule mining confirmed these 3 conversations as having the strongest linkages and suggested other associations between the co-use of chatbot features. CONCLUSIONS: This study has provided insight into the types of people using the ChatPal chatbot, patterns of use, and associations between the usage of the app's features, which can be used to further develop the app by considering the features most accessed by users.

Digital transformation of mental health services.

This paper makes a case for digital mental health and provides insights into how digital technologies can enhance (but not replace) existing mental health services. We describe digital mental health by presenting a suite of digital technologies (from digital interventions to the application of artificial intelligence). We discuss the benefits of digital mental health, for example, a digital intervention can be an accessible stepping-stone to receiving support. The paper does, however, present less-discussed benefits with new concepts such as 'poly-digital', where many different apps/features (e.g. a sleep app, mood logging app and a mindfulness app, etc.) can each address different factors of wellbeing, perhaps resulting in an aggregation of marginal gains. Another benefit is that digital mental health offers the ability to collect high-resolution real-world client data and provide client monitoring outside of therapy sessions. These data can be collected using digital phenotyping and ecological momentary assessment techniques (i.e. repeated mood or scale measures via an app). This allows digital mental health tools and real-world data to inform therapists and enrich face-to-face sessions. This can be referred to as blended care/adjunctive therapy where service users can engage in 'channel switching' between digital and non-digital (face-to-face) interventions providing a more integrated service. This digital integration can be referred to as a kind of 'digital glue' that helps join up the in-person sessions with the real world. The paper presents the challenges, for example, the majority of mental health apps are maybe of inadequate quality and there is a lack of user retention. There are also ethical challenges, for example, with the perceived 'over-promotion' of screen-time and the perceived reduction in care when replacing humans with 'computers', and the trap of 'technological solutionism' whereby technology can be naively presumed to solve all problems. Finally, we argue for the need to take an evidence-based, systems thinking and co-production approach in the form of stakeholder-centred design when developing digital mental health services based on technologies. The main contribution of this paper is the integration of ideas from many different disciplines as well as the framework for blended care using 'channel switching' to showcase how digital data and technology can enrich physical services. Another contribution is the emergence of 'poly-digital' and a discussion on the challenges of digital mental health, specifically 'digital ethics'.

Experiences of a Community Crisis Intervention Service.

This qualitative study explores the experiences of persons who utilised a community crisis intervention service (CCIS) whilst in emotional distress. An anonymised database provided a quantitative overview of all service users profiles. Interpretive Description was used to analyse interviews from five service users about their experience(s) of the CCIS. Findings from the overall client database are reported in terms of gender, proportion of self-referrals (n = 102 of 187) and proportion requiring no other de-escalation services at that point (n = 117 of 187). Within the qualitative interviews, three themes evolved: (1) a more appropriate setting than the ED, (2) states of suicidal crisis; risk factors and fluctuations and (3) unmet needs. The non-clinical setting and the utility of the intervention in de-escalating states of crisis were valued. Findings are discussed in terms of the delivery of crisis intervention services, with emphasis on early identification and effective management through brief interventions in community settings.

An analysis of the impact of suicide prevention messages and memorials on motorway bridges.

Recently, there has been activity at public locations where people have died by suicide, including the erection of suicide prevention messages and memorials (decorations). This research looks at the impact of these decorations and associated media coverage of the decorations on suicidal behaviour at bridges. Incidents (n = 160) of suicidal behaviour on 26 bridges across motorways in England were analysed. Overall, there was no significant difference in the proportion of incidents pre-decoration versus post-decoration (p-value = .55). The incident rates were not significantly different pre- and post-decoration (p = .46). Only one bridge had statistically significantly more incidents post-decoration and media reporting (p = .03). However, following correction for multiple testing there was no significant difference in pre- and post-incident rates at any of the bridges. In total, 58% of bridges had a greater frequency of incidents when decorations were absent; however, this proportion was not statistically significant (p = .41). Further research is required to establish how suicide prevention messages are perceived. There does not appear to be any benefit, but it often generates media coverage which has been shown to increase risk.

Behavior of Callers to a Crisis Helpline Before and During the COVID-19 Pandemic: Quantitative Data Analysis.

