Adult Psychiatric Morbidity Survey Research Articles

Suicidal Thoughts and Behaviors in Parents Caring for Children with Disabilities and Long-Term Illnesses

Objective There is a growing body of evidence on suicide risk in family carers, but minimal research on parents caring for children with disabilities and long-term illnesses. The aim of this study was to conduct the first dedicated research on suicide risk in parent carers and identify: (1) the number of parent carers experiencing suicidal thoughts and behaviors, and (2) the risk and protective factors for suicidality in this population. Method A cross-sectional survey of parent carers in England (n = 750), co-produced with parent carers. Suicidal thoughts and behaviors were measured with questions from the Adult Psychiatric Morbidity Survey. Frequencies summarized the proportion of carers experiencing suicidal thoughts and behaviors. Logistic regressions identified risk and protective factors. Results 42% of parents had experienced suicidal thoughts and behaviors while caring for a disabled or chronically ill child. Only half had sought help for these experiences. Depression, entrapment, dysfunctional coping, and having a mental health diagnosis prior to caring, were significant risk factors. Conclusion Parent carers contemplate suicide at levels that exceed those of other family carers and the general public. There is an urgent need, in policy and practice, to recognize parent carers as a priority group for prevention and intervention.

Personality traits and change in depression status at 18 months: Findings from a British Psychiatric Morbidity Survey

BackgroundDepression is a common mental disorder, yet it shows low remission rates. The available evidence on personality traits as factors associated with the course of depression has common methodological limitations. Identifying personality traits linked with depression can improve understanding of the course of illness. Therefore, we aimed to investigate personality traits that are associated with the course of depression over 18 months. Methodslongitudinal data of 2366 Adult Psychiatric Morbidity Survey respondents were analysed. Assessments were applied at two-time points (baseline) and follow-up (about 18 months later). We assessed the total score on the screening questionnaire from the Structured Clinical Interview (SCID-II) for the dependent, obsessive-compulsive, and borderline personalities. Depression was measured using the revised Clinical Interview Schedule (CIS-R) version. ResultsAn increase of one score on the borderline personality scale at baseline increased the odds of experiencing persistent depression by 1.50 times (OR = 1.50, 95 % CI [1.22–1.86]), depression onset by 1.30 times (OR = 1.30, 95 % CI [1.14–1.50]), and recovery by 1.52 times (OR = 1.52, 95 % CI [1.35–1.70]), comparing to no depression group. Elevated scores of dependent personality traits significantly predicted depression persistence (OR = 1.95, 95 % CI [1.52–2.49]). An increase of one score on the obsessive-compulsive personality scale increases the odds of depression onset by 1.21 times (OR = 1.21, 95 % CI [1.04–1.39]). LimitationsThe APMS survey defined depression statuses in a limited sense, which may affect the generalisability of these results. ConclusionThe present study confirms previous findings and contributes evidence suggesting that personality dysfunctions worsen depression outcomes.

Indirect victims of violence: Mental health and the close relatives of serious assault victims in England

An extensive body of evidence shows the impact of being the direct victim of a serious assault. However, much less is known about the impact on the family and close relatives of victims, who may be considered indirect victims. Based on analyses of the 2014 Adult Psychiatric Morbidity Survey, a face-to-face, cross-sectional probability-sample survey of 7519 adults aged 16 and over in England, this article estimates what proportion of the population was closely related to a victim of serious assault, and whether this experience was associated with a higher prevalence of feeling unsafe, depression and anxiety disorder, post-traumatic stress, self-harm, and suicidality. Descriptive and multivariable regression analyses were conducted, adjusting for complex survey design and potentially confounding factors. Results show that one in twenty adults (4.5%, n = 345) was closely related to a victim of serious assault (95% confidence interval (CI):4.0–5.2%). Close adult relatives of assault victims were more likely than the rest of the population to have been direct victims of violence and abuse themselves, to have experienced multiple other adversities, and to live in more deprived neighbourhoods. However, even when controlling for these experiences, relatives of victims had adjusted odds of feeling unsafe in the neighbourhood where they lived 2.36 times higher than the rest of the population (CI:1.26–4.44), and their odds of having a depressive or anxiety disorder were 1.37 times higher (0.99–1.90). These analyses indicate that relatives in England may already be vulnerable, with potential to also be further affected by the experiences of family members. To more fully account for the effects of violence in society, research with indirect victims of serious violence in the context of their own experiences of direct victimization and wider adversities is required. This could be factored into a broader remit for victim support services which includes support for victims’ families.

