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Background: Google Trends data are increasingly used by researchers as an indicator of population mental health, but few studies have investigated the validity of this approach during a public health emergency.Methods: Relative search volumes (RSV) for the topics depression, anxiety, self-harm, suicide, suicidal ideation, loneliness, and abuse were obtained from Google Trends. We used graphical and time-series approaches to compare daily trends in searches for these topics against population measures of these outcomes recorded using validated self-report scales (PHQ-9; GAD-7; UCLA-3) in a weekly survey (n = ~70,000) of the impact COVID-19 on psychological and social experiences in the UK population (21/03/2020 to 21/08/ 2020).Results: Self-reported levels of depression, anxiety, self-harm/suicidal ideation, self-harm, loneliness and abuse decreased during the period studied. There was no evidence of an association between self-reported anxiety, self-harm, abuse and RSV on Google Trends. Trends in Google topic RSV for depression and suicidal ideation were inversely associated with self-reports of these outcomes (p = 0.03 and p = 0.04, respectively). However, there was statistical and graphical evidence that self-report and Google searches for loneliness (p < 0.001) tracked one another.Limitations: No age/sex breakdown of Google Trends data available. Survey respondents were not representative of the UK population and no pre-pandemic data were available.Conclusion: Google Trends data do not appear to be a useful indicator of changing levels of population mental health during a public health emergency, but may have some value as an indicator of loneliness. [ABSTRACT FROM AUTHOR]

Objectives: Most of the evidence on the effects of internet use on mental health derives from cross-sectional research. We set out to explore prospective associations between internet use (hours online and specific internet experiences) and future mental health problems. Methods: Participants were 1,431 respondents from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK birth cohort, who completed a questionnaire on internet use (time online and ten different internet experiences) when they were aged 18 years. Outcomes included past year self-harm, assessed at 21 years and high levels of depression and anxiety symptoms, assessed at 22 years. Associations were investigated using logistic regression models and analyses were conducted separately for males and females. Results: Females reporting high levels of internet use (number of hours online) were found to be at increased risk of depression at follow-up (highest tertile vs lowest tertile OR = 1.41, 95% CI 0.90 to 2.20), whereas males with high levels of internet use were at increased risk for self-harm (highest tertile vs lowest tertile OR = 2.53, 95%CI 0.93 to 6.90). There was no evidence to suggest an association between hours spent online and anxiety. With regards to the specific internet experiences, associations were found for females but not for males. In fully adjusted models, being bullied online (OR = 1.76, 95% CI 1.09 to 2.86) and meeting someone face to face (OR = 1.55, 95% CI 1.00 to 2.41) were associated with an increased risk of future depression. Being bullied online was also associated with an increased risk of future self-harm (OR = 2.42, 95% CI 1.41 to 4.15), along with receiving unwanted sexual comments or material, and coming across pornography and violent/gruesome material. Conclusions: Our findings highlight the importance of digital citizenship training to help teach young people to use technology safely and responsibly. [ABSTRACT FROM AUTHOR]

Suicide is the 15th most common cause of death worldwide. Although relatively uncommon in the general population, suicide rates are much higher in people with mental health problems. Clinicians often have to assess and manage suicide risk. Risk assessment is challenging for several reasons, not least because conventional approaches to risk assessment rely on patient self reporting and suicidal patients may wish to conceal their plans. Accurate methods of predicting suicide therefore remain elusive and are actively being studied. Novel approaches to risk assessment have shown promise, including empirically derived tools and implicit association tests. Service provision for suicidal patients is often substandard, particularly at times of highest need, such as after discharge from hospital or the emergency department. Although several drug based and psychotherapy based treatments exist, the best approaches to reducing the risk of suicide are still unclear. Some of the most compelling evidence supports long established treatments such as lithium and cognitive behavioral therapy. Emerging options include ketamine and internet based psychotherapies. This review summarizes the current science in suicide risk assessment and provides an overview of the interventions shown to reduce the risk of suicide, with a focus on the clinical management of people with mental disorders. [ABSTRACT FROM AUTHOR]

Studies in young male conscripts suggest that low IQ scores are associated with an increased risk of suicide. Mechanisms underlying this association are unclear. To investigate the association of IQ, as indexed by the national adult reading test (NART), with the incidence of, and recovery from, suicidal thoughts. An 18-month follow-up of 2,278 of the adults who took part in the Britain’s second national psychiatric morbidity survey who completed the NART at baseline. There was no evidence that poor performance on the NART was associated with an increased incidence of suicidal thoughts over the 18 month follow-up (adjusted odds ratio per 10 unit increase in NART-IQ 1.08 (95% CI 0.86–1.36). However, amongst the 155 subjects with suicidal thoughts at baseline, those with low NART-IQ were least likely to recover from them: the adjusted odds of recovery per 10 unit increase in NART-IQ was 1.42 (95% CI 0.96–2.10). The association between low IQ and an increased risk of suicide may be because people with low IQ experience suicidal thoughts for more prolonged periods than those with high IQ or because low IQ increase the likelihood that people experiencing suicidal thoughts act upon them. [ABSTRACT FROM AUTHOR]