BACKGROUND: The World Health Organization declared the outbreak of COVID-19 to be an international pandemic in March 2020. While numbers of new confirmed cases of the disease and death tolls are rising at an alarming rate on a daily basis, there is concern that the pandemic and the measures taken to counteract it could cause an increase in distress among the public. Hence, there could be an increase in need for emotional support within the population, which is complicated further by the reduction of existing face-to-face mental health services as a result of measures taken to limit the spread of the virus. OBJECTIVE: The objective of this study was to determine whether the COVID-19 pandemic has had any influence on the calls made to Samaritans Ireland, a national crisis helpline within the Republic of Ireland. METHODS: This study presents an analysis of calls made to Samaritans Ireland in a four-week period before the first confirmed case of COVID-19 (calls=41,648, callers=3752) and calls made to the service within a four-week period after a restrictive lockdown was imposed by the government of the Republic of Ireland (calls=46,043, callers=3147). Statistical analysis was conducted to explore any differences between the duration of calls in the two periods at a global level and at an hourly level. We performed k-means clustering to determine the types of callers who used the helpline based on their helpline call usage behavior and to assess the impact of the pandemic on the caller type usage patterns. RESULTS: The analysis revealed that calls were of a longer duration in the postlockdown period in comparison with the pre-COVID-19 period. There were changes in the behavior of individuals in the cluster types defined by caller behavior, where some caller types tended to make longer calls to the service in the postlockdown period. There were also changes in caller behavior patterns with regard to the time of day of the call; variations were observed in the duration of calls at particular times of day, where average call durations increased in the early hours of the morning. CONCLUSIONS: The results of this study highlight the impact of COVID-19 on a national crisis helpline service. Statistical differences were observed in caller behavior between the prelockdown and active lockdown periods. The findings suggest that service users relied on crisis helpline services more during the lockdown period due to an increased sense of isolation, worsening of underlying mental illness due to the pandemic, and reduction or overall removal of access to other support resources. Practical implications and limitations are discussed.

Why do people call crisis helplines? Identifying taxonomies of presenting reasons and discovering associations between these reasons.

The objective of this study is to identify the most common reasons for contacting a crisis helpline through analysing a large call log data set. Two taxonomies were identified within the call log data from a Northern Ireland telephone crisis helpline (Lifeline), categorising the cited reason for each call. One taxonomy categorised the reasons at a fine granular level; the other taxonomy used the relatively coarser International Classification of Diseases-10. Exploratory data analytic techniques were applied to discover insights into why individuals contact crisis helplines. Risk ratings of calls were also compared to assess the associations between presenting issue and of risk of suicide as assessed. Reasons for contacting the service were assessed across geolocations. Association rule mining was used to identify associations between the presenting reasons for client's calls. Results demonstrate that both taxonomies show that calls with reasons relating to suicide are the most common reasons for contacting Lifeline and were a prominent feature of the discovered association rules. There were significant differences between reasons in both taxonomies concerning risk ratings. Reasons for calling helplines that are associated with higher risk ratings include those calling with a personality disorder, mental disorders, delusional disorders and drugs (legal). In conclusion, employing two differing taxonomy approaches to analyse call log data reveals the prevalence of main presenting reasons for contacting a crisis helpline. The association rule mining using each taxonomy provided insights into the associations between presenting reasons. Practical and research applications are discussed.

Coping, stress, and negative childhood experiences: The link to psychopathology, self-harm, and suicidal behavior.

