Enhancing the population-wide Northern Ireland Registry of Self-Harm and Suicide Ideation through data linkage

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Self-Harm and suicide ideation (i.e. thoughts about dying by suicide) are two of the most important known risk factors for death by suicide. Increasing suicide rates are a major public health concern and Northern Ireland consistently has the highest rate of suicide in the UK and Ireland. Recent policies to reduce the rates of suicide nationwide are now including a focus on reducing self-harm and suicide ideation as these are precursors to suicide. However, little is known about what causes self-harm and suicide ideation, how these two factors are related and what impact they have on mortality risk either individually or in combination. Understanding the individual level, household-level, area-level and health related predictors for self-harm and suicide is of vital public health importance so that intervention services can be targeted accurately. Northern Ireland is unique in that it has a national Registry of Self-Harm that has collated information on all presentations to emergency department for self-harm and suicide ideation since 2012 (approximately 8,000 per/year) and the research team has secured access to these data from the data custodians in each of the Health and Social Care Trusts. The proposed project will link these data to additional health, social services, Census and death data to generate a unique dataset of health and social information to achieve a better understanding of the risk factors associated with self-harm, suicide ideation and death by suicide. Our researchers partners in the Public Health Agency and each of the five Health Trusts have acknowledged that the increased knowledge from this project could be instrumental in shaping future policies around the prevention and treatment of self-harm and suicide ideation. The overarching aim of the project is to be the first ever population-wide cohort study of both self-harm and suicide ideation, investigating a range of demographic, physical health, mental health and psychosocial factors to tease apart the strength of association between each of these factors and the outcomes of interest to better understand those most at risk. The project will address three overlapping research questions: (i) Which factors are most associated with self-harm/suicide ideation/both, (ii) What happens after self-harm/suicide ideation, and (iii) an evaluation of the 'card before you leave' scheme.The extensive detail in the Registry of Self-Harm, enhanced by linkage to the Enhanced Prescribing Database (population-wide data on all prescriptions dispensed in community pharmacies in NI), the Social Services Client Administration and Retrieval Environment data (population-wide data on interaction with social services), mortality data from the death register and the 2011 Census data, will be used to explore a range of predictors and outcomes of both self-harm and suicide ideation. Prescription medication data will allow for an investigation into whether or not individuals are using their own medication to self-harm by self-poisoning. Census data will allow for the identification of individuals within households to investigate whether individuals are using medication from other household members. We will capitalise on a naturally occurring experiment within the data to evaluate the 'card before you leave' scheme (a treatment pathway for self-harmers deemed low risk) which was rolled out in 2010 by examining outcomes pre- and post-intervention and identifying those individuals eligible who do and do not avail of the scheme.This project will be the first to link the Registry of Self-harm to other data sources and will become a pioneer study to facilitate access to this data for other researchers across the UK. The project will also provide a significant training opportunity for ADRC-NI support staff and the associated researchers, including the named early career researcher.