Suicide risk following ED presentation with self-harm varies by hospital.

BACKGROUND: Patients presenting to Emergency Department (ED) with self-harm are recognized to be at high risk of suicide and other causes of death in the immediate period following ED presentation. It is also recognized that there is a large variation in the management and care pathways that these patients experience at EDs. AIMS: This study asks if there is a significant variation in mortality risk according to hospital attended and if this is explained by differences in care management. METHODS: Population-wide data from the Northern Ireland Registry of Self-Harm from April 2012 were linked with centrally held mortality records to December 2019, providing data on self-harm type and ED care. Cox proportional hazards models analyzed mortality risk, coded as suicide, all-external causes and all-cause mortality. RESULTS: Analysis of the 64,350 ED presentations for self-harm by 30,011 individuals confirmed a marked variation across EDs in proportion of patients receiving mental health assessment and likelihood of admission to general and psychiatric wards. There was a significant variation in suicide risk following attendance according to ED attended with the three-fold range between the lowest (HRadj 0.32 95% CIs 0.16, 0.67) and highest. These differences persisted even after adjustment for patient characteristics, variation in types of self-harm, and care management at the ED. CONCLUSIONS: This study suggests that while the management of self-harm cases in the ED is important, it is the availability and access to, and level of engagement with, the subsequent management and care in the community rather than the immediate care at EDs that is most critical for patients presenting to ED with self-harm. However, the initial care in ED is an important gateway in initiating referrals to these services.

Childhood contact with social services and risk of suicide or sudden death in young adulthood: identifying hidden risk in a population-wide cohort study.

BACKGROUND: Childhood out-of-home care is associated with premature death in adulthood, in particular death by suicide, accidents and violence. However, little is known about the mortality risk in the much larger population of adults that had contact with social services in childhood but never entered out-of-home care. We determine the association between all tiers of contact with children's social services and risk of suicide and other sudden deaths in young adulthood. METHODS: This population-wide, longitudinal, record-linkage study of adults in Northern Ireland born between 1985 and 1997 (n=437 008) followed each individual from age 18 years to July 2021 (maximum age 36 years). Cox 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 risk of death by suicide and sudden death in young adulthood. RESULTS: Individuals with childhood social care contact (n=51 097) comprised 11.7% of the cohort yet accounted for 35.3% of sudden deaths and 39.7% of suicide deaths. Risk of suicide or sudden death increased stepwise with level of childhood contact and was highest in adults with a history of out-of-home care (suicide HR 8.85 (95% CI 6.83 to 11.4)). Individuals assessed as NIN, and those deemed a CIN, had four times the risk of death by suicide in young adulthood compared with unexposed peers (HR 4.25 (95% CI 3.26 to 5.53) and HR 4.49 (95% CI 3.75 to 5.39), respectively). CONCLUSION: Childhood contact with social services is a risk marker for death by suicide and sudden death in young adulthood. Risk is not confined to adults with a history of out-of-home care but extends to the much larger population that had contact with social services but never entered care.

Impact of the COVID-19 pandemic on self-harm and self-harm/suicide ideation: population-wide data linkage study and time series analysis.

BACKGROUND: The COVID-19 pandemic and associated lockdowns were predicted to have a major impact on suicidal behaviour, including self-harm. However, current studies have produced contradictory findings with limited trend data. AIMS: Nine years of linked individual-level administrative data were utilised to examine changes in hospital-presenting self-harm and ideation (thoughts of self-harm or suicide) before and during the pandemic. METHOD: National self-harm registry data were linked to demographic and socioeconomic indicators from healthcare registration records (n = 1 899 437). Monthly presentations of self-harm or ideation were split (pre-COVID-19 restrictions: April 2012 to February 2020; and during restrictions: March to September 2020). Auto-regressive integrated moving average (ARIMA) models were trained in R taking into consideration trends and seasonal effects. Forecast ('expected') monthly values were compared with 'actual' values, stratified by demographic factors and method of harm. RESULTS: The number of individuals presenting with self-harm or ideation dropped significantly at the beginning of the pandemic (March-May 2020), before returning mostly to expected trends from June 2020. Stratified analysis showed similar presentation trends across most demographic subgroups except for those aged over 65 years, living alone or in affluent areas, where presentations remained unaffected, and those aged under 16 years, where numbers presenting with self-harm or ideation increased above expected levels. CONCLUSIONS: Although population trends show an overall drop in presentations before a return to 'normal' from June 2020, the demographic profile of those presenting with self-harm or ideation varied significantly, with increases in children under the age of 16 years. This highlights important potential target groups who may have been most negatively affected by the pandemic.

