Determinants of unintentional injuries in preschool age children in high-income countries: A systematic review.

BACKGROUND: Injuries are the leading cause of death and disability in preschool children who are subject to specific risk factors. We sought to clarify the determinants of unintentional injuries in children aged 5 years and under in high-income countries and report on the methodological quality of the selected studies. METHODS: A systematic review was conducted of observational studies investigating determinants of unintentional injury in children aged 0-5. Searches were conducted in Web of Science, Medline, Embase, PsycInfo and CINAHL. All methods of data analysis and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2021) guidelines. Determinants are reported at the child, parental, household and area level. RESULTS: An initial search revealed 6179 records. Nineteen studies met the inclusion criteria: 17 cohort studies and 2 case control studies. While studies included longitudinal surveys and administrative healthcare data analysis, the highest quality studies examined were case-control designs. Child factors associated with unintentional injury include male gender, age of the child at the time of injury, advanced gross motor score, sleeping problems, birth order, attention deficit hyperactivity disorder (ADHD) diagnosis and below average score on the standard strengths and difficulties scale. Parental factors associated with unintentional injuries included younger parenthood, poor maternal mental health, hazardous or harmful drinking by an adult within the home, substance misuse, low maternal education, low paternal involvement in childcare and routine and manual socioeconomic classification. Household factors associated with injury were social rented accommodation, single-parent household, White ethnicity in the United Kingdom, number of children in the home and parental perception of a disorganised home environment. Area-level factors associated with injury were area-level deprivation and geographic remoteness. CONCLUSION: Child factors were the strongest risk factors for injury, whereas parental factors were the most consistent. Further research is needed to examine the role of supervision in the relationships between these risk factors and injury. Injury intent should be considered in studies using administrative healthcare data. Prospective research may consider utilising linked survey and administrative data to counter the inherent weaknesses of these research approaches.

Physical health disparities and severe mental illness: A longitudinal comparative cohort study using hospital data in Northern Ireland.

BACKGROUND: People with severe mental illness (SMI) die prematurely, mostly due to preventable causes. OBJECTIVE: To examine multimorbidity and mortality in people living with SMI using linked administrative datasets. METHOD: Analysis of linked electronically captured routine hospital administrative data from Northern Ireland (2010-2021). We derived sex-specific age-standardised rates for seven chronic life-limiting physical conditions (chronic kidney disease, malignant neoplasms, diabetes mellitus, chronic obstructive pulmonary disease, chronic heart failure, myocardial infarction, and stroke) and used logistic regression to examine the relationship between SMI, socio-demographic indicators, and comorbid conditions; survival models quantified the relationship between all-cause mortality and SMI. RESULTS: Analysis was based on 929,412 hospital patients aged 20 years and above, of whom 10,965 (1.3%) recorded a diagnosis of SMI. Higher likelihoods of an SMI diagnosis were associated with living in socially deprived circumstances, urbanicity. SMI patients were more likely to have more comorbid physical conditions than non-SMI patients, and younger at referral to hospital for each condition, than non-SMI patients. Finally, in fully adjusted models, SMI patients had a twofold excess all-cause mortality. CONCLUSION: Multiple morbidities associated with SMI can drive excess mortality. While SMI patients are younger at referral to treatment for these life-limiting conditions, their relatively premature death suggests that these conditions are also quite advanced. There is a need for a more aggressive approach to improving the physical health of this population.

Severe mental illness and ophthalmic health: A linked administrative data study.