Population density and receipt of care for common mental disorders: a cross-sectional analysis of English household data from the 2014 Adult Psychiatric Morbidity Survey

ObjectivesPeople living in less urban areas in the UK may have reduced access to mental healthcare compared with people in urban areas. Although this was not reported in the 2000...

Socioeconomic status, alcohol use and the role of social support and neighbourhood environment among individuals meeting criteria for a mental health problem: a cross-sectional study

PurposeIndicators of socioeconomic status (SES), such as education and occupational grade, are known to be associated with alcohol use but this has not been examined among individuals with a mental health problem. This study developed latent classes of SES, their associations with alcohol use, and examined the indirect effect via social support and neighbourhood environment.MethodsA secondary analysis of the 2014 Adult Psychiatric Morbidity Survey was conducted among participants with a mental health problem (N = 1,436). SES classes were determined using a range of indicators. Alcohol use was measured using the Alcohol Use Disorder Identification Test. Social support and neighbourhood neighbourhood environment were measured using validated questionnaires. A latent class analysis was conducted to develop SES classes. Multinomial logistic regression examined associations of SES and alcohol use. Structural equation models tested indirect effects via social support and neighbourhood environment.ResultsA four-class model of SES was best-fitting; “economically inactive,GCSE-level and lower educated,social renters”, “intermediate/routine occupation,GCSE-level educated,mixed owner/renters”, “retired, no formal education,homeowners”, and “professional occupation,degree-level educated,homeowners”. Compared to “professional occupation,degree-level educated, homeowners”, SES classes were more likely to be non-drinkers; odds were highest for “economically inactive,GCSE-level and lower educated,social renters” (OR = 4.96,95%CI 3.10–7.93). “Retired, no formal education,homeowners” were less likely to be hazardous drinkers (OR = 0.35,95%CI 0.20–0.59). Associations between “economically inactive,GCSE-level and lower educated,social renters” and “retired, no formal education,homeowners” and non- and harmful drinking via social support and neighbourhood environment were significant.ConclusionsIn contrast to the alcohol harms paradox, among individuals with a mental health problem, lower SES groups were more likely to be non-drinkers while no associations with harmful drinking were found. There is also a need to examine the alcohol harms paradox in the context of the area in which they live.

Prevalence and nature of workplace bullying and harassment and associations with mental health conditions in England: a cross-sectional probability sample survey