The mental health of all children in contact with social services: a population-wide record-linkage study in Northern Ireland.

AIMS: Children in contact with social services are at high risk for mental ill health, but it is not known what proportion of the child population has contact with social services or how risk varies within this group compared to unexposed peers. We aim to quantify the extent and nature of contact with social services within the child population in Northern Ireland (NI) and the association with mental ill health. We also examine which social care experiences identify those most at risk. METHODS: This is a population-based record-linkage study of 497,269 children (aged under 18 years) alive and resident in NI in 2015 using routinely collected health and social care data. Exposure was categorized as (1) no contact, (2) referred but assessed as not in need (NIN), (3) child in need (CIN) and (4) child in care (CIC). Multilevel logistic regression analyses estimated odds ratios (ORs) for mental ill health indicated by receipt of psychotropic medication (antidepressants, anxiolytics, antipsychotics and hypnotics), psychiatric hospital admission and hospital-presenting self-harm or ideation. RESULTS: Over one in six children (17.2%, n = 85,792) were currently or previously in contact with social services, and almost one child in every 20 (4.8%, n = 23,975) had contact in 2015. Likelihood of any mental ill health outcome increased incrementally with the level of contact with social services relative to unexposed peers: NIN (OR 5.90 [95% confidence interval (CI) 5.10-6.83]), CIN (OR 5.99 [95% CI 5.50-6.53]) and CIC (OR 12.60 [95% CI 10.63-14.95]). All tiers of contact, number of referrals, number of care episodes and placement type were strongly associated with the likelihood of mental ill health. CONCLUSION: Children who have contact with social services account for a large and disproportionate amount of mental ill health in the child population. Likelihood of poor mental health across indicators is highest in care experienced children but also extends to the much larger population of children in contact with social services but never in care. Findings suggest a need for targeted mental health screening and enhanced support for all children in contact with social services.

Mortality risk following self-harm in young people: a population cohort study using the Northern Ireland Registry of Self-Harm.

BACKGROUND: Self-harm is a recognised predictor of suicide and is most common in those aged under 25 years. The aims of this study were to describe the characteristics of young people who present with self-harm; quantify the risk of suicide and other causes of death during follow up, and to identify factors associated with mortality risk. METHODS: The Northern Ireland Registry of Self-Harm (NIRSH) is a national registry capturing complete data on all presentations made to the 12 Emergency Departments (EDs) in Northern Ireland (NI). Data relating to self-harm presentations registered in the NIRSH between 2012 and 2015 were linked to primary care registrations and death records up until 31st December 2018. Logistic regression was employed to examine the factors associated with self-harm. Cox regression was used to estimate mortality risk following self-harm and explore the associated risk factors. RESULTS: The cohort consisted of 390,740 individuals aged 10-24 years registered with a General Practitioner (GP) in NI. During follow-up, 4,450 individuals presented with self-harm. Rates of self-harm were highest in females, those aged 20-24 years (ORadj  = 3.53, 95% CI 3.28-3.80, p < .001), and in the most deprived areas (ORadj  = 2.71, 95% CI 2.45-2.99, p < .001). Thirty five individuals who presented with self-harm died by suicide, accounting for 23% of all suicide deaths in the cohort. Suicide risk was increased 19-fold in those who presented with self-harm after adjustment for age, sex and area-level factors (HRadj  = 19.00, 95% CI 12.80-28.21, p < .001). Increased suicide risk was observed in males (HRadj  = 2.04, 95% CI 0.99-4.23, p = .05) and those using more violent methods of self-injury (HRadj  = 3.89, 95% CI 1.65-9.13, p < .001). CONCLUSIONS: Young people who self-harm are at a significantly greater risk of suicide. Almost a quarter of young people who died by suicide in NI had presented to EDs with self-harm, highlighting that the ED may provide a nodal point of intervention among a typically hard to identify and reach population.