BACKGROUND: While evidence has emerged highlighting the potential benefits of the eye as a window to the central nervous system, research on severe mental illness (SMI) and eye health is rare. AIMS: We examine the association of SMI with a range of ophthalmic health outcomes, and whether any relationship is modified by age. METHODS: We used linked administrative data from general practitioner (GP), hospital and ophthalmic records to examine receipt of any Health and Social Care (HSC) eye-test; and (based on eligibility recorded for a sight test) any glaucoma, any diabetes, and any blindness among the Northern Ireland (NI) hospital population between January 2015 and November 2019 (N = 798,564). RESULTS: When compared with non-SMI patients, those with SMI recorded a higher prevalence of having had a sight test, diabetes, and blindness. In fully adjusted logistic regression models, higher likelihood of an eye-test and diabetes (OR = 1.71: 95%CI = 1.63, 1.79 and OR = 1.29: 1.19, 1.40 respectively); and lower likelihood of glaucoma remained (OR = 0.69: 0.53, 0.90). Amongst persons with SMI there was evidence that the likelihood of having had an eye-test was lower in the older age-groups. CONCLUSION: Our study provides new evidence on ophthalmic health inequalities associated with SMI. While the study has immediate relevance to its NI context, we believe it is generalizable to wider UK health concerns. We emphasize the need for more research of this type, using large linkable electronic administrative databases to further our understanding of both health inequalities associated with SMI and poor eye health, and health outcomes in general.

Adolescent mental well-being, religion and family activities: a cross-sectional study (Northern Ireland Schools and Wellbeing Study).

OBJECTIVES: In this study, we seek to explore the relationship between adolescent mental well-being, religion and family activities among a school-based adolescent sample from Northern Ireland. SETTING: The Northern Ireland Schools and Wellbeing Study is a cross-sectional study (2014-2016) of pupils in Northern Ireland aged 13-18 years. PARTICIPANTS: 1618 adolescents from eight schools participated in this study. OUTCOMES MEASURES: Our primary outcome measure was derived using the Warwick-Edinburgh Mental Wellbeing Scale. We used hierarchical linear regression to explore the independent effects of a range of personal/social factors, including religious affiliation, importance of religion and family activities. RESULTS: In fully adjusted models, older adolescents and females reported lower mental well-being scores-for the year-on-year increase in age ß=-0.45 (95% CI=-0.84, -0.06), and for females (compared with males) ß=-5.25 (95% CI=-6.16, -4.33). More affluent adolescents reported better mental well-being. No significant differences in mental well-being scores across religious groups was found: compared with Catholics, Protestant adolescents recorded ß=-0.83 (95% CI=-2.17, 0.51), other religious groups ß=-2.44 (95% CI=-5.49, 0.62) and atheist adolescents ß=-1.01 (95% CI=-2.60, 0.58). The importance of religion in the adolescents' lives was also tested: (compared with those for whom it was not important) those for whom it was very important had better mental well-being (ß=1.63: 95% CI=0.32, 2.95). Higher levels of family activities were associated with higher mental well-being: each unit increase in family activity produced a 1.45% increase in the mental well-being score (ß=0.78: 95% CI=0.67, 0.90). CONCLUSIONS: This study indicates that non-religious adolescents may have lower mental well-being scores when compared with their more religious peers, irrespective of religious denomination. This may relate to both a sense of lack of firm identity and perceived marginalisation. Additionally, adolescents with poor family cohesion are more vulnerable to poor mental well-being.

Occupation type, family demands and mental health: analysis of linked administrative data.

BACKGROUND: While employment generally promotes positive health and wellbeing, some jobs may be less salutogenic than others. Few studies have examined mental health across a range of broadly defined occupation types using a large population sample. AIMS: To examine the prevalence of mental health problems across a wide range of occupation types, and further examine the association of family demands, controlling for key social determinants and health-related factors. METHODS: We used linked administrative data from 2011 NI Census returns; NI Properties data; and Enhanced Prescribing Data (EPD) 2011/12. We examined self-reported mental health problems and receipt of psychotropic medication among 553,925 workers aged 25 and 59 years. RESULTS: Self-reported chronic mental ill health was more prevalent among workers in lower paid occupations, while "public- facing" occupations had the highest rates of medication. In fully adjusted models, informal caregivers were less likely to report mental health problems but more likely to be in receipt of psychotropic medication, as were lone parents. The association of family demands also varied across occupational groupings. CONCLUSION: Future development of mental health at work plans should take cognisance of occupation specific mental health risk and wider family circumstances to support workers' mental wellbeing most effectively.