BackgroundEvidence on workplace bullying and harassment (WBH) in the UK has not used probability-sample surveys with robust mental health assessments. This study aimed to profile the prevalence and nature of WBH in England, identify inequalities in exposure, and quantify adjusted associations with mental health.MethodsData were from the 2014 Adult Psychiatric Morbidity Survey, a cross-sectional probability-sample survey of the household population in England. Criteria for inclusion in the secondary analysis were being aged 16–70 years and in paid work in the past month (n = 3838). Common mental disorders (CMDs) were assessed using the Clinical Interview Schedule-Revised and mental wellbeing using the Warwick-Edinburgh Mental Wellbeing Scale. Analyses were weighted. We examined associations between past-year WBH and current CMD using multivariable regression modelling, adjusting for sociodemographic factors. Interaction terms tested for gender differences in associations. The study received ethical approval (ETH21220–299).ResultsOne in ten employees (10.6%, n = 444/3838) reported past-year experience of WBH, with rates higher in women (12.2%, n = 284/2189), those of mixed, multiple, and other ethnicity (21.0%, n = 15/92), and people in debt (15.2%, n = 50/281) or living in cold homes (14.6%, n = 42/234). Most commonly identified perpetrators of WBH were line managers (53.6%, n = 244/444) or colleagues (42.8%, n = 194/444). Excessive criticism (49.3%, n = 212/444), verbal abuse (42.6%, n = 187/444), and humiliation (31.4%, n = 142/444) were the most common types. WBH was associated with all indicators of poor mental health, including CMD (adjusted odds ratio [aOR] 2.65, 95% CI 2.02–3.49), and 11 of 14 mental wellbeing indicators, including lower levels of confidence (aOR 0.57, 0.46–0.72) and closeness to others (aOR 0.57, 0.46–0.72). Patterns of association between WBH and mental health were similar in men and women.ConclusionsThese findings reinforce a need for more cohesive UK legislation against WBH; guidance on recognition of bullying behaviours for employees, managers, and human resources, focusing on prevention and early intervention, and increased awareness of the impact of WBH on mental health among health service practitioners. Limitations include reliance on cross-sectional data collected before pandemic-related and other changes in workplace practices. Longitudinal data are needed to improve evidence on causality and the longevity of mental health impacts.

The public health significance of prior homelessness: findings on multimorbidity and mental health from a nationally representative survey.

The associations of prior homelessness with current health are unknown. Using nationally representative data collected in private households in England, this study aimed to examine Common Mental Disorders (CMDs), physical health, alcohol/substance dependence, and multimorbidities in people who formerly experienced homelessness compared to people who never experienced homelessness. This cross-sectional study utilised data from the 2007 and 2014 Adult Psychiatric Morbidity Surveys. Former homelessness and current physical health problems were self-reported. Current CMDs, alcohol dependence and substance dependence were ascertained using structured validated scales. Survey-weighted logistic regression was used to compare multimorbidities (conditions in combination) for participants who formerly experienced homelessness with those who had never experienced homelessness, adjusting for sociodemographic characteristics, smoking status and adverse experiences. Population attributable fractions (PAFs) were calculated. Of 13,859 people in the sample, 535 formerly experienced homelessness (3.6%, 95% CI 3.2-4.0). 44.8% of people who formerly experienced homelessness had CMDs (95% CI 40.2-49.5), compared to 15.0% (95% CI 14.3-15.7) for those who had never experienced homelessness. There were substantial associations between prior homelessness and physical multimorbidity (adjusted odds ratio [aOR] 1.98, 95% CI 1.53-2.57), CMD-physical multimorbidity (aOR 3.43, 95% CI 2.77-4.25), CMD-alcohol/substance multimorbidity (aOR 3.53, 95% CI 2.49-5.01) and trimorbidity (CMD-alcohol/substance-physical multimorbidity) (aOR 3.26, 95% CI 2.20-4.83), in models adjusting for sociodemographic characteristics and smoking. After further adjustment for adverse experiences, associations attenuated but persisted for physical multimorbidity (aOR 1.40, 95% CI 1.10-1.79) and CMD-physical multimorbidity (aOR 1.55, 95% CI 1.20-2.00). The largest PAFs were observed for CMD-alcohol/substance multimorbidity (17%) and trimorbidity (16%). Even in people currently rehoused, marked inequities across multimorbidities remained evident, highlighting the need for longer-term integrated support for people who have previously experienced homelessness.

Prevalence and nature of workplace bullying and harassment and associations with mental health conditions in England: a cross-sectional probability sample survey

