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

自我伤害和自杀意念(即关于自杀死亡的想法)是自杀死亡的两个最重要的已知危险因素。不断上升的自杀率是一个主要的公共卫生问题，北爱尔兰的自杀率一直是英国和爱尔兰中最高的。最近旨在降低全国自杀率的政策现在包括将重点放在减少自我伤害和自杀意念上，因为这些都是自杀的前兆。然而，关于是什么导致自我伤害和自杀意念，这两个因素是如何相关的，以及它们单独或合并对死亡风险有什么影响，人们知之甚少。了解个体水平、家庭水平、地区水平和与健康相关的自残和自杀预测因素对公共卫生至关重要，以便能够准确地针对干预服务。北爱尔兰的独特之处在于，它有一个国家自我伤害登记处，该登记处整理了自2012年以来向急诊部提交的所有关于自我伤害和自杀念头的信息(每年约8,000份)，研究小组从每个卫生和社会护理信托基金的数据保管人那里获得了这些数据。拟议的项目将把这些数据与更多的健康、社会服务、人口普查和死亡数据联系起来，生成一个独特的健康和社会信息数据集，以便更好地了解与自我伤害、自杀意念和自杀死亡有关的风险因素。我们的研究人员、公共卫生机构的合作伙伴和五个健康信托基金中的每一个都承认，这个项目增加的知识可能有助于制定未来关于预防和治疗自我伤害和自杀意念的政策。该项目的总体目标是成为有史以来第一个关于自残和自杀意念的全人群队列研究，调查一系列人口、身体健康、心理健康和心理社会因素，以梳理出这些因素与感兴趣的结果之间的关联强度，以更好地了解哪些人处于最大的风险之中。该项目将解决三个相互重叠的研究问题：(I)哪些因素与自残/自杀意念/两者最相关，(Ii)自残/自杀意念之后会发生什么，以及(Iii)对“临走前卡片”计划的评估。自我伤害登记中的广泛细节，通过与增强的描述数据库(关于NI社区药房分发的所有处方的全人口数据)、社会服务客户管理和检索环境数据(关于与社会服务相互作用的全人口数据)、来自死亡登记的死亡率数据和2011年人口普查数据的链接而得到加强。将被用来探索自我伤害和自杀意念的一系列预测因素和结果。处方药数据将允许调查个人是否使用自己的药物自毒自残。人口普查数据将允许识别家庭中的个人，以调查个人是否在使用其他家庭成员的药物。我们将利用数据中的一项自然发生的实验来评估2010年推出的“离开前卡”计划(一种针对被认为风险较低的自我伤害者的治疗途径)，方法是检查干预前后的结果，并确定哪些人有资格使用该计划，哪些人没有。该项目将是第一个将自我伤害登记处与其他数据来源联系起来的项目，并将成为促进英国其他研究人员访问这些数据的开创性研究。该项目还将为ADRC-NI的支持人员和相关研究人员提供重要的培训机会，包括指定的早期职业研究人员。

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.