Early life experiences, such as childhood adversities or poor parenting practices, can impact on the ability to cope with stressors across the lifespan. Furthermore, poor coping skills can lead to the development of mental illnesses, self-harm, and suicidal behavior. This study aimed to examine demographic differences in stress levels and to determine if those who had endured negative childhood experiences would be more likely to develop psychological problems and display suicidal behavior when current stress levels were accounted for. The study also explored the link between coping and mental health problems. Finally, it aimed to predict risk and protective factors related to good coping skills. The study utilized data obtained from the Ulster University Student Wellbeing Study, conducted across four university campuses in Northern Ireland in 2015 (n = 716) as part of the World Health Organization World Mental Health (WMH) International College Student Initiative. Mental health problems and early childhood experiences were examined using questions adapted from the WMH Composite International Diagnostic Interview, with self-harm and suicidal behavior measured using the Self-Injurious Thoughts and Behaviors Interview (SITBI). Females, non-heterosexuals, and older students experienced more current stress. When current stress levels were high, childhood adversities and parental overcontrol and overindulgence were related to higher rates of mental health problems, self-harm, and suicidal behavior. Poor coping skills were associated with negative mental health outcomes. Social support and good emotion-regulation strategies were related to effective coping, while parental overcontrol and overindulgence, female gender, and younger age were related to poorer coping. The study highlights the importance of developing good coping skills to deal with life stressors, thereby minimizing the risk of psychological problems and suicidal behavior. The findings provide support for initiatives to help parents improve their parenting skills and other programs to help young people cope with stress, and to develop social networks and adaptive emotion-regulation strategies.

Readiness to change and barriers to treatment seeking in college students with a mental disorder.

BACKGROUND: College students have high prevalence of mental disorders and suicidal thoughts and behaviours, and low rates of treatment uptake. This study assesses treatment access, intentions to seek help, and perceived barriers to help-seeking, considering gender and suicidal thoughts or behaviours (STBs) as predictors. METHODS: Data is from the Ulster University Student Wellbeing study (2015) conducted in Northern Ireland (NI), as part of the WHO World Mental Health Surveys International College Student Project. Participants are 392 new college entrants (162 males (41.3%)/230 females (58.7%)), who all reported some lifetime mental disorder or STBs. RESULTS: Receipt of treatment was low (37.8%), particularly among males and those with no STBs. Males were less likely to intend to access external professional services and were less likely than females to rate embarrassment (OR = 0.60) or worry about being treated differently (OR = 0.63) as important reasons for not seeking treatment. Those with STBs rated wanting to handle things on their own as a more important barrier those with no STBs (OR = 0.55 for non STBs group) and rated being unsure where to go as a less important barrier than those with no STBs (OR = 1.80 for non STBs group). LIMITATIONS: Data is correlational and concerns lifetime criteria for mental disorder, with no consideration of current mental status nor disorder type. CONCLUSIONS: These findings have implications for the active screening and intervention for vulnerable college students, particularly males and those with mental disorders but no STBs.

Lifetime and 12-month treatment for mental disorders and suicidal thoughts and behaviors among first year college students.

OBJECTIVES: Mental disorders and suicidal thoughts and behaviors (STB) are common and burdensome among college students. Although available evidence suggests that only a small proportion of the students with these conditions receive treatment, broad-based data on patterns of treatment are lacking. The aim of this study is to examine the receipt of mental health treatment among college students cross-nationally. METHODS: Web-based self-report surveys were obtained from 13,984 first year students from 19 colleges in eight countries across the world as part of the World Health Organization's World Mental Health-International College Student Initiative. The survey assessed lifetime and 12-month common mental disorders/STB and treatment of these conditions. RESULTS: Lifetime and 12-month treatment rates were very low, with estimates of 25.3-36.3% for mental disorders and 29.5-36.1% for STB. Treatment was positively associated with STB severity. However, even among severe cases, lifetime and 12-month treatment rates were never higher than 60.0% and 45.1%, respectively. CONCLUSIONS: High unmet need for treatment of mental disorders and STB exists among college students. In order to resolve the problem of high unmet need, a reallocation of resources may focus on innovative, low-threshold, inexpensive, and scalable interventions.

Characteristics of Lifeline, Crisis Line, Service Users Who Have Died by Suicide.

OBJECTIVE: Despite their widespread use, there is limited evidence on whether crisis lines are effective, how to identify callers at risk or the best ways of supporting callers to prevent suicide. This study compared the features of callers and call patterns in service users who had died by suicide with those who were currently alive from 2008 to 2011. METHODS: Using information contained on Contact's (Northern Ireland's "Lifeline" service) Client Information Management System (CIMS), 118 deaths by suicide from 2008 to 2011 were compared with a matched control group (matched on age, gender, and main presenting issue on first contact) who had not died by suicide. RESULTS: Clients who had "check-in" calls were significantly less likely to die by suicide. Those with a substance dependency or those who had made a prior suicide attempt were significantly more likely to die by suicide. Duration of service access had a negative association with suicide risk. CONCLUSIONS: "Check-in" calls are an important part of the service. Information on previous suicide attempts and substance dependency may be useful in identifying callers who may benefit from proactive support and outreach. Wider interventions are needed to promote service user follow-up and to encourage longer term engagement with the service.