BackgroundEvidence on workplace bullying and harassment (WBH) in the UK has not used probability-sample surveys with robust mental health assessments. This study aimed to profile the prevalence and nature of WBH in England, identify inequalities in WBH exposure, and quantify adjusted associations with mental health. MethodsData were from the 2014 Adult Psychiatric Morbidity Survey, a cross-sectional probability-sample survey of the household population in England, interviewed with verbal informed consent. Criteria for inclusion in the secondary analysis were being aged 16–70 years and in paid work in the past month (n=3838). Common mental disorders were assessed using the Clinical Interview Schedule-Revised and mental wellbeing using the Warwick-Edinburgh Mental Wellbeing Scale. Analyses were weighted. We examined associations between past-year WBH and current common mental disorders using multivariable regression modelling, adjusting for demographic and socioeconomic factors. Interaction terms tested for gender differences in associations. The study received ethics approval (ETH21220–299). FindingsOne in ten employees (10·6% (weighted), n=444/3838) reported past-year experience of WBH, with rates higher in women (12·2%, n=284/2189); those of mixed, multiple, and other ethnicity (21·0%, n=15/92); and people in debt (15·2%, n=50/281) or living in cold homes (14·6%, n=42/234). Most commonly identified perpetrators of WBH were line managers (53·6%, n=244/444) or colleagues (42·8%, n=194/444). Excessive criticism (49·3%, n=212/444), verbal abuse (42·6%, n=187/444), and humiliation (31·4%, n=142/444) were the most common types. WBH was associated with all adverse mental health indicators, including common mental disorders (adjusted odds ratio [aOR] 2·65, 95% CI 2·02–3·49), and 11 of 14 mental wellbeing indicators, including lower levels of confidence (aOR 0·57, 0·46–0·72) and of closeness to others (aOR 0·57, 0·46–0·72). Patterns of association between WBH and mental health were similar in men and women. InterpretationThese findings reinforce a need for more cohesive UK legislation at the national level; guidance on recognition of bullying behaviours for employees, managers, and human resources at the organisational level, focusing on prevention and early intervention, and increased awareness of the impact of WBH on mental health among health-service practitioners. Study limitations include reliance on cross-sectional data collected before pandemic-related and other major changes in workplace practices. Longitudinal data are needed to improve evidence on causality and the longevity of mental health impacts. FundingUK Prevention Research Partnership.

Mental health and service use of parents with and without borderline intellectual functioning.

People with borderline intellectual functioning (BIF) encounter greater social adversities than the general population and have an increased prevalence of mental illness. However, little is known about the socio-demographic characteristics and mental health of parents with BIF. A secondary data analysis of the Adult Psychiatric Morbidity Survey 2014 was conducted. Logistic regression models were fitted to compare differences in socio-demographic, mental health and service-use characteristics between parents and non-parents with and without BIF, and to investigate if the relationship between parent status and mental health outcomes was modified by BIF status, sex, and employment. Data from 6872 participants was analyzed; 69.1% were parents. BIF parents had higher odds of common mental disorder, severe mental illness, post-traumatic stress disorder, self-harm/suicide and were more likely to see their General Practitioner (GP) and to receive mental health treatment than non-BIF parents. BIF parents did not have a higher prevalence of mental health problems than BIF non-parents. Being a parent, after adjusting for BIF status and other confounders, was associated with increased odds of having a common mental disorder, visits to see a GP and treatment for mental health. Female parents had higher odds of treatment for mental health problems. Being a parent is associated with elevated rates of common mental disorders. There is a higher burden of mental health problems and service use in people with BIF. A greater provision of specialist support services including ascertainment is indicated for this group.

Violence and abuse exposure and health complications in older age

Abstract Background Due to the ageing population, the extent and impacts of violence in later life could become increasingly prominent. However, there is a lack of evidence on violence and its effects in older age, which impedes prevention measures. The present research draws on data collected from two nationally representative population health surveys - the Adult Psychiatric Morbidity Survey (APMS) 2014 and the English Longitudinal Study of Ageing (ELSA) to examine associations between violence and health outcomes in older adults in England. Methods APMS is a cross-sectional design and collected data on violence and abuse as well as mental health in adults aged 16+. Multivariable regression analyses were run to measure associations between violence and common mental disorder (CMD) in adults aged 60+ in comparison with the younger population group (16-59). ELSA is a panel data study, which has collected information on health, social, and economic lives of individuals aged 50 and over every two years since 2002. In wave 3, ELSA included questions on childhood abuse and life experiences of physical and sexual violence. Logistic multilevel regressions were used to examine associations between violence and subsequent limiting illness and depression. Results Violence conferred an independent risk for CMD (AOR 2.2, 95% CI:1.0-4.8) based on the APMS data. According to ELSA results, physical violence (AOR 2.50, 95%CI 1.69-3.68) and childhood abuse (AOR 2.47, 95%CI 1.51-4.04) were associated with the development of limiting illness, with sex differences between men and women observed. Conclusions Violence remains a problem that affects older people and presents risks to their health. Moreover, earlier life victimization could cause long-lasting health impacts that persist in later life. To mitigate the challenges associated with the ageing population, policies and interventions should focus on the prevention of violence and its long-lasting effects on health.