Impact of the COVID-19 pandemic on psychotropic medication uptake: time-series analysis of a population-wide cohort.

BACKGROUND: The COVID-19 pandemic and associated lockdowns were predicted to have a major impact on mental health, however current studies have produced contradictory findings with limited longitudinal data. AIMS: Nine years of linked, individual-level administrative data were used to examine changes in psychotropic medication uptake before and during the pandemic. METHOD: Medication data from a population-wide prescribing database were linked to demographic and socioeconomic indicators from healthcare registration records (n = 1 801 860). Monthly prescription uptake was split (pre-restrictions: January 2012 to February 2020 and during restrictions: March to October 2020). Auto regressive integrated moving average (ARIMA) models were trained in R taking into consideration trends and seasonal effects. Forecast ('expected') monthly values were compared with 'actual' values, stratified by demographic factors. RESULTS: Over the study period 38.5% of the study population were in receipt of ≥1 psychotropic medication. Uptake of these medications have been following a strong upward trend since January 2012. In March 2020 uptake of all medications increased beyond expected values, returning to expected trends from May 2020 for antidepressants, anxiolytics and antipsychotics. In the 8 months during restrictions uptake of hypnotic medication was 12% higher than expected among those <18 years, and anxiolytic medication higher than expected in those >65 years. CONCLUSIONS: Results suggest an initial 'stockpiling' of medications in March 2020 before trends mostly returned to expected levels. The anticipated tsunami of mental ill health is not yet manifest in psychotropic medication uptake. There are indications of increased anxiety and sleep difficulties in some subgroups, although these conditions may resolve as we emerge from the pandemic without need for psychiatric intervention.

GroundsWell: Community-engaged and data-informed systems transformation of Urban Green and Blue Space for population health - a new initiative.

Natural environments, such as parks, woodlands and lakes, have positive impacts on health and wellbeing. Urban Green and Blue Spaces (UGBS), and the activities that take place in them, can significantly influence the health outcomes of all communities, and reduce health inequalities. Improving access and quality of UGBS needs understanding of the range of systems (e.g. planning, transport, environment, community) in which UGBS are located. UGBS offers an ideal exemplar for testing systems innovations as it reflects place-based and whole society processes , with potential to reduce non-communicable disease (NCD) risk and associated social inequalities in health. UGBS can impact multiple behavioural and environmental aetiological pathways. However, the systems which desire, design, develop, and deliver UGBS are fragmented and siloed, with ineffective mechanisms for data generation, knowledge exchange and mobilisation. Further, UGBS need to be co-designed with and by those whose health could benefit most from them, so they are appropriate, accessible, valued and used well. This paper describes a major new prevention research programme and partnership, GroundsWell, which aims to transform UGBS-related systems by improving how we plan, design, evaluate and manage UGBS so that it benefits all communities, especially those who are in poorest health. We use a broad definition of health to include physical, mental, social wellbeing and quality of life. Our objectives are to transform systems so that UGBS are planned, developed, implemented, maintained and evaluated with our communities and data systems to enhance health and reduce inequalities. GroundsWell will use interdisciplinary, problem-solving approaches to accelerate and optimise community collaborations among citizens, users, implementers, policymakers and researchers to impact research, policy, practice and active citizenship. GroundsWell will be shaped and developed in three pioneer cities (Belfast, Edinburgh, Liverpool) and their regional contexts, with embedded translational mechanisms to ensure that outputs and impact have UK-wide and international application.

Data linkage and pain medication in people with cerebral palsy: a cross-sectional study.