The role impairment associated with mental disorder risk profiles in the WHO World Mental Health International College Student Initiative.

OBJECTIVE: The objective of this study is to assess the contribution of mental comorbidity to role impairment among college students. METHODS: Web-based self-report surveys from 14,348 first-year college students (Response Rate [RR] = 45.5%): 19 universities, eight countries of the World Mental Health International College Student Initiative. We assessed impairment (Sheehan Disability Scales and number of days out of role [DOR] in the past 30 days) and seven 12-month DSM-IV disorders. We defined six multivariate mental disorder classes using latent class analysis (LCA). We simulated population attributable risk proportions (PARPs) of impairment. RESULTS: Highest prevalence of role impairment was highest among the 1.9% of students in the LCA class with very high comorbidity and bipolar disorder (C1): 78.3% of them had severe role impairment (vs. 20.8%, total sample). Impairment was lower in two other comorbid classes (C2 and C3) and successively lower in the rest. A similar monotonic pattern was found for DOR. Both LCA classes and some mental disorders (major depression and panic, in particular) were significant predictors of role impairment. PARP analyses suggest that eliminating all mental disorders might reduce severe role impairment by 64.6% and DOR by 44.3%. CONCLUSIONS: Comorbid mental disorders account for a substantial part of role impairment in college students.

Socio-demographic, mental health and childhood adversity risk factors for self-harm and suicidal behaviour in College students in Northern Ireland.

BACKGROUND: Prevalence estimates of suicidal behaviour in the college student population are consistently higher than rates for the general adult population. This study examines mental health disorders and childhood adversities as predictors of self-harm and suicidal behaviours. METHODS: The Ulster University Student Wellbeing study commenced in September 2015 as part of the WHO World Mental Health Surveys International College Student Project. In Northern Ireland (NI) 739 students participated (462 female, 274 male and 3 other specified), with the WMH-CIDI used to examine psychopathology. Mean age was 21 years old. RESULTS: Thirty-one percent endorsed suicidal ideation (24.3% of males and 36.9% of females) with almost 1 in 5 students having made a plan for suicide in the 12 months prior to the survey. Latent profile analysis revealed three profiles of childhood adversity (high, moderate, and low risk). Logistic regression analyses showed that there was an increased likelihood of all queried self-harm and suicidal behaviours in those who were not heterosexual orientation, and among those with either moderate or high levels of childhood adversities. Probable alcohol dependence was associated with a significantly increased likelihood of suicide attempt or self-harm with either a suicide plan or a suicide attempt. LIMITATIONS: Influences of self-report measures and the generalizability of the sample are discussed. CONCLUSIONS: Policies and strategies for early identification of those with mental illnesses or adversities that increase their risk, should be prioritised. It would also be useful to identify individuals at risk in secondary schools to allow for additional support to be offered to them during the key time of transitioning into higher education.

Severe role impairment associated with mental disorders: Results of the WHO World Mental Health Surveys International College Student Project.