Mind the gap: an administrative data analysis of dental treatment outcomes and severe mental illness.

BACKGROUND: Oral health of people with severe mental illness (SMI) remains an important public health issue, despite evidence pointing suboptimal dental health outcomes in this population. AIMS: We test the hypotheses that individuals with SMI have lower contact with dental services and higher levels of fillings and extractions. We also examine effect modification by age-group. METHODS: We used linked administrative data from general practitioner (GP), hospital and dental records to examine dental service use and treatments (extractions, fillings, crowns and x-rays) among the Northern Ireland hospital population between January 2015 and November 2019 (N = 798,564). RESULTS: After adjusting for available socio-demographic characteristics, analysis indicated lower levels of dental service use (OR = 0.80, 95% CI = 0.77, 0.84), including lower likelihood of fillings (OR = 0.81, 0.77, 0.84) and x-rays (OR = 0.77, 0.74, 0.81), but higher levels of extractions (OR = 1.23, 1.18, 1.29) among patients with SMI. We also found effect modification by age-group, with older individuals with SMI less likely to have each of the four dental treatments. CONCLUSIONS: We suggest that in the general area of physical healthcare for people with SMI, oral healthcare is neglected. There is a need for improved understanding of the barriers to routine care and treatment, and development of psychoeducational interventions.

Prevalence and Risk Factors of Psychiatric Symptoms Among Older People in England During the COVID-19 Pandemic: a Latent Class Analysis.

The COVID-19 pandemic has affected mental health and social connections. Older people may be disproportionately affected, placing them at increased risk for complex mental ill-health outcomes and quality of life undermined by anxiety and depression. Understanding gender differences in the determinants of anxiety and depression symptoms is crucial to policy and practice. This study aims to examine gender-specific symptom subtypes (and subthreshold symptoms) in an older English population sampled during the COVID period, in relation to their socio-demographic, social, and health circumstances. The sample comprises all individuals aged 50 years or older and included in the English Longitudinal Study of Ageing COVID-19 sub-study conducted during June-July 2020. Latent class analysis (LCA) defined indicative sample subgroups of clinically relevant anxiety and depression. Multinomial logistic regression assessed associations between socio-demographic characteristics, health and social care indicators, loneliness, and pre-pandemic mental ill-health. LCA derived three classes of self-reported depression and anxiety: for females (1) comorbid depression and anxiety (19.9% of the sample), (2) depression and subthreshold anxiety (31.6%), and (3) no or low symptoms of depression and anxiety (48.5%), and for males (1) comorbid depression and anxiety (12.8%), (2) subthreshold anxiety and depression (29.6%), and (3) no or low depression and anxiety (57.6%). Multinomial logistic regression analyses indicate that compared to those with low/no mental health symptoms, severity of pandemic-era mental ill-health was positively associated with pre-pandemic mental health levels, worry over finances, having access to essentials, loneliness, and access to health and social care services. Findings support the persistence of comorbidity of both depression and anxiety in the pandemic period. Results may inform government health strategy on interventions to prevent social isolation and mitigate the effects of the pandemic on deteriorating mental health in older people who may be more susceptible.

Dramaturgical Accounts of Transgender Individuals: Impression Management in the Presentation of Self to Specialist Gender Services.

Demand for gender dysphoria (GD) treatment has increased markedly over the past decade. Access to gender-affirming treatments is challenging for most people. For dysphoric individuals, much is at stake. Little is known about the specific needs, challenges, and coping strategies of this hard-to-reach group. We examined the experiences of treatment-seeking adolescents and adults using in-depth unstructured interviews with 26 people attending specialist gender services and 14 transgender people not referred to services. Patients with gender dysphoria distrust clinical services and describe considerable anxiety in sustaining their impression management strategies to obtain treatment. An authentic presentation is regarded by some participants, especially non-binary individuals, as inauthentic and emotionally difficult to maintain. Impression management strategies have partial success in accessing services. The presentation of "idealized" selves may result in unmet mental health needs of patients, and the receipt of interventions incongruent with their authentic selves.