AIM: To explore data linkage and pain medication as a proxy for pain, to assess differences in pain medication between the cerebral palsy (CP) and the general populations, and to identify factors associated with pain medication in CP. METHOD: This cross-sectional study linked the Northern Ireland CP Register and two administrative health care databases for people resident in Northern Ireland born between 1981 and 2008. Pain medication as a proxy was validated by replicating analyses from the Study of Participation of Children with Cerebral Palsy Living in Europe (SPARCLE) studies. Logistic regression compared pain medication in the CP and general populations. Multi-level regression models assessed factors associated with pain medication in the CP cohort. RESULTS: The sample size was 701 075, of whom 1430 (0.2%) were people with CP. There were 358 969 males and 340 677 females in the general population, and 810 males and 620 females in the CP population, with an age range of 4 to 31 years in both groups. The validation exercise produced results similar to the SPARCLE studies. More people with CP received pain medication (61% vs 50.9%) and had twice the odds of being prescribed opioid analgesics (odds ratio [OR]=2.81, 95% confidence interval [CI] 2.32-3.40). Among those with CP, the odds of being prescribed pain medication were higher for: females (OR=1.34, 95% CI 1.06-1.70), younger age (OR=1.60, 95% CI 1.02-2.51), Gross Motor Function Classification System level V (OR=2.60, 95% CI 1.52-4.47), seizures (OR=2.55, 95% CI 1.68-3.87), and higher deprivation score (OR=2.06, 95% CI 1.41-3.24). INTERPRETATION: Pain medication is an effective proxy for pain. More people with CP were prescribed pain medication than the general population. Pain medication for people with CP is not only dependent on physiological and clinical characteristics, but also environmental factors. What this paper adds Data linkage using pain medication as a proxy for experiencing pain is a valid method. People with cerebral palsy (CP) are more likely to experience pain than the general population. People with CP have over twice the odds of receiving opioids compared to the general population. The odds of being prescribed pain medication were higher for females with CP. Prescription of pain medication among those with CP is not only dependent on clinical characteristics, but also environmental factors.

The association between self-reported mental health, medication record and suicide risk: A population wide study.

Suicide mortality and mental ill health are increasing globally. Mental ill health can be measured in multiple ways. It is unclear which measure is most associated with suicide risk. This study explored the association between self-rated mental health and medication record and death by suicide. The 2011 Northern Ireland Census records of adults aged 18-74 years (n=1,098,967) were linked to a centralised database of dispensed prescription medication and death registrations until the end of 2015. Mental health status was ascertained through both a single-item self-reported question in the Census and receipt of psychotropic medication. Logistic regression models examined the association between indicators of mental ill health and likelihood of suicide mortality. Of the 1,098,967 cohort members, 857 died by suicide during the study period. Just over half of these deaths (n=429, 50.1%) occurred in individuals with neither indicator of mental ill health. Cohort members with both self-reported mental ill health and receipt of psychotropic medication had the highest risk of suicide (OR=6.13, 95%CI: 4.94-7.61), followed by those with psychotropic medication record only (OR=4.00, 95%CI: 3.28-4.88) and self-report only (OR=2.88, 95%CI: 2.16-3.84). Individuals who report mental ill health and have a history of psychotropic medication use are at a high risk of suicide mortality. However, neither measure is particularly sensitive, as both failed to signal over half of subsequent suicides. Some individuals who report poor mental health but are not in receipt of psychotropic medication are at increased risk of suicide, indicating possible unmet treatment need. The combination of the two indicators offers more precision for identifying those most at risk for targeted interventions.

Pilot study exploring the incidence of lower urinary tract symptoms during pregnancy in a district general hospital in Northern Ireland: a prospective survey.

INTRODUCTION AND HYPOTHESIS: The objective of this study was to ascertain the prevalence of lower urinary tract symptoms (LUTS) during pregnancy with a prospective survey in the UK. MATERIALS AND METHODS: Pregnant women over the age of 18 years booked for shared antenatal care at a district general hospital were asked to complete a validated 14-stem questionnaire enquiring about lower urinary tract symptoms. (ICIQ-FLUTS). Primary outcome measure was completion of the ICIQ-FLUTS questionnaire. Secondary analysis included the prevalence and odds ratios of individual symptoms that make up the ICIQ-FLUTS score. RESULTS: In all, 383 women completed the questionnaire. The most common symptom reported was urgency with a prevalence of 80%. Urgency was over twice as likely to be reported in those with a BMI > 30. The next most common symptom reported was stress incontinence with 65% of participants reporting some leakage on exertion. The likelihood of reporting stress incontinence increased with parity, BMI > 30 and participants in the third trimester with odds ratios of 1.81, 2.07 and 2.09, respectively. Women were almost four times more likely to report any type of urinary incontinence if they had had a vaginal birth in their first pregnancy compared to those who had a caesarean section and women who had a forceps delivery were seven times more likely to report incontinence. CONCLUSIONS: The antenatal period may represent an important opportunity for health promotion and intervention. The high prevalence of LUTS in our antenatal population highlights the need to educate women on bladder care.