Costing the mental health harms of sexual and physical violence in adulthood: a prevalence-based analysis

Abstract Background When economists estimate how much violence ‘costs’, they rarely address the longer-term mental health harms resulting from sexual violence or the combined impact of sexual and physical violence, nor have most gender-disaggregated costs. Methods We applied prevalence-based modelling techniques to estimate the annual cost of experience of violence in adulthood, in terms of reduced quality of life and health service costs. Data were drawn from multiple sources, including the general population probability sample Adult Psychiatric Morbidity Survey. Prevalence and duration estimates used weighted data. Adjusted marginal effects for limiting mental health conditions and substance dependence were estimated for experience of sexual violence, physical violence, and sexual and physical violence combined. Disability weights were applied to estimate associated reduced quality of life and relative risks applied to health service delivery costs. Findings The estimated cost in 2019 of long-term reduced quality of life adults in England experienced because of violence during their adult years was £3,767 mil (€4,290 mil), with associated healthcare costs of £4,130 mil (€4703 mil). Both the costs of long-term lost quality of life and healthcare were higher in women than men. The costs associated with combined sexual and physical violence were particularly high, with an estimated 96% of these costs resulting from experiences of violence in women. Combined sexual and physical violence in women was associated with the highest cost per victim. Conclusions Sexual and physical violence both have substantial and independent associations with long-term mental distress, substance dependence and treatment and service use. Violence reduction interventions have the potential to reduce health service costs and increase population level quality of life. Future costings of sexual violence should fully incorporate the long-term impacts on mental health and gender-disaggregate estimate.

Eating disorders and physical multimorbidity in the English general population

PurposePeople with eating disorders may be at increased risk for physical health problems, but there are no data on the relationship between eating disorders and physical multimorbidity (i.e., ≥ 2 physical conditions) and its potential mediators. Thus, we investigated this association in a representative sample of adults from the UK, and quantified the extent to which this can be explained by various psychological and physical conditions, and lifestyle factors.MethodsCross-sectional data of the 2007 Adult Psychiatric Morbidity Survey were analyzed. Questions from the five-item SCOFF screening instrument were used to identify possible eating disorder. Respondents were asked about 20 physical health conditions. Multivariable logistic regression and mediation analysis were conducted.ResultsData on 7403 individuals aged ≥ 16 years were analyzed [mean (SD) age 46.3 (18.6) years; 48.6% males]. After adjustment, possible eating disorder was associated with 2.11 (95%CI = 1.67–2.67) times higher odds for physical multimorbidity. Anxiety disorder explained the largest proportion this association (mediated percentage 26.3%), followed by insomnia (21.8%), perceived stress (13.4%), depression (13.1%), obesity (13.0%), and alcohol dependence (4.3%).ConclusionFuture longitudinal studies are warranted to understand potential causality and the underlying mechanisms in the association between eating disorder and multimorbidity, and whether addressing the identified potential mediators in people with eating disorders can reduce multimorbidity.

Sexual abuse and psychotic phenomena: a directed acyclic graph analysis of affective symptoms using English national psychiatric survey data.