Impact of the COVID-19 Pandemic on Loneliness and Social Isolation: A Multi-Country Study.

The COVID-19 global pandemic and subsequent public health social measures have challenged our social and economic life, with increasing concerns around potentially rising levels of social isolation and loneliness. This paper is based on cross-sectional online survey data (available in 10 languages, from 2 June to 16 November 2020) with 20,398 respondents from 101 different countries. It aims to help increase our understanding of the global risk factors that are associated with social isolation and loneliness, irrespective of culture or country, to support evidence-based policy, services and public health interventions. We found the prevalence of severe loneliness was 21% during COVID-19 with 6% retrospectively reporting severe loneliness prior to the pandemic. A fifth were defined as isolated based on their usual connections, with 13% reporting a substantial increase in isolation during COVID-19. Personal finances and mental health were overarching and consistently cross-cutting predictors of loneliness and social isolation, both before and during the pandemic. With the likelihood of future waves of COVID-19 and related restrictions, it must be a public health priority to address the root causes of loneliness and social isolation and, in particular, address the needs of specific groups such as carers or those living alone.

Mental ill-health among health and social care professionals: an analysis using administrative data.

OBJECTIVE: Health and Social Care (HSC) workers are at high risk of job-related stress, burnout and mental ill-health. This study examines differences in self-reported mental health and psychotropic medication uptake across HSC occupational groups. METHOD: Northern Ireland (NI) data linkage study of people working in the Health and Care sector, aged between twenty and sixty-four years, enumerated at the 2011 Northern Ireland Census and living in private households, and their uptake of prescribed psychotropic medications during 2011-2012 (using data derived from routine electronically captured information on prescriptions issued within the NHS and linked at an individual level using a NI-specific Health and Care key identifier). Comparing HSC workers with all those professionals not involved in HSC occupations, we used multinomial logistic regression to examine (a) self-reported chronic mental illness and (b) uptake of psychotropic medication by occupational groups adjusting for age, sex and socio-demographic circumstance. RESULTS: When compared against other professionals highest risks for mental health problems (associated with psychotropic prescription uptake) were associated with nursing/midwifery (OR = 1.25: 95%CI = 1.17-1.33; OR = 1.84: 1.58-2.15 for females and males respectively), welfare (OR = 1.34: 1.21-1.48; OR = 1.71: 1.44-2.03) and formal caregiving roles (OR = 1.42: 1.31-1.53; OR = 1.70: 1.50-1.91), again for females/males respectively). These higher risk professions record notable increases in psychotropic medication use. CONCLUSION: Working in the Health and Social Care sector, irrespective of gender, may be more stressful than other jobs. Additionally, self-reported mental ill-health and psychotropic medication treatment both appear to be associated with social class inequity.

Complex childhood trauma, gender and depression: Patterns and correlates of help-seeking and maladaptive coping.

BACKGROUND: Little is known about access to treatment or maladaptive coping amongst those with a history of childhood trauma and subsequent depressive disorder, which is often complicated by post traumatic stress disorder (PTSD). AIMS: To (1) identify profiles of complex childhood trauma amongst men and women with major depression, (2) examine patterns of service access and treatment or maladaptive coping (drug misuse, alcohol abuse or suicidality), and (3) associations with socio-economic/demographic characteristics, comorbid PTSD, anxiety/mood disorders and perceived social support. METHOD: Analysis of Wave 3 of the national epidemiologic survey on alcohol and related conditions (NESARC) (2012-2013). We use the Latent Class Analysis 3-step approach in Mplus to examine individual differences in childhood experiences and coping behaviour. We examined both (a) the inter-relationship of this patterning, and (b) the extent to which proactive and maladaptive coping are associated with socio-economic/demographic characteristics, comorbid PTSD, anxiety disorders and perceived social support. RESULTS: a diagnosis of Major Depression was recorded for 7432 people, two thirds of whom reported a history of complex childhood trauma. Maladaptive coping is associated with the most severe trauma groups, comorbid PTSD, dysthymia, and anxiety disorders. CONCLUSION: Given the evidence of the current study, suggesting a poorer treatment course for depression in adults with complex childhood trauma, early screening for a trauma history will facilitate preventive efforts before onset of depression, possibly mitigating a poorer treatment course.