Social variations in uptake of disability benefits: A census-based record linkage study.

BACKGROUND: Significant variation in disability-related social security benefits receipt might highlight sub-populations and groups with unmet needs and also have implications for areal indicators of disadvantage that are largely derived from uptake of benefits. In this paper we examine Disability Living Allowance (DLA), a non means-tested contribution towards disability-related living costs for disabled people aged less than sixty-five. METHOD: ology: Three census-based measures of self-reported health (number of chronic physical disabilities; activity limitation (a little; a lot); and chronic poor mental health) were linked to contemporaneous DLA records. The 2011 Census returns provided individual demographic, socio-economic, social and area-level characteristics. DLA uptake was modelled using logistic regression, stratified into 0-15 and 16-64 year old age groups. RESULTS: Overall, 118329 (8.4%) of this population received DLA. Poor health outcomes were the main determinants for uptake, which was higher amongst females, those non-married and those of lower socio-economic status: for example those with no qualifications compared against third level education (ORad = 1.80: 95%CI = 1.75-1.85); and those social renting compared against those in more expensive owner occupation (ORadj = 1.92: 1.83-2.02). Uptake was lower amongst Protestants than Catholics (ORadj = 0.75: 0.74-0.77) and amongst immigrants (ORadj = 0.36: 0.34-0.39) and slightly lower in rural communities. CONCLUSIONS: Poor health is the predominant determinant of disability benefits uptake but other social and socioeconomic factors have influence. These findings may assist in the reshaping of outreach programmes leading to better targeting of benefits, and therefore a more indirect influence on the derivation of area deprivation measures in the United Kingdom.

Experience of child welfare services and long-term adult mental health outcomes: a scoping review.

PURPOSE: This is the first comprehensive review of empirical research that investigated the association between receipt of child welfare services and adult mental health outcomes. The review summarised the results of studies about mental health outcomes of adults with a history of child welfare involvement. METHODS: A scoping review methodology was used to search five electronic databases (MEDLINE, EMBASE, PsychINFO, IBSS, Social Policy and Practice). Studies were included if they examined any child welfare exposure (including receipt of services while remaining at home/being placed in care) and adult mental health status. RESULTS: In total 4591 records were retrieved, of which 55 met the eligibility criteria. Overall, receipt of child welfare services was associated with an increased risk of adult mental ill-health, suicide attempt and completed suicide. Results regarding potential moderating factors, such as gender and care-related experiences, were mixed. Relatively few studies investigated the reasons for requiring child welfare services, the experience of abuse or neglect or the adult outcomes of child welfare service users who remained in their own homes. Mental ill-health was defined and measured heterogeneously and details about the nature and type of welfare service utilisation were lacking. CONCLUSION: There is a need for detailed, longitudinal studies to better understand the relative contribution of pre-existing adversity versus experiences during and after exposure to child welfare services on adult mental health outcomes. More standardised measures of mental ill-health and greater detail from authors on specific care exposure are also needed.

Disparities in Breast Cancer Screening Uptake for Women With Mental Illness in the United Kingdom.

