Category: Blog post

Dr Zoë Haime has written a blog post for the Association for Child and Adolescent Mental Health (ACAMH). Zoë’s blog focuses on what University of Bristol research has taught us about talking to young people about their online use and mental health. She also highlights some ongoing research – the ‘digital dialogues’ project, led by Dr Lucy Biddle, which aims to identity knowledge gaps, and co-create training and resources to help mental health practitioners have these conversations with young people

Zoë says “Recently, The Royal College of the Psychiatrists in the UK advised that social media and online use should be considered in assessing risk of all young people they meet (RCPsych Report CR225, 2020). However, it is currently unclear whether this advice has been implemented in practice. Additionally, there is little evidence of guidance on how to approach these conversations with young people, or of similar direction for other mental health practitioners, teachers or parents.”

Click here to read the full ACAMH blog post

Click here for further information and guidance on how to talk about mental health and digital technology with young people

Despite growing numbers of university students reporting mental health challenges during their studies, there is still limited longitudinal data concerned with student wellbeing in the UK. SASH members Drs Jacks Bennett and Myles Jay Linton have been involved in a SMARTEN funded project developing sector guidance for universities looking to develop cohort studies.  See the research behind this new national ‘toolkit’ of standardised measures here

We were delighted to host Dr Nanette Lee Mayol who is the Director and a Research Fellow of the USC-Office of Population Studies Foundation, Inc., University of San Carlos, Cebu City, Philippines. Nanette is a GW4 co-supervisor for SASH member Lucy Barrass. Nanette met with several members of the team and we’re excited to be exploring potential opportunities for future collaborations using the rich longitudinal data that her team collects.

Dr Jacks Bennett has been awarded an ESRC postdoctoral fellowship to continue her work focused on student mental health and wellbeing in university settings. The year-long post which starts in October 2023 will allow her to build on her doctoral research evaluating the impact of new wellbeing support provision at a UK university – one of the first health studies of its kind in higher education. Jacks aims to extend that research to examine the links between differing demographics and social factors for student mental health and academic outcomes. The fellowship means Jacks can also strengthen existing collaborations with SMARTEN researchers working in the student wellbeing field, building on the mental health measurement work already underway.

Dr Lizzy Winstone has been awarded a Fellowship from the Churchill Foundation to continue her work on the relationship between social media and mental health. Lizzy’s fellowship will focus on improving teaching of social media algorithmic literacy in UK schools in order to reduce exposure to harmful (self-harm and suicide-related) social media content. During this 6-week project, she will meet with and interview international experts in social media algorithmic literacy and media literacy education from several countries, to learn from best practice overseas and influence change in the UK

Bruna Rubbo joined the University of Bristol as a Research Fellow funded by the Centre for Pesticide Suicide Prevention at the University of Edinburgh. She obtained a PhD in Clinical Epidemiology at the University of Southampton in 2020, where she continued to work as a research fellow before relocating to the University of Southern California for a postdoctoral scholarship investigating the effects of pesticide exposure on weight loss in obese adolescents.

Bruna is now working on multiple projects focused on the effects of changes in pesticide regulation and national bans on the overall and pesticide suicide rates in low- and middle-income countries. She was particularly interested in this line of research as “having previously conducted research that had potential clinical applications, this position provides me the unique opportunity to contribute to epidemiological studies that, in addition to clinical impact, also have direct policy implications, and these could lead to the prevention of numerous suicides worldwide.”

Co-leads Drs Becky Mars and Duleeka Knipe have recorded short spotlight talks for the International Association for Suicide Research which provide an overview of the problem of suicide globally. Watch the short videos here:

 

In this blog post from the Association for Child and Adolescent Mental Health (ACAMH), Dr Abigail Russell talks about research into adverse childhood experiences or ‘ACEs’ and what we know about the relationship between ACES, mental health and self-harm. Abby also discusses her ongoing research at the University of Bristol (PI Dr Becky Mars), which is investigating potential biological mechanisms linking ACEs and self-harm. These include inflammation, pubertal timing and DNA methylation.