Assessment of pain in people living with dementia at the end of life: a systematic review.

BACKGROUND: People with dementia may not receive the same quality of palliative care as those with other life-limiting conditions, particularly at end of life (EoL). AIMS: To understand the best way to examine pain in people with dementia. METHODS: A systematic review of tools to assess pain in patients with dementia near the end of life; PubMed, Medline, Embase, EBSCO Host, CINAHL Plus, Web of Science, Psycinfo, PsycArticles and Scopus were searched. FINDINGS: A total of 15 articles were identified, which were qualitatively synthesised. CONCLUSION: There are a range of pain assessment tools that are appropriate for use in people with dementia, but all 15 studies used a formal tool. A more robust approach is needed to improve the quality of research for measurement and management of pain in this population.

The impact of reduced working on mental health in the early months of the COVID-19 pandemic: Results from the Understanding Society COVID-19 study.

BACKGROUND: The COVID-19 pandemic has precipitated an unpredictable economic crisis, currently affecting daily life for millions of workers. We examined the mental health impact of reduced working in a nationally representative sample of employees. METHOD: We used Wave one (April 2020) of the Understanding Society UK Household Longitudinal Study (UKHLS) COVID-19 study, with linkage to baseline mental health data from the UKHLS annual survey (January 2017- December 2018). Analysis was based on adults aged 18-65 who were employees in January/February 2020 (n=8,708), with psychological distress assessed using the GHQ-12. Logistic regression examined the mental health impact of reduced working and reasons for the reduction. RESULTS: Forty two percent of employees reported reduced working by April 2020, with 22% furloughed. There was no evidence of an association between reduced working per se and psychological distress in the fully adjusted model (OR=1.06, 95%CI 0.91-1.23). Those permanently laid-off (less than 1% of employees) were most vulnerable to adverse mental health effects in the early months of the pandemic (OR=3.60, 95%CI 1.55-8.37). We also found evidence of higher levels of psychological distress among those sick or self-isolating, and those with reduced working due to caring responsibilities. LIMITATIONS: While the GHQ is a widely used and validated instrument in identifying potential psychiatric disorders, it is important to note that it does not represent a clinical assessment. CONCLUSIONS: Longitudinal examination of employment transitions and mental ill-health related to pandemic outcomes is imperative and should help inform public health responses and ongoing government policy in supporting those adversely affected.

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

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

Social Capital and Mental Health Among Black and Minority Ethnic Groups in the UK.

Black and minority ethnic communities are at higher risk of mental health problems. We explore differences in mental health and the influence of social capital among ethnic minority groups in Great Britain. Cross-sectional linear and logistic regression analysis of data from Wave 6 (2014-2016) of the Understanding Society databases. In unadjusted models testing the likelihood of reporting psychological distress (i) comparing against a white (British) reference population Indian, Pakistani, Bangladeshi and mixed ethnic minority groups recorded excess levels of distress; and (ii) increasing levels of social capital recorded a strong protective effect (OR = 0.94: 95% CI 0.935, 0.946). In a subsequent series of gender-specific incremental logistic models-after adjustment for sociodemographic and socioeconomic factors Pakistani (males and females) and Indian females recorded higher likelihoods of psychological distress, and the further inclusion of social capital in these models did not materially alter these results. More research on the definition, measurement and distribution of social capital as applies to ethnic minority groups in Great Britain, and how it influences mental wellbeing is needed.

