Written by Shruti Menon, MSc Student, UCL Division of Psychiatry

I recently attended a webinar held on 22 May 2024 by a team of mental health researchers at the UCL Institute of Mental Health (IoMH) and Generating Research Insights for Development (GRID) Council, India. This was to facilitate a discussion about the quantitative investigation of suicide risk in patients with cancer using routine data in which there was also the opportunity to access Stata/R/Python code and analysis plans from previous analyses. The webinar was supported by the UCL Global Engagement Fund and attended by clinicians and researchers working with data in India, Sri Lanka, Bangladesh, Pakistan, Bhutan, Nepal, Afghanistan and the Maldives. I enrolled as a student in the UCL MSc course in Clinical Mental Health Sciences as I was interested in learning more about how to access and analyse cancer registry data in order to investigate mental health outcomes.

The webinar began with a warm introduction to the event from Dr Neethu Mohan, executive at the State Health Agency of Kerala. Dr Mohan briefly elucidated the aim of the webinar to promote the analysis of cancer registry data linked to mortality data as it would help answer key questions in suicide research. 

This was followed by insights into the findings of a systematic review by Heinrich et al (2022) from Dr Alexandra Pitman at UCL Division of Psychiatry. Through her work as a psychiatrist in a cancer team, she described her experience of having observed the impact of cancer on the mental health of people with cancer including their risk of suicidal thoughts. She summarised the findings which indicated that the risk of suicide was significantly higher in patients with cancer compared to the general population. It highlighted how the mental health needs of cancer patients are often overlooked and how factors including time since diagnosis and stage of cancer are linked to the risk of suicide. Dr Pitman emphasised the need to not only monitor the psychological health of people with cancer but to inquire carefully about any suicidal thoughts and screen for untreated depression and anxiety to improve outcomes and well-being. Finally, the Heinrich et al systematic review also brought attention to the geographical gaps in research literature on this topic as the review was limited to studies conducted in high-income countries.

The webinar then provided participants with an opportunity for discussion in which participants were invited to share their clinical experiences and research priorities. Participants described issues such as medical staff not being trained to screen for mental health problems and suicidal thoughts. Such training could be crucial in vulnerable periods such as immediately after a cancer diagnosis when evidence demonstrates that the risk of suicide is heightened. Important research questions were also raised such as the role of psychiatric conditions in increasing suicide risk in patients with cancer and whether treatment expenditure or lack of social support could potentially heighten the risk of suicide. Participants pointed out the importance of acknowledging to patients how distressing a cancer diagnosis can be so that patients might find it acceptable to disclose any struggles with suicidal thoughts.

Dr Katherine Thackray (née Henson), a data analyst in the National Disease Registration Service (NDRS) at NHS England discussed the methods used in her population-based analysis of English cancer registry data investigating the risk of suicide after cancer diagnosis (Henson et al, 2019). She provided a detailed overview of the analysis, including the statistical techniques used, and sub-groups evaluated. She also outlined the methodological considerations when replicating the analysis such as considering biases in data ascertainment. She highlighted a key limitation of the study which was that due to challenges with linking cancer registry datasets with mental health datasets, the influence of psychiatric disorders on suicide risk in people with cancer could not be explored. She summarised the results of the study which indicated that the risk of suicide was 20% higher in individuals with cancer than in the matched general population, and the increased risk was particularly marked in the first six months post-diagnosis. She also noted that the risk of suicide may have been underestimated as suicide tends to be underreported as a cause of death. Dr Thackray emphasised the implication of these findings namely the potential to prevent these deaths through additional support.

Dr Justin Yang, Research Fellow in the UCL Division of Psychiatry provided a summary of the code used in the study by Henson et al (2019) including details about the variables and confounders to be considered. He also elaborated on various aspects of the analyses such as how to calculate the Standardised Mortality Rate (SMR). This talk illustrated how to conduct the analyses by providing examples of code in different statistical software packages such as Stata, R and Python. Dr Yang discussed the advantages and disadvantages of each of these software packages. While Stata is commonly taught in universities and has supportive online forums, cost can be a limiting factor. R is a free software package with useful statistical functions, however, less formal support tends to be available to researchers using it. While Python has a good capacity to handle large datasets and offers useful statistical functions, it might be the most challenging software to learn. Dr Yang emphasised that the best software to use would be that which one is most familiar with.

A second discussion ensued in which participants identified critical barriers in low and middle-income countries to investigating this research question such as paper records recording deaths, or administrative issues while linking cancer registry data to mortality data. Other important research questions were identified such as exploring the role of acquired capability for suicide in the context of cancer (as patients with cancer may have a reduced fear of death, a reduced pain threshold and/or access to lethal medications) and the need to explore more proximal outcomes than suicide. In particular, risk-taking or self-destructive behaviour such as alcohol use was identified as important to study in people with cancer. The inclusion of participants/researchers with lived experiences in primary research was recognised as beneficial. The participants brainstormed ways to navigate these practical issues, for example by collaborating with data guardians within organisations that collect registry data or using probabilistic data linkage methods to link datasets.

A wide range of resources were provided on the project website after the session, including annotated data analysis code (with Stata/R/Python versions), a list of 321 cancer registries across South Asia and access to a Slack channel for networking with potential collaborators. Through these resources, the project aimed to create a community of researchers and facilitate collaboration so that future analyses might identify any patient groups at risk who might need increased support. The longer-term goal was therefore to help reduce psychiatric co-morbidity in people with cancer.

I learned a lot about how to evaluate suicide risk in cancer patients using routine data in this webinar and was grateful to all the speakers, the participants for their key insights and the IoMH and GRID council for organising this webinar. I hope that this will foster collaboration among researchers interested in suicide prevention in people with cancer.