Sexual abuse and bullying are associated with poor mental health in adulthood. We previously established a clear relationship between bullying and symptoms of psychosis. Similarly, we would expect sexual abuse to be linked to the emergence of psychotic symptoms, through effects on negative affect. We analysed English data from the Adult Psychiatric Morbidity Surveys, carried out in 2007 (N = 5954) and 2014 (N = 5946), based on representative national samples living in private households. We used probabilistic graphical models represented by directed acyclic graphs (DAGs). We obtained measures of persecutory ideation and auditory hallucinosis from the Psychosis Screening Questionnaire, and identified affective symptoms using the Clinical Interview Schedule. We included cannabis consumption and sex as they may determine the relationship between symptoms. We constrained incoming edges to sexual abuse and bullying to respect temporality. In the DAG analyses, contrary to our expectations, paranoia appeared early in the cascade of relationships, close to the abuse variables, and generally lying upstream of affective symptoms. Paranoia was consistently directly antecedent to hallucinations, but also indirectly so, via non-psychotic symptoms. Hallucinosis was also the endpoint of pathways involving non-psychotic symptoms. Via worry, sexual abuse and bullying appear to drive a range of affective symptoms, and in some people, these may encourage the emergence of hallucinations. The link between adverse experiences and paranoia is much more direct. These findings have implications for managing distressing outcomes. In particular, worry may be a salient target for intervention in psychosis.

Associations between common mental disorders and menopause: cross-sectional analysis of the 2014 Adult Psychiatric Morbidity Survey.

We investigated whether women who participated in a household survey in England were more likely to screen positive for possible generalised anxiety disorder and depression during and after menopause. We used logistic regression in secondary cross-sectional analyses of 1413 participants from the 2014 Adult Psychiatric Morbidity Survey data, adjusting for potential confounders (including age, deprivation score and chronic disease).We found that participants who were post-menopausal were more likely to screen positive for possible depression compared with participants who were pre-menopausal (3.9% v. 1.7%; adjusted odds ratio 3.91, 95% CI 1.23-12.46), but there was no association with perimenopause. We found no evidence of an association between menopausal stage and possible generalised anxiety disorder or symptom score. Clinicians should be aware of the association between menopause and depression, to best support women. Future research could focus on to what extent associations are driven by somatic features, and how this might be modified.

Intimate partner violence perpetration and mental health service use in England: analysis of nationally representative survey data.

Intimate partner violence perpetration (IPVP) is associated with psychiatric disorders, but an association with mental health service use has not been fully established and is relevant for policy. Mental health service contact by perpetrators of intimate partner violence presents an opportunity for reducing harmful behaviours. To examine the association between IPVP and mental health service use. Analysis of national probability sample data from the 2014 Adult Psychiatric Morbidity Survey, testing for associations between lifetime IPVP and mental health service use. We assessed the impact of missing data with multiple imputation and examined misreporting using probabilistic bias analysis. The prevalence of reported lifetime IPVP was similar for men (8.0%) and women (8.6%). Before adjustments, IPVP was associated with mental health service use (odds ratio (OR) for any mental health service use in the past year for men: 2.8 (95% CI: 1.8-4.2), for women: 2.8 (95% CI: 2.1-3.8)). Adjustments for intimate partner violence victimisation and other life adversities had an attenuative influence. Associations remained on restricting comparisons with those without criminal justice involvement (OR for any mental health service use in the past year for men: 2.9 (95% CI: 1.7-4.8), for women: 2.3 (95% CI: 1.7-3.2)). The strong association of IPVP with mental health service use is partly attributable to the concurrent presence of intimate partner violence victimisation and other life adversities. Efforts to improve the identification and assessment of IPVP in mental health services could benefit population health.