Adolescent mental health problems, suicidality and seeking help from general practice: A cross-sectional study (Northern Ireland Schools and Wellbeing study).

BACKGROUND: Adolescent mental health problems and suicidality appear to be increasing in Western countries but contact with health services remains stubbornly low. While social disadvantage is often implicated in aetiology and help-seeking, evidence on the relative contribution of school and family life factors is limited. We sought (a) to examine the prevalence and factors associated with mental health problems in adolescent boys and girls; and (b) to examine factors associated with trust and contact with GPs for mental health problems. METHOD: Cross-sectional study of adolescent pupils in Northern Ireland RESULTS: High rates of mental health problems and suicidality were recorded, especially among females. While social circumstances do not influence mental health outcomes, factors of interest were atheist/agnostic beliefs and having a bedroom to oneself. While overall trust in GPs was high, more than 36% of the sample reported low trust. GP Trust was associated with positive home life factors. Importantly, adolescents with mental health problems including suicidality were much less likely to seek help. LIMITATIONS: Cross-sectional data CONCLUSIONS: This study confirms the high rates of mental health problems and suicidality among adolescents in Northern Ireland, particularly among young women. Those most in need of professional help appear least prepared to seek it. The influence of home life and environment on both poor mental health and trust and help-seeking from family doctors, is considerable and there is a need to find interventions that nurture appropriate levels of trust and help-seeking guidance for adolescents.

Autism trait prevalence in treatment seeking adolescents and adults attending specialist gender services.

BACKGROUND: To assess the prevalence of autism traits in individuals accessing gender affirming treatments, we conducted a cross-sectional survey in the regional specialist gender services in Northern Ireland. METHODS: One hundred and twenty-three individuals (38 adolescents and 69 adults) currently attending or who previously attended specialist gender services in Northern Ireland were recruited. Fifty-six individuals assigned male at birth (AMAB) and 66 individuals assigned female at birth (AFAB) took part in the study. Main outcome measures: Autism Quotient (AQ), Cambridge Behavior Scale (EQ), and RAADS-14. RESULTS: Autism trait prevalence rates of 19.5% (AQ); 25.4% (RAADS-14); and 35.8% (poor empathy traits). A combined measure comprising all three provided a prevalence of 17.2%. There were no mean differences in the scores between AMAB (assigned male at birth) individuals and AFAB (assigned female at birth) individuals. CONCLUSIONS: Autism traits present additional challenges during the assessment and treatment of individuals with gender dysphoria. Autism screening tools can aid in the identification of individual with additional needs.

Prevalence and factors associated with anxiety and depression in older adults: Gender differences in psychosocial indicators.

BACKGROUND: With increasing numbers of people living into old age, health functioning and good quality of life are central to public health policy in aging. However, quality of life for many elders is undermined by anxiety and depression. Understanding gender differences in the determinants of anxiety and depression symptoms is crucial to policy and practice. OBJECTIVE: To examine gender-specific symptom subtypes of later-life anxiety and depression, in relation to their socio-demographic, social and health context. METHOD: Cross-sectional study using data from The Irish Longitudinal Study on Ageing (TILDA, 2009-2011). Latent class analysis defined gender-specific symptom profiles for anxiety and depression. Correlates of latent classes were analysed using logistic regression, assessing associations between socio-demographic factors; social indicators and health indicators. RESULTS: Four classes of self-reported anxiety and depression were derived: 'low', 'comorbidity', 'anxiety and subthreshold depression' and 'anxiety' only. With males 8% were comorbid, 26% subthreshold and 26% with anxiety only. With female 12% were comorbid, 27% subthreshold and 29% with anxiety only. While symptom expression may relate to stress from common ageing, our findings show clear gradations of symptoms associated with a range of social and health indicators. CONCLUSION: Our findings support the actuality of comorbid depression and anxiety with further evidence for anxiety and subthreshold depression. A sizeable subgroup confirms that many older people experience anxiety only. Our study indicates the need for a more sensitive recognition of needs and a more nuanced policy agenda for older people towards improving the quality of their social life.