INTRODUCTION: Although there is evidence of disparities in breast cancer screening for women with mental illness in the U.S., there is a dearth of studies examining this association in the United Kingdom, where health care is provided free at the point of access. This population-based study examines the influence of mental illness, as assessed by the uptake of psychotropic medications, on breast screening uptake in the United Kingdom. METHODS: A cohort of 57,328 women identified from 2011 Census records within the Northern Ireland Longitudinal Study was followed through a single 3-year screening cycle (2011-2014) of the National Health Service Breast Screening Programme. Mental illness was identified by a receipt of psychotropic medication in the 3 months preceding screening invite. Individual- and household-level attributes were derived from Census records. Data were analyzed in 2019. RESULTS: More than a third of women received ≥1 prescription for psychotropic medication in the 3 months preceding screening invite. The odds of attendance in these individuals were reduced by 15% (OR=0.85, 95% CI=0.81, 0.88). Attendance was particularly low for women prescribed antipsychotics (OR=0.63, 95% CI=0.56, 0.70), anxiolytics (OR=0.61, 95% CI=0.57, 0.66), and hypnotics (OR=0.68, 95% CI=0.63, 0.72). CONCLUSIONS: These findings confirm the existence of significant disparities in breast screening uptake for women with mental illness. Targeted interventions are warranted to prevent avoidable breast cancer deaths in these individuals, especially given the increasing prevalence of mental illness.

Does poor mental health explain socio-demographic gradients in breast cancer screening uptake? A population-based study.

BACKGROUND: Research from the USA indicates disparities in breast cancer screening uptake for women with poor mental health. However, no attempt has been made to examine the contribution of poor mental health to socio-demographic variations in breast screening uptake. The current study aims to examine the impact of self-reported chronic poor mental health on attendance at breast screening in the UK, and to what extent this explains socio-demographic inequalities in screening uptake. METHODS: Breast screening records were linked to 2011 Census records within the Northern Ireland Longitudinal Study. This identified a cohort of 57 328 women who were followed through one 3-year screening cycle of the National Health Service Breast Screening Programme. Information on mental health status, in addition to other individual and household-level attributes, was derived from the 2011 Census. Logistic regression was employed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of attendance at screening. RESULTS: 10.7% of women in the cohort reported poor mental health, and in fully adjusted analyses, these individuals were 23% less likely to attend breast screening (OR 0.77; 95% CI 0.73-0.82). Although poor mental health was a strong predictor of screening uptake, it did not explain the observed inequalities in uptake by socio-economic status, marital status, or area of residence. CONCLUSIONS: This study provides novel evidence of inequalities in breast screening uptake for women with chronic poor mental health in the UK. Targeted interventions are necessary to ensure equitable screening access and to enhance overall mortality benefit.

Disability as a predictor of breast cancer screening uptake: A population-based study of 57,328 women.

OBJECTIVE: Despite a growing body of evidence suggesting inequalities in breast cancer screening uptake in the United States for women with disabilities, few attempts have been made to examine whether this association applies to the United Kingdom. We conducted the first population-wide study investigating the impact of disability on uptake of breast cancer screening in Northern Ireland. METHODS: Breast screening records extracted from the National Breast Screening System were linked to the Northern Ireland Longitudinal Study. This identified a cohort of 57,328 women who were followed through one complete three-year screening cycle of the National Health Service Breast Screening Programme in Northern Ireland. The presence of disability was identified from responses to the 2011 Census. RESULTS: Within this cohort, 35.8% of women reported having at least one chronic disability, and these individuals were 7% less likely to attend compared with those with no disability (odds ratio 0.93; 95% confidence interval 0.89-0.98). Variation in the degree of disparity observed was evident according to the type and number of comorbid disabilities examined. CONCLUSION: This is the first population-wide study in Northern Ireland to identify disparities in breast screening uptake for women with chronic disabilities, in particular, those with multimorbidity. This is of particular concern, given the projected rise in the prevalence of disability associated with the ageing population.

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.

Aircraft noise and self-assessed mental health around a regional urban airport: a population based record linkage study.