OBJECTIVE To aid the interpretation of the trends in prostate cancer mortality, which declined in the UK in the early 1990s for unknown reasons, by investigating prostate cancer death rates, incidence and treatments in England and Wales in 1975–2004. METHODS Join-point regression was used to assess secular trends in mortality and incidence (source: Office of National Statistics), radical prostatectomy and orchidectomy (source: Hospital Episode Statistics database) and androgen-suppression drugs (source: Intercontinental Medical Statistics). RESULTS Prostate cancer mortality declined from 1992 (95% confidence interval, CI, 1990–94). The relative decline in mortality to 2004 was greater and more sustained amongst men aged 55–74 years (annual percentage mortality reduction 2.75%; 95% CI 2.33–3.18%) than amongst those aged ≥75 years (0.71%, 0.26–1.15%). The use of radical prostatectomy increased between 1991 (89 operations) and 2004 (2788) amongst men aged 55–74 years. The prescribing of androgen suppression increased between 1987 (33 000 prescriptions) and 2004 (470 000). CONCLUSIONS The decrease in prostate cancer mortality was greater amongst men aged 55–74 years than in those aged ≥75 years, but pre-dated the substantial use of prostate-specific antigen screening and radical prostatectomy in the UK. An increase in radical therapy amongst younger groups with localized cancers and screen-detected low-volume locally advanced disease as a result of stage migration, as well as prolonged survival from increased medical androgen suppression therapy, might partly explain recent trends. [ABSTRACT FROM AUTHOR]

In this paper we show that, by accounting for the varying influence of just three area indicators of social isolation, it is possible to predict the number of deaths due to suicide and undetermined injuries (most of which are suicides) across a great many areas remarkably closely. The exceptions to this model suggest that in a few unique areas of the country other local, often historical and cultural or intrinsically geographical factors matter also. These findings of the general predictability of suicide matter because suicide is such a common cause of death, particularly for the young. Between 1 January 1981 and 31 December 2000, the underlying cause of the deaths of 130 000 people in Britain were recorded as being directly due to suicide, or in all probability being due to suicide. Collectively, these thousands of personal stories are brought together here to show how a pattern of despair in Britain over this period was spread across the country, affecting different places and different groups in society to differing extents over changing times. The changing geography of despair can be shown to be largely the product of changing economic, social and demographic geographies. This paper is concerned with determining the extent to which the stories of suicide in Britain were more than the sum of thousands of individual acts of misery and the extent to which they reflected the changing social structure of the country. Quantitative analysis is used to identify possible key trends with a more qualitative set of interpretations placed on the possible meanings of these findings. The paper concludes by speculating on how current social trends may influence the future map of the extremes of despair in Britain. [ABSTRACT FROM AUTHOR]

Discusses the epidemiology of suicide in Great Britain, especially among the young. Geographical comparison of suicide rates; Secular trends in suicide; Characteristics associated with increased suicide risk, such as age, gender, and marital status; Suicide risk of mental health patients; Conclusions.

Ongoing concern for the unique mental health challenges faced by university students has been magnified by the disruption of the global COVID-19 pandemic since March 2020. This study aimed to investigate changes in mental health and wellbeing outcomes for UK university students since the pandemic began, and to examine whether more vulnerable groups were disproportionately impacted. Students at a UK university responded to anonymous online cross-sectional surveys in 2019 (N = 2637), 2020 (N = 3693), and 2021 (N = 2772). Students completed measures of depression, anxiety and subjective wellbeing (SWB). Multivariable logistic regression models investigated associations of survey year and sociodemographic characteristics with mental health and SWB. Compared to 2019, fewer students showed high levels of depression and anxiety symptoms in 2020. However, there was evidence of worsened levels of anxiety and SWB in 2021 compared to 2019. Interaction effects indicated that students from a Black, Asian or minority ethnicity background and students previously diagnosed with a mental health difficulty showed improved outcomes in 2021 compared to previous years. There is a need for sector-wide strategies including preventative approaches, appropriate treatment options for students already experiencing difficulties and ongoing monitoring post-pandemic. [ABSTRACT FROM AUTHOR]

Focuses on prevention of suicidal incidents in Great Britain. Identification of causes of suicides and parasuicides; Conduction of general practitioner education programme on depression management; Evaluation of lithium and antidepressants marketing.

Social class differences in height have been recognised for many centuries. However, few studies have examined the extent to which these differences are made up of differences in leg length or trunk length. This paper reanalyses cross-sectional information on children examined in Britain in the 1930s. We assess associations between socio-economic status and diet and the components of childhood stature. The analyses were based on the records of 2990 children aged 2 years to 14 years 9 months who were examined in the Carnegie (Boyd Orr) survey of diet and health (1937-39). z-Scores for the measures of childhood stature were calculated using polynomial regression techniques with the study population as the standard. Univariable and multivariable statistical techniques were used to assess the relationships between childhood height, leg length and trunk length, and dietary and socio-economic factors measured at the level of the household. Leg length was the component of stature most strongly associated with measures of childhood diet and socio-economic status. A greater part of the difference in stature between socio-economic groups was caused by differences in leg length rather than trunk length. In multiple regression analyses, district of residence and family food expenditure were generally the two factors most strongly related to stature. In a subsample of the surveyed children, for whom birthweight information was available, trunk length and leg length were equally strongly related to birthweight. Leg length appears to be a particularly sensitive indicator of childhood socio-economic circumstances. Although contemporary studies highlight the importance of biological factors in determining childhood height, the data analysed in this study suggest that socio-economic circumstances were also important in explaining height differentials in prewar Britain. [ABSTRACT FROM AUTHOR]

Average paternal age in the UK is increasing. The public health implications of this trend have not been widely anticipated or debated. This commentary aims to contribute to such a debate. Accumulated chromosomal aberrations and mutations occurring during the maturation of male germ cells are thought to be responsible for the increased risk of certain conditions with older fathers. Growing evidence shows that the offspring of older fathers have reduced fertility and an increased risk of birth defects, some cancers, and schizophrenia. Adverse health outcomes should be weighed up against advantages for children born to older parents, mindful that these societal advantages are likely to change over time. [ABSTRACT FROM AUTHOR]