Rates and predictors of anti-depressant prescribing in Northern Ireland 2011-2015: a data linkage study using the Administrative Data Research Centre (NI).

OBJECTIVES: Research indicates that anti-depressant prescribing is higher in Northern Ireland (NI) than in the rest of the UK, and that socio-economic and area-level factors may contribute to this. The current study provides comprehensive population-based estimates of the prevalence of anti-depressant prescription prescribing in NI from 2011 to 2015, and examined the associations between socio-demographic, socio-economic, self-reported health and area-level factors and anti-depressant prescription. METHODS: Data were derived from the 2011 NI Census (N = 1 588 355) and the Enhanced Prescribing Database. Data linkage techniques were utilised through the Administrative Data Research Centre in NI. Prevalence rates were calculated and binary logistic analysis assessed the associations between contextual factors and anti-depressant prescription. RESULTS: From 2011 to 2015, the percentages of the population in NI aged 16 or more receiving anti-depressant prescriptions were 12.3%, 12.9%, 13.4%, 13.9% and 14.3%, respectively, and over the 5-year period was 24.3%. The strongest predictors of anti-depressant prescription in the multivariate model specified were 'very bad' (OR = 4.02) or 'Bad' general health (OR = 3.98), and self-reported mental health problems (OR = 3.57). Other significant predictors included social renting (OR = 1.67) and unemployment (OR = 1.25). Protective factors included Catholic religious beliefs, other faith/philosophic beliefs and no faith/philosophic beliefs in comparison to reporting Protestant/other Christian religious beliefs (ORs = 0.78-0.91). CONCLUSION: The prevalence of anti-depressant prescription in NI appears to be higher than the prevalence of depressive disorders, although this may not necessarily be attributable to over-prescribing as anti-depressants are also prescribed for conditions other than depression. Anti-depressant prescription was linked to several factors that represent socio-economic disadvantage.

Patterns of long-term conditions in older age and subsequent mortality: a national study of inequalities in health.

BACKGROUND: Multiple long-term health conditions in older people are associated with increased mortality. The study aims to identify patterns of long-term health in a national ageing population using a census-based self-reported indicator of long-term health conditions. We assessed associations with subsequent mortality and socio-economic and demographic risk factors. METHODS: Using linked administrative data from the Northern Ireland Mortality Study, we assessed the presence of latent classes of morbidity in self-reported data on 11 long-term health conditions in a population aged 65 or more (N = 244 349). These classes were associated with demographic and socio-economic predictors using multi-nomial logistic regression. In a 3.75-year follow-up, all-cause and cause-specific mortality were regressed on morbidity patterns. RESULTS: Four latent classes of long-term ill-health conditions were derived, and labelled: 'low impairment'; 'pain/mobility'; 'cognitive/mental'; 'sensory impairment'. Groupings reflecting higher levels of long-term ill-health were associated with class-specific increases in all-cause and cause-specific mortality. Strongest effects were found for the 'cognitive/mental' group, which predicted all-cause mortality [hazard ratio (HR) = 2.96: 95% confidence interval (CI) = 2.83, 3.10) as well as some cause-specific mortality (i.e. dementia-related death: HR = 10.78: 95% CI = 9.39, 12.15). Class membership was predicted by a range of socio-demographic factors. Lower socio-economic status was associated with poorer health. CONCLUSION: Results indicate that long-term ill-health clusters in specific patterns, which are both predicted by socio-demographic factors and are themselves predictive of mortality in the elderly. The syndromic nature of long-term ill-health and functioning in ageing populations has implications for healthcare planning and public health policy in older populations.