BACKGROUND: College entrance is a stressful period with a high prevalence of mental disorders. AIMS: To assess the role impairment associated with 12-month mental disorders among incoming first-year college students within a large cross-national sample. METHODS: Web-based self-report surveys assessing the prevalence of DSM-IV mental disorders and health-related role impairment (Sheehan Disability Scale) were obtained and analyzed from 13,984 incoming first-year college students (Response = 45.5%), across 19 universities in eight countries. Impairment was assessed in the following domains: home management, work (e.g., college-related problems), close personal relationships, and social life. RESULTS: Mean age of the sample was 19.3 (SD = 0.59) and 54.4% were female. Findings showed that 20.4% of students reported any severe role impairment (10% of those without a mental disorder vs. 42.9% of those with at least one disorder, P < 0.01). In bivariate analyses, panic disorder, and mania were associated most frequently with severe impairment (60.6% and 57.5%, respectively). Students reporting three or more mental disorders had almost fivefold more frequently severe impairment relative to those without mental disorders. Multiple logistic regression showed that major depression (OR = 4.0; 95%CI = 3.3, 4.8), generalized anxiety (OR = 3.9; 95%CI = 3.1, 4.8), and panic disorder (OR = 2.9; 95%CI 2.4, 4.2) were associated with the highest odds of severe impairment. Only minimal deviations from these overall associations were found across countries. CONCLUSION: Mental disorders among first-year college students are associated with substantial role impairment. Providing preventative interventions targeting mental disorders and associated impairments is a critical need for institutions to address.

Facilitation of child health research in hospital settings: The views of nurses.

AIMS AND OBJECTIVES: To explore the views of nurses towards child health research and to identify factors influencing their willingness to facilitate it in practice. BACKGROUND: Child health research in clinical practice is increasing throughout the UK. Nurses and midwives facilitate access to patients, enact research study protocols and have a critical role in parental decisions to enrol children into research studies. Little is known about their perception of this process. DESIGN: This study was a descriptive study design. METHODS: A newly designed questionnaire was completed in 2013 by 105 nurses in three neonatal and two children's units in two discrete acute hospital sites. RESULTS: Overwhelming support for clinical research was reported. Participants were motivated to facilitate research in order to improve patient care and contribute to the evidence base, but discouraged by external organisational factors and ethical concerns. Training, education and a dedicated team to support research were considered important. Misconceptions regarding consent and the allocation of treatment were reported. Participants raised particular concerns about trials of investigational medicinal product. CONCLUSION: Negative views of nurses towards research, combined with a lack of knowledge of research processes, governance and ethics, have the potential to threaten the success of clinical research studies. RELEVANCE TO CLINICAL PRACTICE: Focus on three main areas: staff education, improved communication and the demonstration of managerial commitment to clinical research.

Financial Sector Workers' Experiences of Managing Suicidal Clients.

BACKGROUND: Financial sector workers interface with indebted clients, who may be distressed and have heightened vulnerability to suicidality. AIM(S): This study examined the experiences of 10 Irish financial sector workers who had experiences of encountering distressed clients who discuss suicide. METHOD: Semistructured interviews (open-ended questions) were used. RESULTS: Interpretative phenomenological analysis (IPA) identified four themes, namely: (1) avoidance versus confrontation of reality (management of the debt); (2) role conflict (recovering the debt vs. supporting the client); (3) emotional impact and distancing from clients (coping with concerns for client welfare); (4) desire for support (practical and emotional training and support needs). LIMITATIONS: The frequency with which such clients were encountered was not assessed. CONCLUSION: These themes demonstrate the need to provide support to this group, and also the difficulties in providing training to manage suicidal clients in a context where the staff member's goal is to recover debt.

Mental health, behavioural problems and treatment seeking among students commencing university in Northern Ireland.

Mental health and behavioural problems are common among students commencing university. University life can be stressful and problems often exacerbate during their course of study, while others develop disorders for the first time. The WHO World Mental Health Surveys International College Student Project aims to conduct longitudinal research to examine and monitor student mental health and wellbeing. The Ulster University Student Wellbeing study, which commenced in September 2015 in Northern Ireland (NI), was conducted as part of this initiative (wave 1, n = 739), using the WMH-CIDI to examine psychopathology. Baseline prevalence rates of lifetime and 12-month mental health and substance disorders, ADHD and suicidality were high, with more than half of new undergraduate students reporting any lifetime disorder. Co-morbidity was common with 19.1% of students experiencing three or more disorders. Logistic regression models revealed that females, those over 21, non-heterosexual students, and those from a lower SES background were more likely to have a range of mental health and behavioural problems. Overall, 10% of new entry students received treatment for emotional problems in the previous year. However, 22.3% of students with problems said they would not seek help. The study provides important information for universities, policy makers and practice, on mental health and wellbeing in young people generally but particularly for students commencing university. The findings will assist in the development and implementation of protection and prevention strategies in the university setting and beyond.