In this blog, Lucy Barrass talks about her plans for her PhD which is using data from the Philippines to improve our knowledge of what contributes to poor mental health in this country, focusing on socioeconomic position. Lucy also reflects on her experiences as a new PhD student at Bristol University.

Mental health research is severely lacking in low and middle income countries (LMICs). The burden of disease is high, but the evidence surrounding it is low. Evidence in high income countries (HIC) may not be  generalizable to LMICs due to differences in cultural and societal exposures. Studies from LMICs are mainly performed at one time point or they collect data retrospectively, making it difficult to determine if the exposure came before the outcome; very little evidence is from birth cohort data that can be used to explore causality and early life exposures. A life course approach allows early life exposures to be analysed in synergy with later life exposures.

I’m Lucy Barrass and I am a first year PhD student at Bristol. I previously studied and worked at Newcastle University before I moved to Bristol to pursue this PhD, motivated by an opportunity to improve public health, and develop skills in global health and epidemiology.  As part of a GW4 PhD I plan to use data from a unique dataset in the Philippines to improve our knowledge of what contributes to poor mental health in this country.  I will use data from the Cebu Longitudinal Health and Nutrition Survey (CLHNS), a birth cohort situated in a metropolitan area in the Philippines. The CLHNS was first conducted in 1983, collecting data about pregnant women and their new-born children. The study has collected data between the ages of 0 to 35,  allowing for a comprehensive longitudinal analysis exploring early and later life exposures.  This PhD will use the CLHNS to provide support of the associations between socioeconomic position and mental health in a LMIC. The study aims to identify socioeconomic risk factors for depression and suicidal thoughts, that are contextually relevant and can be used as measures to design interventions. Despite the existence of the CLHNS, there is very little evidence on mental health in the Philippines, particularly on risk factors across the life course and exploring socioeconomic position.

The below image shows some variables which will be used in my analysis, that are present in, or can be constructed from, the CHLNS.

I am still considering comparing the results from the Filipino data to other birth cohorts that measure depression/suicidal thoughts in other LMICs, such as the Birth to Twenty in South Africa. It may provide an added dimension to the results and potentially highlight differences that occur between different populations.

Having been a PhD student for a few months now, I am starting to settle into PhD life and can begin to think about goals and things I hope to achieve whilst I complete it. So far, I am really enjoying it, and I’m looking forward to progressing as a researcher in the coming months and years! I am particularly excited to learn new statistical methods to explore the longitudinal data as I haven’t previously used this type of data and I think this will be really beneficial for my career. Equally, hopefully being able to present my work at international conferences will be something I would love to work towards. I am also excited to be given the opportunity to visit the Philippines to further understand the dataset, both methodologically and culturally and ensure my findings are utilised. If you are interested in hearing more about my PhD, please do get in contact with me!

“People get tremendous anxiety and depression and you have suicide over things like this, when you have a terrible economy, you have death…definitely in far greater numbers than we’re talking about with regard to the virus.”

White House press conference, 23^rd March 2020, US President Donald Trump

In recent days, US President Donald Trump has repeatedly argued that the economic consequences of public health measures to limit the spread of Covid-19 could result in more deaths, due to suicide, than the virus itself. Existing scientific evidence does not, however, support this claim.

It is important to consider the impact that both the Covid-19 outbreak and related public health interventions will have on mental health, mental healthcare, and suicide rates. However, if no public health measures are implemented, the predicted number of Covid-19 deaths in the US over four months is nearly 500 times greater than the number of suicide deaths occurring between 2007-2010 attributable to the 2008 economic recession. The 2008 economic recession would have to last over 1,300 years, for the number of resultant suicide deaths to surpass the number of lives saved by stringent public health measures. Furthermore, evidence indicates the number of suicide deaths can be reduced with employment support measures and historically, in the US, the total number of deaths in the population falls during periods of recession.

Estimated number of suicide deaths in relation to economic recession

In the US between 2007-2010, there were on average 35,850 suicide deaths annually. An estimated 4,750 of these suicide deaths were attributed to the economic recession. Unemployment is a key mechanism through which economic recessions can contribute to increased suicide rates; the increase in unemployment from 5.8% to 9.6% post-recession (2007-2010) was associated with approximately 1,330 of the suicide deaths.