Background: Adverse childhood experiences (ACEs) such as physical and emotional abuse are strongly associated with self‐harm, but mechanisms underlying this relationship are unclear. Inflammation has been linked to both the experience of ACEs and self‐harm or suicide in prior research. This is the first study to examine whether inflammatory markers mediate the association between exposure to ACEs and self‐harm. Methods: Participants were 4,308 young people from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population‐based birth cohort in the United Kingdom. A structural equation modelling approach was used to fit a mediation model with the number of ACEs experienced between ages 0 and 9 years old (yo), levels of the inflammatory markers interleukin‐6 and C‐reactive protein measured at 9.5 yo, and self‐harm reported at 16 yo. Results: The mean number of ACEs young people experienced was 1.41 (SE 0.03). Higher ACE scores were associated with an increased risk of self‐harm at 16 yo (direct effect relative risk (RR) per additional ACE 1.11, 95% CI 1.05, 1.18, p < 0.001). We did not find evidence of an indirect effect of ACEs on self‐harm via inflammation (RR 1.00, 95% CI 1.00, 1.01, p = 0.38). Conclusions: Young people who have been exposed to ACEs are a group at high risk of self‐harm. The association between ACEs and self‐harm does not appear to be mediated by an inflammatory process in childhood, as indexed by peripheral levels of circulating inflammatory markers measured in childhood. Further research is needed to identify alternative psychological and biological mechanisms underlying this relationship. [ABSTRACT FROM AUTHOR]

Studies the increased suicide rates among males in England and Wales. Decrease in the suicide rate of females; What the trend implies about the mental health of young males; Statistics on the methods used; Changes in domestic gas supply in the 1960s from coal gas to the less toxic natural gas which resulted in reductions in the number of suicides using this method; Results; Conclusions.

Objective: Non-response to antidepressant treatment is a substantial problem in primary care, and many patients with depression require additional second-line treatments. This study aimed to examine the prevalence and patterns of antidepressant switching in the UK, and identify associated demographic and clinical factors.Method: Cohort analysis of antidepressant prescribing data from the Clinical Practice Research Datalink, a large, anonymised UK primary care database. The sample included 262,844 patients who initiated antidepressant therapy between 1 January 2005 and 31 June 2011.Results: 9.3% of patients switched to a different antidepressant product, with most switches (60%) occurring within 8 weeks of the index date. The proportion switching was similar for selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants and other antidepressants (9.3%, 9.8% and 9.2%, respectively). Most switches were to an SSRI (64.5%), and this was the preferred option regardless of initial antidepressant class. Factors predictive of switching included male gender, age, and history of self-harm and psychiatric illness.Conclusion: Over one in every 11 patients who initiates antidepressant therapy will switch medication, suggesting that initial antidepressant treatment has been unsatisfactory. Evidence to guide choice of second-line treatment for individual patients is currently limited. Additional research comparing different pharmacological and psychological second-line treatment strategies is required in order to inform guidelines and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: The occurrence of early childhood adversity is strongly linked to later self-harm, but there is poor understanding of how this distal risk factor might influence later behaviours. One possible mechanism is through an earlier onset of puberty in children exposed to adversity, since early puberty is associated with an increased risk of adolescent self-harm. We investigated whether early pubertal timing mediates the association between childhood adversity and later self-harm. Methods: Participants were 6698 young people from a UK population-based birth cohort (ALSPAC). We measured exposure to nine types of adversity from 0 to 9 years old, and self-harm when participants were aged 16 and 21 years. Pubertal timing measures were age at peak height velocity (aPHV – males and females) and age at menarche (AAM). We used generalised structural equation modelling for analyses. Results: For every additional type of adversity; participants had an average 12–14% increased risk of self-harm by 16. Relative risk (RR) estimates were stronger for direct effects when outcomes were self-harm with suicidal intent. There was no evidence that earlier pubertal timing mediated the association between adversity and self-harm [indirect effect RR 1.00, 95% confidence interval (CI) 1.00–1.00 for aPHV and RR 1.00, 95% CI 1.00–1.01 for AAM]. Conclusions: A cumulative measure of exposure to multiple types of adversity does not confer an increased risk of self-harm via early pubertal timing, however both childhood adversity and early puberty are risk factors for later self-harm. Research identifying mechanisms underlying the link between childhood adversity and later self-harm is needed to inform interventions. [ABSTRACT FROM AUTHOR]

Previous research suggesting that over-general memory (OGM) may moderate the effect of life events on depressive symptoms and suicidality has sampled older adolescents or adults, or younger adolescents in high-risk populations, and has been conducted over relatively short follow-up periods. The authors examined the relationship between OGM at age 13 and life events and mental health outcomes (depression, self-harm, suicidal ideation and planning) at age 16 years within a sample of 5792 adolescents participating in the Avon Longitudinal Study of Parents and Children (ALSPAC), approximately 3800 of whom had also provided data on depression and self-harm. There was no clear evidence of either direct or interactive effects of OGM at age 13 on levels of depression at age 16. Similarly there was no clear evidence of either direct or interactive effects of OGM on suicidal ideation and self-harm. Although there was some evidence that over-general autobiographical memory was associated with reduced risk of suicidal planning and increased risk of self-harm, these associations were absent when confounding variables were taken into account. The findings imply that although OGM is a marker of vulnerability to depression and related psychopathology in high-risk groups, this cannot be assumed to generalise to whole populations. [ABSTRACT FROM AUTHOR]