Links:

• Investigating risk of suicide in patients with cancer globally
• UCL Special Interest Group in Self-harm and Suicide

Earlier this year a prospective PhD supervisor blogged for us about recruiting for a PhD scholarship focused on historically marginalised groups and mental health inequalities. That student is Alua Yeskendir, who provides this post on new research summarising the current state of the evidence around the social determinants of mental health.

We used to see mental health problems as primarily a biological phenomenon. But is it true? If we say that your mental health also depends on the distribution of social, economic and political wealth, power, and resources, does it make easier to solve the problem?

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UCL Psychiatry MSc student Kangning Zheng’s research focuses on the experiences of loneliness among international students. This blog describes what her work reveals about the impact on students’ mental health.

Studying in another country might be an exciting prospect for many people but some international students can feel lonely during a period of study abroad. Transient loneliness at the start of a move to a new country is common and can be a positive stimulus to meet more people and establish oneself. However, some people can become chronically lonely, and this poses a threat to health and wellbeing. Loneliness is therefore an important consideration for policymakers in relation to the economic and social benefits of international students.

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Earlier this year in a BBC Radio 4 programme Tania Gergel documented her treatment for bipolar. In this blog, she describes how she has used ‘self-binding directives’ to manage the risks associated with these treatments.

Shortly after I moved into the field of mental health ethics and law about twelve years ago, I found my work focusing on one particular area – mental health advance directives or ‘advance choice documents’, as they will soon be known within the upcoming revisions to the Mental Health Act in England and Wales.

Research and practice in this area had been dominated by the idea that advance choice documents could provide a way for people with severe mental illness to avoid hospitalisation and involuntary treatment. But it soon became evident that, in fact, many people might also want to harness the power of advance decision-making to do the opposite – to ensure that they received treatment, even if against their will, during future episodes of illness when they knew from past experience, they would resist.

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Entries are invited for the 2023 Michael King Prize, which is awarded to the UCL PhD awardee with the best thesis on a subject relating to mental health. In this blog, last year’s winner Aaron Kandola, shares his experiences of the award and reveals what he’s been doing since then.

Last year I was awarded the Michael King Prize for my PhD thesis on the relationship between physical activity, fitness, and sedentary behaviour with depression and anxiety symptoms in the population.

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Recent UCL research finds that lesbian, gay, and bisexual adults report higher rates of suicidal thoughts and suicide attempts than their heterosexual peers. In this blog Garrett Kidd describes how the study came about and its significance.

In the 2021 census lesbian, gay and bisexual (LGB) people represented 3.2% of the English and Welsh populations.

However, the UK is a heteronormative society where LGB people have experienced systemic and historical persecution under British law; homosexuality was partially decriminalised only in 2017. Legal recognition and protections have advanced since then, but a legacy of discrimination and lack of legal protection has impacted the lives of generations of LGB individuals.  Minority stress theory suggests that experiences such as discrimination or bullying might account for the poorer mental health of LGB people, as suggested in our previous work at UCL.

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A project to bring South Asian music and dance to people with dementia will be showcased next month at Bloomsbury Theatre. Dr Naaheed Mukadam, the researcher behind the project, shares her experiences of this project.

I have been a dementia researcher for more than 15 years and have always focused on ethnic inequalities, initially in the diagnostic pathway and more recently in genetic risk, prevention and post diagnostic support.

My research has highlighted the stigma that can exist around memory loss and dementia and I have tried to counteract this during my career so far. I am used to the scientific method – hypothesis testing and use of both qualitative and quantitative methods to answer specific questions. However, after attending public engagement workshops at UCL and reflecting on the power of personal stories in connecting with others, I started to think about how else I could go about capturing the experiences of those with dementia and those who care for them. Music was one way of connecting that I thought would be quite universal.

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The discoveries and positive impacts of academic research can give researchers great job satisfaction but the role also brings stresses that pose a risk to their mental health. University mental health day is a chance for researchers to reflect on these, write Helen Nicholls, Jo Billings and Danielle Lamb.

Mental wellbeing at work has been relatively neglected until very recently, despite working age adults spending on average 35% of their waking hours at work and 90,000 hours at work over a lifetime. We know that good work can be good for mental health, but that poor working environments – including discrimination and inequality, excessive workloads, lack of resources, limited job control and job insecurity – can pose a risk to mental health.

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After living through an extended period of turbulence, how are our children and young people coping? Charlotte Burdge and Tamsin Ford highlight what the research reveals and how we can better support our young people.

The mental health of children and young people deteriorated over the last decade, particularly among young women in their mid-teens and early twenties, who were more likely to struggle with anxiety, depression and self-harm than previously. This may come as no surprise, considering today’s children and young people have lived through what could be called a permacrisis; or an extended period of uncertainty and instability resulting from a chain of catastrophic events. Those born since the Millennium have experienced – directly or indirectly – severe financial crises, COVID-19, war, and increased global insecurity. Many young people have also voiced concerns about their own prospects for longer-term issues such as climate change, political instability, and the cost-of-living crisis. 

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This blog was written by Freya Robb, Senior Press Officer for Science Media Centre

The third Institute of Mental Health International Conference took place on the 21^st September 2022. This was the first time the conference had been held in person and was a sell-out event.

Led by its Director, Professor Anthony David, the UCL Institute of Mental Health was created to bring together the best interdisciplinary research to help tackle mental illness. This year’s conference aimed to reflect this broad and diverse approach, covering some key topics of interest that are at the forefront of public discussion and interest.

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