BACKGROUND: Limited evidence suggests that residential exposure to aircraft noise negatively influences population mental health around large airports, but it is not known whether the same is true for smaller airports. We investigated whether residential exposure to aircraft noise near a regional urban airport was associated with risk of chronic self-assessed mental ill health. METHODS: This is a cross-sectional study of 198,532 people aged 18 years and over living in Belfast, United Kingdom, enumerated at the 2011 Census. Residential exposure to aircraft noise (LAeq,16h) was assessed by linking Census records with modelled noise contours surrounding George Best Belfast City Airport (c.42,000 annual aircraft movements). Associations between noise and mental ill health were estimated using multiple logistic regression adjusting for demographic characteristics, socio-economic status and comorbidity. RESULTS: Prevalence of self-assessed mental ill health was greater in high noise (≥57 dB) compared to low noise (< 54 dB) areas (12.4% vs. 9.7%). We found no association between aircraft noise and risk of mental ill health after adjustment for socio-economic status (high vs. low noise odds ratio: 1.03 CI: 0.93, 1.14). DISCUSSION: Associations between aircraft noise and mental health have been reported near large airports at similar average noise levels to those observed here. Our findings indicate that the noise environment around this smaller airport (with fewer flights and no night flights) has little influence on population mental health.

Consanguineous Marriage and the Psychopathology of Progeny: A Population-wide Data Linkage Study.

Importance: Approximately 1 in 10 children worldwide are born to consanguineous parents. The literature on consanguinity and mental health of progeny is scarce despite the fact that many of the factors associated with consanguineous unions are also associated with mental health. Objective: To investigate if children of consanguineous parents are at increased risk of common mood disorders or psychoses. Design, Setting, and Participants: This investigation was a retrospective population-wide cohort study of all individuals born in Northern Ireland between January 1, 1971, and December 31, 1986, derived from the Child Health System data set and linked to nationwide administrative data sources on prescription medication and death records. Data from the Child Health System data set identified all 447 452 births delivered to mothers residing in Northern Ireland between 1971 and 1986. The final data set comprised 363 960 individuals, alive and residing in Northern Ireland in 2014, with full data on all variables. The dates of analysis were June 1 to October 31, 2017. Main Outcomes and Measures: Degree of parental consanguinity was assessed from questions asked of the parents during routine health visitor house calls within 2 weeks of the child's birth. Potential mental ill health was estimated by receipt of psychotropic medication in 2010 to 2014. Ever or never use was used for the main analysis, with sensitivity analyses using a cutoff of at least 3 months' prescriptions. Receipt of antidepressant or anxiolytic medications was used as a proxy for common mood disorders, whereas receipt of antipsychotic medications was used as a proxy indicator of psychoses. Results: Of the 363 960 individuals (52.5% [191 102] male), 609 (0.2%) were born to consanguineous parents. After full adjustment for factors known to be associated with poor mental health, multilevel logistic regression models found that children of first-cousin consanguineous parents were more than 3 times as likely to be in receipt of antidepressant or anxiolytic medications (odds ratio, 3.01; 95% CI, 1.24-7.31) and more than twice as likely to be in receipt of antipsychotic medication (odds ratio, 2.13; 95% CI, 1.29-3.51) compared with children of nonrelated parents. Conclusions and Relevance: A child of consanguineous parents is at increased risk of common mood disorders and psychoses.

Variation of Caregiver Health and Mortality Risks by Age: A Census-Based Record Linkage Study.

Due to the focus of studies about caregiving responsibilities on older caregivers, there has been a deficit of research on young caregivers. We aimed to investigate the association between caregiving and health/mortality risk in young caregivers when compared with their noncaregiving peers and older caregivers. A census-based record linkage was implemented, linking all residents enumerated in the 2011 Northern Ireland Census with subsequently registered deaths data, until the end of 2015. Among those aged 5-24 years at the 2011 Census, approximately 4.5% (19,621) of the cohort reported that they were caregivers. The presence of a chronic physical condition (such as mobility difficulties) and/or mental health condition was measured through the Census; all-cause mortality was assessed by official mortality records. Young caregivers were less likely than their noncaregiving peers to report chronic mobility problems (adjusted odds ratio (OR) = 0.84, 95% confidence interval (CI): 0.73, 0.96) but more likely to report chronic poor mental health (adjusted OR = 1.44, 95% CI: 1.31, 1.58). They also differed from older caregivers (P < 0.001) and were at significantly higher mortality risk than their peers (adjusted hazard ratio = 1.54, 95% CI: 1.10, 2.14). A dose-response relationship between hours devoted to caregiving duties and mortality risk was evident. We found that young caregivers were at significantly increased risk of poor health outcomes.