Abstract: Background: Overgeneral autobiographical memory has repeatedly been identified as a risk factor for adolescent and adult psychopathology but the factors that cause such over-generality remain unclear. This study examined the association between childhood exposure to traumatic events and early adolescent overgeneral autobiographical memory in a large population sample. Methods: Thirteen-year-olds, n = 5,792, participating in an ongoing longitudinal cohort study (ALSPAC) completed a written version of the Autobiographical Memory Test. Performance on this task was examined in relation to experience of traumatic events, using data recorded by caregivers close to the time of exposure. Results: Results indicated that experiencing a severe event in middle childhood increased the likelihood of an adolescent falling into the lowest quartile for autobiographical memory specificity (retrieving 0 or 1 specific memory) at age 13 by approximately 60%. The association persisted after controlling for a range of potential socio-demographic confounders. Limitations: Data on the traumatic event exposures was limited by the relatively restricted range of traumas examined, and the lack of contextual details surrounding both the traumatic event exposures themselves and the severity of children's post-traumatic stress reactions. Conclusions: This is the largest study to date of the association between childhood trauma exposure and overgeneral autobiographical memory in adolescence. Findings suggest a modest association between exposure to traumatic events and later overgeneral autobiographical memory, a psychological variable that has been linked to vulnerability to clinical depression. [Copyright &y& Elsevier]

Background: Teachers are at heightened risk of poor mental health and well-being, which is likely to impact on the support they provide to students, and student outcomes. We conducted a cluster randomised controlled trial, to test whether an intervention to improve mental health support and training for high school teachers led to improved mental health and well-being for teachers and students, compared to usual practice. We also conducted a cost evaluation of the intervention.Methods and Findings: The intervention comprised (i) Mental Health First Aid training for teachers to support students; (ii) a mental health awareness session; and (iii) a confidential staff peer support service. In total 25 mainstream, non-fee-paying secondary schools stratified by geographical area and free school meal entitlement were randomly allocated to intervention (n = 12) or control group (n = 13) after collection of baseline measures. We analysed data using mixed-effects repeated measures models in the intention-to-treat population, adjusted for stratification variables, sex, and years of experience. The primary outcome was teacher well-being (Warwick-Edinburgh Mental Well-being Scale). Secondary outcomes were teacher depression, absence, and presenteeism, and student well-being, mental health difficulties, attendance, and attainment. Follow-up was at months 12 (T1) and 24 (T2). We collected process data to test the logic model underpinning the intervention, to aid interpretation of the findings. A total of 1,722 teachers were included in the primary analysis. Teacher well-being did not differ between groups at T2 (intervention mean well-being score 47.5, control group mean well-being score 48.4, adjusted mean difference -0.90, 95% CI -2.07 to 0.27, p = 0.130). The only effect on secondary outcomes was higher teacher-reported absence among the intervention group at T2 (intervention group median number of days absent 0, control group median number of days absent 0, ratio of geometric means 1.04, 95% CI 1.00 to 1.09, p = 0.042). Process measures indicated little change in perceived mental health support, quality of relationships, and work-related stress. The average cost of the intervention was £9,103 per school. The study's main limitations were a lack of blinding of research participants and the self-report nature of the outcome measures.Conclusions: In this study, we observed no improvements to teacher or student mental health following the intervention, possibly due to a lack of impact on key drivers of poor mental health within the school environment. Future research should focus on structural and cultural changes to the school environment, which may be more effective at improving teacher and student mental health and well-being.Trial Registration: www.isrctn.com ISRCTN95909211. [ABSTRACT FROM AUTHOR]

Although the Autobiographical Memory Test (AMT) is widely used its psychometric properties have rarely been investigated. This paper utilises data gathered from a 10-item written version of the AMT, completed by 5792 adolescents participating in the Avon Longitudinal Study of Parents and Children, to examine the psychometric properties of the measure. The results show that the scale derived from responses to the AMT operates well over a wide range of scores, consistent with the aim of deriving a continuous measure of over-general memory. There was strong evidence of group differences in terms of gender, low negative mood, and IQ, and these were in agreement when comparing an item response theory (IRT) approach with that based on a sum score. One advantage of the IRT model is the ability to assess and consequently allow for differential item functioning. This additional analysis showed evidence of response bias for both gender and mood, resulting in attenuation in the mean differences in AMT across these groups. Implications of the findings for the use of the AMT measure in different samples are discussed. [ABSTRACT FROM AUTHOR]

Background: Little is known about the characteristics of people who die by jumping from different locations (e.g. bridges, buildings) and the factors that might influence the effectiveness of suicide prevention measures at such sites. Methods: We collected data on suicides by jumping (n = 134) between 1994 and 2003 in Bristol, UK, an area that includes the Clifton Suspension Bridge, a site renowned for suicide. We also carried out interviews with Bridge staff and obtained records of fatal and non-fatal incidents on the bridge (1996–2005) before and after preventive barriers were installed in 1998. Results: The main sites from which people jumped were bridges (n = 71); car parks (n = 12); cliffs (n = 20) and places of residence (n = 20). People jumping from the latter tended to be older than those jumping from other sites; people jumping from different sites did not differ in their levels of past self-harm or current psychiatric care. As previously reported, suicides from the bridge halved after the barriers were erected; people jumping from the Clifton Suspension Bridge following their construction were more likely to have previously self-harmed and to have received specialist psychiatric care. The number of incidents on the bridge did not decrease after barriers were installed but Bridge staff reported that the barriers ‘bought time’, making intervention possible. Conclusion: There is little difference in the characteristics of people jumping from different locations. Barriers may prevent suicides among people at lower risk of repeat self-harm. Staff at suicide hotspots can make an important contribution to the effectiveness of installations to prevent suicide by jumping. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the national distribution of prolonged waiting for elective day case and inpatient surgery, and to examine associations of prolonged waiting with markers of NHS capacity, activity in the independent sector, and need. Setting: NHS hospital trusts in England. Population: People waiting for elective treatment in the specialties of general surgery; ear, nose and throat surgery; ophthalmic surgery; and trauma and orthopaedic surgery. Main outcome measure: Numbers of people waiting six months or longer (prolonged waiting). Characteristics of trusts with large numbers waiting six months or longer were examined by using logistic regression. Results: The distribution of numbers of people waiting for day case or elective surgery in all the specialties examined was highly positively skewed. Between 52% and 83% of patients waiting longer than six months in the specialties studied were found in one quarter of trusts, which in turn contributed 23-45% of the national throughput specific to the specialty. In general, there was little evidence to show that capacity (measured by numbers of operating theatres, dedicated day case theatres, available beds, and bed occupancy rate) or independent sector activity were associated with prolonged waiting, although exceptions were noted for individual specialties. There was consistent evidence showing an increase in prolonged waiting, with increased numbers of anaesthetists across all specialties and with increased bed occupancy rates for ear, nose, and throat surgery. Markers of greater need for health care, such as deprivation score and rate of limiting long term illness, were inversely associated with prolonged waiting. Conclusion: In most instances, substantial numbers of patients waiting unacceptably long periods for elective surgery were limited to a small number of hospitals. Little and inconsistent support was found for associations of prolonged waiting with markers of capacity, independent sector... [ABSTRACT FROM AUTHOR]

