Exploiting population data, uses and methods in uncovering factors associated with suicide and psychological distress

Abstract

Society faces significant challenges caring for people with urgent mental health needs. General hospitals are well equipped for dealing with medical emergencies, but much less skilled in managing mental health problems. Ambulance and policing staff frequently encounter such individuals, with transport to Emergency Department often the only care pathway. In the UK, no evidence existed on general hospital patterns prior to suicide, or on outcomes for pre-hospital mental health emergencies. This thesis contains five papers, consisting of four research studies and one protocol. Three papers report innovative quantitative approaches using linked datasets. Using 30 years of Scottish hospital data, I showed that 10,907 people who died by suicide with hospital records were 3.1 times more frequently last discharged from general, not psychiatric hospital; 24% within three months of last discharge, of whom 58% were from general hospital. Using national deaths registrations, I reported that cohorts of men born around 1965-70 had been at greater vulnerability to suicide in the 1990s, with stark differences in suicide rates between Scotland, and England & Wales. Analyses of data on unscheduled care revealed that within one year of paramedic attendances for 6,802 people with ‘psychiatric emergency’, 297 had died, 35% of whom were deaths by suicide. Paramedics were in contact with 8% of people in the year before they died by suicide. Police officers encountering people with mental health concerns have no formal means of vulnerability assessment to support triaging. A review of the evidence found no consensus definition for vulnerability or means of assessing vulnerability, a lack of congruence in terminology across policing and health, and a likely barrier to accessing services. Finally, a protocol was published outlining methods for an analysis of childhood adversity as seen in national hospital datasets. This thesis provides evidence to support redesign of more integrated services, highlights areas for suicide prevention, and closes with an impact generation exemplar.