Exposure to Trauma and Mental Health Service Engagement Among Adults Who Were Children of the Northern Ireland Troubles of 1968 to 1998.

Northern Ireland is an appropriate region to examine the impact of traumatic experiences, owing to the many years of civil violence that have characterized its recent history, known colloquially as the "Troubles." Given the prominence of traumatic experiences among the aging population of Northern Ireland (NI), an evidence base is required to inform the planning and provision of effective mental health and other services. We analyzed the follow-up interviews (n = 225) of individuals from the Northern Ireland Study of Health and Stress (NISHS), aged 45 years and older, who experienced one or more conflict-related traumatic events. This study demonstrated that in NI traumatic events, such as being involved in an explosion, seeing someone killed or seriously injured, and living in a region of terror were most likely to be related to the Troubles. However, event types that we had not previously known to be related to conflict (such as the sudden death of a loved one), were also often related to the Troubles. Two-thirds of participants (67.1%) reported exposure to a Troubles-related event, and 57.8% reported being a civilian in a region of terror. The vast majority (85.9%) of participants who experienced a Troubles-related trauma never sought help, despite 59.1% meeting the criteria for a lifetime mental disorder. The reasons for not seeking help and sources of help are outlined. Policy makers must address Troubles-related mental health effects, in terms of how they carry forward into aging, and consider ways of improving engagement with services and treatments.

Days out of role due to common physical and mental conditions: results from the Northern Ireland study of health and stress.

PURPOSE: Days out of role due to health problems are a major source of lost human capital. We examined the relative importance of common physical and mental disorders in accounting for days out of role in Northern Ireland using the Northern Ireland Study of Health and Stress (NISHS) WHO World Mental Health (WMH) Survey. METHODS: Face-to-face interviews were carried out with 4340 respondents (68.4 % response rate). Multiple regression analysis estimated associations of specific chronic physical disorders and mental disorders conditions and comorbidities with days out of role controlling for basic socio-demographics. RESULTS: Overall, 16.8 % of respondents had at least one day totally out of role in the previous year. The strongest population-level effect was associated with arthritis, which accounted for 23.5 % of all days out of role. The strongest individual-level effects (days out of role per year) were associated with any anxiety disorder (32.3) arthritis (26.1) and pain (22.0). The 11 conditions accounted for 93 % of all days out of role, as measured by population attributable risk proportions (PARPs). CONCLUSIONS: Common health conditions, including mental disorders, make up a large proportion of the number of days out of role and should be addressed to substantially increase overall productivity.

Patterns of suicidal ideation and behavior in Northern Ireland and associations with conflict related trauma.

In this study, data from the World Mental Health Survey's Northern Ireland (NI) Study of Health and Stress (NISHS) was used to assess the associations between conflict- and non-conflict-related traumatic events and suicidal behaviour, controlling for age and gender and the effects of mental disorders in NI. DSM mental disorders and suicidal ideation, plans and attempts were assessed using the Composite International Diagnostic Interview (CIDI) in a multi-stage, clustered area probability household sample (N = 4,340, response rate 68.4%). The traumatic event categories were based on event types listed in the PTSD section of the CIDI. Suicidal ideation and attempts were more common in women than men, however, rates of suicide plans were similar for both genders. People with mood, anxiety and substance disorders were significantly more likely than those without to endorse suicidal ideation, plan or attempt. The highest odds ratios for all suicidal behaviors were for people with any mental disorder. However, the odds of seriously considering suicide were significantly higher for people with conflict and non-conflict-related traumatic events compared with people who had not experienced a traumatic event. The odds of having a suicide plan remain significantly higher for people with conflict-related traumatic events compared to those with only non-conflict-related events and no traumatic events. Finally, the odds of suicide attempt were significantly higher for people who have only non-conflict-related traumatic events compared with the other two categories. The results suggest that traumatic events associated with the NI conflict may be associated with suicidal ideation and plans, and this effect appears to be in addition to that explained by the presence of mental disorders. The reduced rates of suicide attempts among people who have had a conflict-related traumatic event may reflect a higher rate of single, fatal suicide attempts in this population.