Background and aims: Varenicline and nicotine replacement therapy (NRT) are the most commonly used medications to quit smoking. Given their widespread use, monitoring adverse risks remains important. This study aimed to estimate the neuropsychiatric and cardiovascular risks associated with varenicline and NRT as used in routine UK care. Design Case–cross‐over study. Setting: UK‐based electronic primary care records in the Clinical Practice Research Datalink from 2006 to 2015 linked to hospital and mortality data sets. Participants: Adult smokers (n =282,429) observed during periods when exposed and not exposed to either varenicline or NRT. Measurements Main outcomes included suicide, self‐harm, myocardial infarction (MI), all‐cause death and cause‐specific death [MI, chronic obstructive pulmonary disease (COPD)]. In primary analyses, conditional logistic regression was used to compare the chance of varenicline or NRT exposure during the risk period (90 days prior to the event) with the chance of exposure during an earlier single reference period (91–180 days prior to the event) or multiple 90‐day reference periods to increase statistical power. Findings In the primary analyses, findings were inconclusive for the associations between varenicline and the main outcomes using a single reference period, while NRT was associated with MI [odds ratio (OR) = 1.40, 95% confidence interval (CI) = 1.18–1.67]. Using multiple reference periods, varenicline was associated with an increased risk of self‐harm (OR = 1.32, 95% CI = 1.12–1.56) and suicide (OR = 3.56, 95% CI = 1.32–9.60) but a reduction in all‐cause death (OR = 0.75, 95% CI = 0.61–0.93). NRT was associated with MI (OR = 1.54, 95% CI = 1.36–1.74), self‐harm (OR = 1.30, 95% CI = 1.18–1.44) and deaths from MI (OR = 1.53, 95% CI = 1.11–2.10), COPD (OR = 1.33, 95% CI = 1.14–1.56) and all causes (OR = 1.28, 95% CI = 1.18–1.40) when using multiple reference periods. Conclusions: There appear to be positive associations between (1) nicotine replacement therapy (NRT) and myocardial infarction, death and risk of self‐harm and (2) varenicline and increased risk of self‐harm and suicide, as well as a negative association between varenicline and all‐cause death. The associations may not be causal. They may reflect health changes at the time of smoking cessation (nicotine replacement therapy is prescribed for people with cardiac problems) or be associated with quit attempts (exposure to both medicines was associated with self‐harm). [ABSTRACT FROM AUTHOR]

Background: Self-harm and eating disorders are often comorbid in clinical samples but their co-occurrence in the general population is unclear. Given that only a small proportion of individuals who self-harm or have disordered eating present to clinical services, and that both self-harm and eating disorders are associated with substantial morbidity and mortality, it is important to study these behaviours at a population level.Methods: We assessed the co-occurrence of self-harm and disordered eating behaviours in 3384 females and 2326 males from a UK population-based cohort: the Avon Longitudinal Study of Parents and Children (ALSPAC). Participants reported on their self-harm and disordered eating behaviours (fasting, purging, binge-eating and excessive exercise) in the last year via questionnaire at 16 and 24 years. At each age we assessed how many individuals who self-harm also reported disordered eating, and how many individuals with disordered eating also reported self-harm.Results: We found high comorbidity of self-harm and disordered eating. Almost two-thirds of 16-year-old females, and two-in-five 24-year old males who self-harmed also reported some form of disordered eating. Young people with disordered eating reported higher levels of self-harm at both ages compared to those without disordered eating.Limitations: We were not able to measure whether participants identified their disordered eating as a method of self-harm.Conclusions: Self-harm and disordered eating commonly co-occur in young people in the general population. It is important to screen for both sets of difficulties to provide appropriate treatment. [ABSTRACT FROM AUTHOR]

Background: Suicide rates have risen in young people in several high-income countries over the last decade. Reasons for the increases are unclear.Methods: We analysed trends in suicide rates in 15-24 year olds over the period 2000-2017 in high-income countries with populations >20 million using Joinpoint analysis. We investigated differences in the following population-level exposures between countries that are and are not experiencing suicide rates rises: 1) 2008 economic recession as indexed by changes in GDP; 2) Gini income inequality; 3) daily social media use.Results: Four of the 11 countries studied are experiencing youth suicide rate rises: Australia, Canada, the UK, the USA. The year the increase began ranged from 2003 (95% confidence interval: 2002, 2007) in the UK to 2009 (95% CI: 2007, 2012) in Australia. There was little evidence of an association between social media use and youth suicide trends, and inconsistent evidence regarding the impact of the 2008 economic recession. Suicide rate rises were seen in countries with higher GDP per capita (Wilcoxon rank sum (WRS) z=-2.27; p=0.02) and income inequality (WRS z=-2.45; p=0.01) in 2008.Limitations: Suicide data were only available until 2016/2017. Social media and income inequality data were not available for all study years. The effect of other important factors were not investigated due to a lack of comparable data.Conclusions: Our analyses indicate that the most populous high-income countries experiencing a rise in youth suicide rates are predominantly English-speaking, with higher levels of income inequality and GDP. These findings provide preliminary evidence regarding possible contributory factors to guide further research. [ABSTRACT FROM AUTHOR]