The clustering of physical health conditions and associations with co-occurring mental health problems and problematic alcohol use: a cross-sectional study

BackgroundThere is strong evidence for the co-occurrence of mental health conditions and alcohol problems, yet physical health outcomes among this group are not well characterised. This study aimed to identify clusters of physical health conditions and their associations with mental health and problematic alcohol use in England’s general population.MethodsCross-sectional analysis of the 2014 Adult Psychiatric Morbidity Survey (N = 7546) was conducted. The survey used standardised measures of problematic alcohol use and mental health conditions, including the Alcohol Use Disorders Identification Test (AUDIT) and the Clinical Interview Schedule-Revised. Participants self-reported any lifetime physical health conditions. Latent class analysis considered 12 common physical illnesses to identify clusters of multimorbidity. Multinomial logistic regression (adjusting for age, gender, ethnicity, education, and occupational grade) was used to explore associations between mental health, hazardous drinking (AUDIT 8 +), and co-occurring physical illnesses.ResultsFive clusters were identified with statistically distinct and clinically meaningful disease patterns: ‘Physically Healthy’ (76.62%), ‘Emerging Multimorbidity’ (3.12%), ‘Hypertension & Arthritis’ (14.28%), ‘Digestive & Bowel Problems’’ (3.17%), and ‘Complex Multimorbidity’ (2.8%). Having a mental health problem was associated with increased odds of ‘Digestive & Bowel Problems’ (adjusted multinomial odds ratio (AMOR) = 1.58; 95% CI [1.15–2.17]) and ‘Complex Multimorbidity’ (AMOR = 2.02; 95% CI [1.49–2.74]). Individuals with co-occurring mental health conditions and problematic alcohol use also had higher odds of ‘Digestive & Bowel Problems’ (AMOR = 2.64; 95% CI [1.68–4.15]) and ‘Complex Multimorbidity’ (AMOR = 2.62; 95% CI [1.61–4.23]).ConclusionsIndividuals with a mental health condition concurrent with problematic alcohol use experience a greater burden of physical illnesses, highlighting the need for timely treatment which is likely to include better integration of alcohol and mental health services.

The association of physical multimorbidity with suicidal ideation and suicide attempts in England: A mediation analysis of influential factors.

Suicide is one of the most important causes of deaths in the United Kingdom, and the numbers are currently increasing. There are numerous identified determinants of suicidality, and physical multimorbidity is potentially important but is currently understudied. Thus, this study aims to investigate the association of physical multimorbidity with suicidality. Cross-sectional data from the Adult Psychiatric Morbidity Survey 2007, which was conducted in England between October 2006 and December 2007 by the National Center for Social Research and Leicester University were analyzed. Respondents were asked about 20 physical health conditions, and suicidal ideation and suicide attempts were assessed. Out of 7,403 individuals aged 16 years or over, the prevalence of physical multimorbidity, suicidal ideation, and suicide attempts were 35.1%, 4.3%, and 0.7%, respectively. After adjustment for potential confounders, compared to no physical conditions, 1, 2, 3, and ⩾4 conditions were associated with significant 1.79 (95% CI [1.25, 2.57]), 2.39 (95% CI [1.63, 3.51]), 2.88 (95% CI [1.83, 4.55]), and 6.29 (95% CI [4.12, 9.61]) times higher odds for suicidal ideation. Mediation analysis showed that cognitive problems (mediated percentage 39.2%) and disability (37.5%) explained the largest proportion between multimorbidity and suicidal ideation. Pain (38.0%) and cognitive problems (30.7%) explained the largest proportion between multimorbidity and suicide attempts. In this large sample of UK adults, physical multimorbidity was associated with significantly higher odds for suicidal ideation and suicide attempts. Moreover, several potential mediators were identified, and these may serve as future targets for interventions that aim to prevent suicidality among people with physical multimorbidity.

Alcohol use and its association with suicide attempt, suicidal thoughts and non-suicidal self-harm in two successive, nationally representative English household samples.