Estimated number of Covid-19 deaths without public health interventions

A key study, which modelled the impact of non-pharmaceutical measures, and led to a change in UK strategy, indicated that without any public health interventions or changes in individual behaviour there would be approximately 2.2 million deaths in the US due to Covid-19. The figures are based on age-stratified infection fatality ratio, ranging from 0.002% among 0- to 9-year olds and 9.3% for those aged ≥80. Most of the deaths are predicted to occur over approximately a four-month period, and around half would be due to healthcare services exceeding their capacity to treat everyone with the infection. In addition, indirect deaths may also occur as a result of over-stretched services. For example, previously treatable heart attacks may now result in death if cardiac care facilities are unavailable. As such, the number of Covid-19-related deaths would be far higher.

Estimated number of Covid-19 deaths with public health interventions

In the UK, case isolation, home quarantine, and social distancing are predicted to reduce the number of deaths that would have occurred with no measures in place (510,000) to approximately 90,000 (an 82% reduction), while adding school and university closure could reduce the number of deaths to around 24,000 (a 95% reduction). These calculations are based on a reproduction number of 2.4 and the triggering of social distancing and closure of educational settings when more than 200 new Covid-19 cases are diagnosed in intensive care units weekly. A similar percentage reduction in the US would equate to around 396,000 or 110,000 deaths respectively.

The wider context

Despite the implementation of a lockdown in Italy, over a six-week period the number of deaths from Covid-19 has far exceeded the 290 excess suicide attempts and deaths that occurred post-recession (2007-2010) as well as the 4,886 total suicide deaths recorded in 2016, the most recent year for which data are available.

A US economic recession may occur irrespective of whether strict public health measures are implemented, although the extent of the recession will likely vary dependent on approach taken. Economic recessions may be associated with a higher prevalence of mental health conditions and cuts to mental health services. In addition to a recession, there may be other mechanisms such as social isolation, by which strict public health measures contribute to increased mortality. Yet, to surpass the number of lives saved from reduced spread of Covid-19, these additional mechanisms would need to contribute to an extra 1.8 million suicide deaths on top of the number of suicides attributed to the 2008 economic recession. This is 40 times more deaths than the annual number of suicide deaths in the US.

Importantly, in contrast to rises in suicide rates, all-cause mortality decreased in the US during both the 2008 economic recession and the Great Depression (1930-33), for example due to shifts in trends in cardiovascular deaths and road traffic accidents. There is also evidence that the effect of unemployment on suicides can be reduced with more generous employment support measures (1,2,3).

There is no doubt that the impact on mental health and risk of suicide for populations, healthcare workers, individuals and their families as a consequence of the Covid-19 outbreak will be profound. It is a situation that could be worsened by a lack of appropriate, albeit extreme, mitigation measures. However, scientific evidence demonstrates that public health interventions to reduce the spread of Covid-19 should not be withheld on the basis that a resultant economic recession would cause more deaths by suicide.

---

Prianka Padmanathan is a MRC MARC PhD clinical fellow at the department of Population Health Sciences @_prianka_

Dee Knipe is a Vice Chancellor’s Postdoctoral Research Fellow in the Department of Population Health Science, University of Bristol @dee_knipe 

David Gunnell is Professor of Epidemiology in the Department of Population Health Science, University of Bristol. His research expertise include the effect of the 2008 economic recession on suicide rates (1, 2, 3).

Jacks Bennett is a Bristol doctoral researcher at looking at student mental health and wellbeing @JacksBennett

Group Twitter: @SASHBristol 

---

If you or anyone you know is affected by the issues covered in this blog, you can contact the Samaritans for free from any telephone on 116 123 in the UK. Alternatively you can email jo@samaritans.org for details of your nearest branch, where you can talk to one of their trained volunteers face to face. The International Association for Suicide Prevention (IASP) has details of support organisations in other countries.