Background: Analgesics are used most frequently in fatal and non-fatal medicinal self-poisonings. Knowledge about their relative toxicity in overdose is important for clinicians and regulatory agencies.Methods: Using data for 2005-2012 we investigated case fatality (number of suicides relative to number of non-fatal self-poisonings) of paracetamol, aspirin, codeine, dihydrocodeine, tramadol, paracetamol with codeine (co-codamol), paracetamol with dihydrocodeine (co-dydramol), ibuprofen and co-proxamol (paracetamol plus dextropropoxyphene; withdrawn in the UK in 2008 due to high toxicity). Data on suicides obtained from the Office for National Statistics and on non-fatal self-poisonings from the Multicentre Study of Self-harm in England. Case fatality was estimated for each drug, using paracetamol as the reference category.Results: Compared to paracetamol and based on single drug deaths the case fatality index of dihydrocodeine was considerably elevated (odds ratio (OR) 12.81, 95% Confidence Interval (CI) 10.19-16.12). Case fatality indices for tramadol (OR 4.05, 95% CI 3.38-4.85) and codeine (OR 2.21, 95% CI 1.81-2.70) were also significantly higher than for paracetamol. The results when multiple drug deaths were included produced similar results. The relative toxicity of co-proxamol far exceeded that of the other analgesics.Limitations: Data on fatal self-poisonings were based on national data, whereas those for non-fatal poisonings were based on local data.Conclusions: Dihydrocodeine and tramadol are particularly toxic in overdose and codeine is also relatively toxic. They should be prescribed with caution, particularly to individuals at risk of self-harm. [ABSTRACT FROM AUTHOR]

Purpose: The number of antidepressants prescribed in the UK has been increasing over the last 25 years; however, the reasons for this are not clear. This study examined trends in antidepressant prescribing in the UK between 1995 and 2011 according to age, sex, and drug class, and investigated reasons for the increase in prescribing over this period.Methods: This is a retrospective analysis of antidepressant prescribing data from the Clinical Practice Research Datalink: a large, anonymised, primary care database in the UK. The dataset used in this study included 138 practices, at which a total of 1,524,201 eligible patients were registered across the 17-year period. The proportion of patients who received at least one antidepressant prescription and the number of patients who started a course of antidepressants were calculated for each year of the study. We used person years (PY) at risk as the denominator. The duration of treatment for those starting antidepressants was also examined.Results: 23% of patients were prescribed an antidepressant on at least one occasion over the 17-year study period. Antidepressant prescriptions rose from 61.9 per 1000 PY in 1995 to 129.9 per 1000 PY in 2011. This was largely driven by an increase in prescribing of selective serotonin reuptake inhibitors and 'other' antidepressants. In contrast, incidence rates of those starting antidepressants remained relatively stable (1995: 21.3 per 1000 PY; 2011: 17.9 per 1000 PY). The duration of treatment increased with later starting years, with an increasing proportion of long-term use, and decrease in short-term use.Conclusion: The increase in antidepressant prescribing over the study period appears to be driven by an increase in long-term use of these medications. [ABSTRACT FROM AUTHOR]

Background: Teachers have been shown to have high levels of stress and common mental disorder, but few studies have examined which factors within the school environment are associated with poor teacher mental health.Methods: Teachers (n=555) in 8 schools completed self-report questionnaires. Levels of teacher wellbeing (Warwick Edinburgh Mental Wellbeing Scale-WEMWBS) and depressive symptoms (Patient Health Questionnaire-PHQ-9) were measured and associations between these measures and school-related factors were examined using multilevel multivariable regression models.Results: The mean (SD) teacher wellbeing score (47.2 (8.8)) was lower than reported in working population samples, and 19.4% had evidence of moderate to severe depressive symptoms (PHQ-9 scores >10). Feeling unable to talk to a colleague when feeling stressed or down, dissatisfaction with work and high presenteeism were all strongly associated with both poor wellbeing (beta coefficients ranged from -4.65 [-6.04, -3.28] to -3.39 [-5.48, -1.31]) and depressive symptoms (ORs ranged from 2.44 [1.41, 4.19] to 3.31 [1.70, 6.45]). Stress at work and recent change in school governance were also associated with poor wellbeing (beta coefficients=-4.22 [-5.95, -2.48] and -2.17 [-3.58, -0.77] respectively), while sickness absence and low student attendance were associated with depressive symptoms (ORs=2.14 [1.24, 3.67] and 1.93 [1.06, 6.45] respectively).Limitations: i) This was a cross-sectional study; causal associations cannot be identified ii) several of the measures were self-report iii) the small number of schools reduced study power for the school-level variablesConclusions: Wellbeing is low and depressive symptoms high amongst teachers. Interventions aimed at improving their mental health might focus on reducing work related stress, and increasing the support available to them. [ABSTRACT FROM AUTHOR]