Alcohol use is a risk factor for suicidal behaviour, yet the nature of the relationship is unclear. Most research on the topic is conducted in clinical populations, with few studies exploring this association across the general population. We investigated the association between specific domains of alcohol use and suicide attempt, suicidal thoughts and non-suicidal self-harm in a general population sample. A total of 14 949 adults who completed the 2007 or 2014 Adult Psychiatric Morbidity Survey were included. We measured alcohol use with the Alcohol Use Disorders Identification Test (AUDIT). Domains of alcohol use relating to risk categories, weekly consumption, binge drinking, dependence symptoms, harmful effects and concern from others were derived from relevant AUDIT items. Self-reported past year suicide attempt, suicidal thoughts and non-suicidal self-harm were measured with the Clinical Interview Schedule, Revised. We found a linear association between total AUDIT score and outcomes. Three of six specific domains of alcohol use (dependence symptoms, harmful effects of drinking and binge drinking) were associated with increased odds of all three outcomes. There was no association of outcomes with the other domains of alcohol use. We found evidence of a linear association between total AUDIT score and suicide attempt, suicidal thoughts and non-suicidal self-harm in a representative English general population sample. Our analyses suggest that where alcohol use significantly disrupts day-to-day functioning, this may underpin the relationship between alcohol use and suicide-related outcomes to a greater extent than higher alcohol consumption. Longitudinal research is needed to further understand these relationships.

Co-occurring psychotic and eating disorders in England: findings from the 2014 Adult Psychiatric Morbidity Survey

BackgroundPsychotic disorders and eating disorders are complex mental illnesses associated with increased mortality and functional impairment. This study aimed to investigate the co-occurrence and relationships between eating disorders and psychotic disorders and assess the mediation effect of mood instability.MethodsThis study used data from the Adult Psychiatric Morbidity Survey (APMS) 2014, a general population-based survey in England. Participants (total N = 7546, female N = 4488, male N = 3058, mean age = 52.3 years) were categorised based on psychotic disorder status into the groups of probable psychosis, diagnosed psychosis, and healthy controls without psychosis. The dependent variable of this study was the presence or absence of an eating disorder, with mood instability as the mediator. Logistic regression and mediation analyses were conducted to assess the relationships between these variables.ResultsBoth probable and diagnosed psychoses were significantly related to the presence of an eating disorder, and mood instability was found to be a mediating variable with moderate effect.ConclusionThe present study demonstrates a significant relationship between eating disorders and psychotic disorders in the English general population, indicating higher levels of co-occurrence between these two groups of disorders than when compared with healthy controls. The findings also suggest the relationship between eating and psychotic disorders is mediated, to an extent, by the presence of mood instability traits. Future research could extend the present study’s findings through assessing whether specific eating disorders are more significantly related to psychotic disorders than others.

Associations between sociodemographic characteristics and receipt of professional diagnosis in Common Mental Disorder: Results from the Adult Psychiatric Morbidity Survey 2014

BackgroundMany people with Common Mental Disorders (CMDs), especially men, people from older age groups, and ethnic minority backgrounds, receive no treatment. Self-acknowledgement of mental illness symptoms, and a professional diagnosis are usually required to access treatment. To understand barriers, we therefore tested whether these groups were relatively less likely to self-diagnose a CMD, or to receive a professional diagnosis. MethodsWe analysed data from the 2014 English Adult Psychiatric Morbidity Survey (APMS). We used regression models to examine whether gender, age, and minority ethnic status were associated with professional and self-diagnosis, after controlling for CMD symptoms. Results27.3 % of the population reported a professional and self-diagnosis of CMD, 15.9 % a self- diagnosis only, and the remainder no diagnosis. Odds of professional diagnosis were lower for men compared with women (adjusted odds ratio [AOR] 0.54, 95 % confidence intervals [CI] 0.47–0.62). People from White Other (0.49, 0.36–0.67), Black (0.31, 0.18–0.51), and Asian (0.22, 0.15–0.33) groups were less likely than the White British group to receive a professional diagnosis. The least likely age group to have a professional CMD diagnosis (relative to adults aged 16–34) were people aged over 75 (0.52, 0.39–0.69). Patterns were similar for self-diagnosis. LimitationsEthnicity categories were heterogeneous. Data are cross-sectional, and selection and response bias are possible. ConclusionsFor every three people who self-diagnose CMD, two have a professional diagnosis. Men, ethnic minority, and older age groups are less likely to receive a diagnosis or self-diagnose after adjustment for presence of symptoms.