Objective: Insulin and the insulin-like growth factor (IGF) system regulate growth and are involved in determining muscle mass, strength and body composition. We hypothesised that IGF-I and IGF-II are associated with improved, and insulin with worse, physical performance in old age. Methods: Physical performance was measured using the get-up and go timed walk and flamingo balance test at 63-86 years. We examined prospective associations of insulin, IGF-I, IGF-II and IGFBP-3 with physical performance in the UK-based Caerphilly Prospective Study (CaPS; n = 739 men); and cross-sectional insulin, IGF-I, IGF-II, IGFBP-2 and IGFBP-3 in the Boyd Orr cohort (n = 182 men, 223 women). Results: In confounder-adjusted models, there was some evidence in CaPS that a standard deviation (SD) increase in IGF-I was associated with 1.5% faster get-up and go test times (95% CI: -0.2%, 3.2%; p = 0.08), but little association with poor balance, 19 years later. Coefficients in Boyd Orr were in the same direction as CaPS, but consistent with chance. Higher levels of insulin were weakly associated with worse physical performance (CaPS and Boyd Orr combined: get-up and go time = 1.3% slower per SD log-transformed insulin; 95% CI: 0.0%, 2.7%; p = 0.07; OR poor balance 1.13; 95% CI; 0.98, 1.29; p = 0.08), although associations were attenuated after controlling for body mass index (BMI) and co-morbidities. In Boyd Orr, a one SD increase in IGFBP-2 was associated with 2.6% slower get-up and go times (95% CI: 0.4%, 4.8% slower; p = 0.02), but this was only seen when controlling for BMI and co-morbidities. There was no consistent evidence of associations of IGF-II, or IGFBP-3 with physical performance. Conclusions: There was some evidence that high IGF-I and low insulin levels in middle-age were associated with improved physical performance in old age, but estimates were imprecise. Larger cohorts are required to confirm or refute the findings. [ABSTRACT FROM AUTHOR]

Background Socio-economic influences over a lifetime impact on health and may contribute to poor physical functioning in old age. Methods The authors examined the impact of both childhood and adulthood socio-economic factors on locomotor function at 63-86 years (measured with the get up and go timed walk and flamingo balance test) in the UK-based Boyd Orr (n=405) and Caerphilly (n=1196) prospective cohorts. Results There was a marked reduction in walking speed and balance time with increasing age. Each year of age was associated with a 1.7% slower walk time and a 14% increased odds of poor balance. Participants who moved from a low socio-economic position in childhood to a high socio-economic position in adulthood had 3% slower walking times (95% CI -- 2% to 8%) than people with a high socio-economic position in both periods. Participants who moved from a high socio-economic position in childhood to a low adulthood socio-economic position had 5% slower walking times (95% CI --2% to 12%). Participants with a low socio-economic position in both periods had 10% slower walking times (95% CI 5% to 16%; p for trend<0.001). In Boyd Orr, low socio-economic position in childhood was associated with poor balance in old age (OR per worsening category=1.26; 95% CI 1.01 to 1.57; p=0.043), as was socio-economic position in adulthood (OR=1.71; 95% CI 1.20 to 2.45; p=0.003). Similar associations were not observed in Caerphilly. Conclusion Accumulating socio-economic disadvantage from childhood to adulthood is associated with slower walking time in old age, with mixed results for balance ability. [ABSTRACT FROM AUTHOR]

Background: In order to reduce fatal self-poisoning legislation was introduced in the UK in 1998 to restrict pack sizes of paracetamol sold in pharmacies (maximum 32 tablets) and non-pharmacy outlets (maximum 16 tablets), and in Ireland in 2001, but with smaller maximum pack sizes (24 and 12 tablets). Our aim was to determine whether this resulted in smaller overdoses of paracetamol in Ireland compared with the UK. Methods: We used data on general hospital presentations for non-fatal self-harm for 2002 - 2007 from the Multicentre Study of Self-harm in England (six hospitals), and from the National Registry of Deliberate Self-harm in Ireland. We compared sizes of overdoses of paracetamol in the two settings. Results: There were clear peaks in numbers of non-fatal overdoses, associated with maximum pack sizes of paracetamol in pharmacy and non-pharmacy outlets in both England and Ireland. Significantly more pack equivalents (based on maximum non-pharmacy pack sizes) were used in overdoses in Ireland (mean 2.63, 95% CI 2.57-2.69) compared with England (2.07, 95% CI 2.03-2.10). The overall size of overdoses did not differ significantly between England (median 22, interquartile range (IQR) 15-32) and Ireland (median 24, IQR 12-36). Conclusions: The difference in paracetamol pack size legislation between England and Ireland does not appear to have resulted in a major difference in sizes of overdoses. This is because more pack equivalents are taken in overdoses in Ireland, possibly reflecting differing enforcement of sales advice. Differences in access to clinical services may also be relevant. [ABSTRACT FROM AUTHOR]

Objective To assess the effect of the UK Committee on Safety of Medicines' announcement in January 2005 of withdrawal of co-proxamol on analgesic prescribing and poisoning mortality. Design Interrupted time series analysis for 1998-2007. Setting England and Wales. Data sources Prescribing data from the prescription statistics department of the Information Centre for Health and Social Care (England) and the Prescribing Services Unit, Health Solutions Wales (Wales). Mortality data from the Office for National Statistics. Main outcome measures Prescriptions. Deaths from drug poisoning (suicides, open verdicts, accidental poisonings) involving single analgesics. Results A steep reduction in prescribing of co-proxamol occurred in the post-intervention period 2005-7, such that the number of prescriptions fell by an average of 859 (95% confidence interval 653 to 1065) thousand per quarter, equating to an overall decrease of about 59%, Prescribing of some other analgesics (co-codamol, paracetamol, co-dydramol, and codeine) increased significantly during this time. These changes were associated with a major reduction in deaths involving co-proxamol compared with the expected number of deaths (an estimated 295 fewer suicides and 349 fewer deaths including accidental poisonings), but no statistical evidence for an increase in deaths involving either other analgesics or other drugs. Conclusions Major changes in prescribing after the announcement of the withdrawal of co-proxamol have had a marked beneficial effect on poisoning mortality involving this drug, with little evidence of substitution of suicide method related to increased prescribing of other analgesics. [ABSTRACT FROM AUTHOR]

Summary: Background: There is no conclusive evidence that screening based on serum prostate-specific antigen (PSA) tests decreases prostate-cancer mortality. Since its introduction in the USA around 1990, uptake of PSA testing has been rapid in the USA, but much less common in the UK. Our aim was to study trends over time in prostate-cancer mortality and incidence in the USA and UK in 1975–2004, and compare these patterns with trends in screening and treatment. Methods: Joinpoint regression analysis of cancer-mortality statistics from Cancer Research UK (London, UK) and from the US National Cancer Institute Surveillance, Epidemiology and End Results (SEER) programme from 1975 to 2004 was used to estimate the annual percentage change in prostate-cancer mortality in both countries and the points in time when trends changed. The ratio of USA to UK age-adjusted prostate-cancer incidence was also assessed. Findings: Age-specific and age-adjusted prostate-cancer mortality peaked in the early 1990s at almost identical rates in both countries, but age-adjusted mortality in the USA subsequently declined after 1994 by −4·17% (95% CI −4·34 to −3·99) each year, four-times the rate of decline in the UK after 1992 (−1·14% [−1·44 to −0·84]). The mortality decline in the USA was greatest and most sustained in patients aged 75 years or older (−5·32% [−8·23 to −2·32]), whereas death rates had plateaued in this age group in the UK by 2000. The mean ratio of USA to UK age-adjusted prostate-cancer incidence rates in 1975–2003 was 2·5, with a pronounced peak around the time that PSA testing was introduced in the USA. Numbers needed to treat to prevent one death from prostate cancer were 33 000 in the 55–64-year age group. Interpretation: The striking decline in prostate-cancer mortality in the USA compared with the UK in 1994–2004 coincided with much higher uptake of PSA screening in the USA. Explanations for the different trends in mortality include the possibility of an early effect of initial screening rounds on men with more aggressive asymptomatic disease in the USA, different approaches to treatment in the two countries, and bias related to the misattribution of cause of death. Speculation over the role of screening will continue until evidence from randomised controlled trials is published. Funding: ProMPT (Prostate Cancer: Mechanisms of Progression and Treatment) collaborative (UK National Cancer Research Institute, London, UK, and UK Medical Research Council, London, UK). [Copyright &y& Elsevier]

Conclusion: Legislation restricting pack sizes of paracetamol and salicylates in the United Kingdom has had substantial beneficial effects on mortality and morbidity associated with self poisoning using these drugs. [ABSTRACT FROM AUTHOR]

Compares the costs associated with early discharge to a hospital at home scheme and those associated with continued care in an acute hospital, while offering the views of the National Health Service (NHS) and social services in Great Britain. Advantages associated with hospital at home schemes; Provision of an economic evaluation of continued care; Methods used to determine the effectiveness of the two processes. INSET: Key messages.

The article presents the case of Kerrie Wooltorton, who died on September 19, 2007 from deliberate self-poisoning with antifreeze after refusing life saving treatment, to discuss the challenges in considering the role of advance directives in suicidal behavior in Great Britain. A brief overview of the Mental Capacity Act 2005 is presented. It references the findings of a research study of individuals in England who had died following self-poisoning in 2005 but had survived long enough to reach hospital. It presents particular questions that clinicians should consider when dealing with advance directives to refuse treatment after suicidal behavior. INSETS: CASE HISTORIES;ADVICE FROM MEDICAL PROTECTION SOCIETY.

Studies the opportunity cost in the rise of antidepressant prescribing in the NHS by evaluating it in terms of the effective treatment, cognitive behavior therapy. Use of the British Department of Health data to quantify changes between 1991 and 2002; Factors contributing to increased antidepressant prescribing; Other alternatives to antidepressants and cognitive behavior therapy; Indication more research is needed to establish a balance between drugs and non-pharmacological treatment for depression.

The article offers information on a study that aimed to analyze the clinical and social of the adolescent self harm. Topics discussed includes associations between suicide attempts in adolescence and poor outcomes in adulthood, influences of self harm on health and development across the life course and lifetime history of self harm.

Background: In order to reduce fatal self-poisoning legislation was introduced in the UK in 1998 to restrict pack sizes of paracetamol sold in pharmacies (maximum 32 tablets) and non-pharmacy outlets (maximum 16 tablets), and in Ireland in 2001, but with smaller maximum pack sizes (24 and 12 tablets). Our aim was to determine whether this resulted in smaller overdoses of paracetamol in Ireland compared with the UK.Methods: We used data on general hospital presentations for non-fatal self-harm for 2002-2007 from the Multicentre Study of Self-harm in England (six hospitals), and from the National Registry of Deliberate Self-harm in Ireland. We compared sizes of overdoses of paracetamol in the two settings.Results: There were clear peaks in numbers of non-fatal overdoses, associated with maximum pack sizes of paracetamol in pharmacy and non-pharmacy outlets in both England and Ireland. Significantly more pack equivalents (based on maximum non-pharmacy pack sizes) were used in overdoses in Ireland (mean 2.63, 95% CI 2.57-2.69) compared with England (2.07, 95% CI 2.03-2.10). The overall size of overdoses did not differ significantly between England (median 22, interquartile range (IQR) 15-32) and Ireland (median 24, IQR 12-36).Conclusions: The difference in paracetamol pack size legislation between England and Ireland does not appear to have resulted in a major difference in sizes of overdoses. This is because more pack equivalents are taken in overdoses in Ireland, possibly reflecting differing enforcement of sales advice. Differences in access to clinical services may also be relevant. [ABSTRACT FROM AUTHOR]