4-year PhD Studentship: What are the impacts of exposure to suicidal behaviour (fatal and non-fatal) in others? A global mental health study.

Suicide is a major global health problem. Suicide bereavement is a strong predictor of suicidal behaviour, with evidence that paternal suicide (especially maternal) increases risk of suicide and self-harm behaviour in offspring. There is evidence that suggests that the time since suicide bereavement also impacts on suicide and self-harming behaviour in the individual bereaved.

This evidence originates from high income countries (HICs). Roughly 80% of all suicide/self-harm occurs in low- and middle-income countries (LMICs), but only 15% of research evidence originates from these settings. Given the difference in suicide/self-harm rates between countries, and the important contextual and cultural differences (including responses to suicidal behaviour), research evidence generated from HICs may not be applicable in LMICs. Additionally in contexts, like Sri Lanka, a lower middle-income country where extended family networks are stronger, the impact of suicidal behaviour in other members of family (and community) may increase suicide or self-harm risk in the individual exposed to that behaviour.

The proposed research will utilise outstanding established infrastructure and cohorts based in Sri Lanka and will lead to new understandings that will inform the support given to individuals following a self-harm or suicide event. This project and associated training are suitable for a student with strong skills and knowledge in epidemiology and statistical modelling, and who wishes to develop these for a career as an independent researcher in global health.

Aims and objectives

This project will investigate the influence of exposure to self-harm behaviour and suicide in others (family and community) on subsequent suicide and self-harm risk, as well as educational attainment using an established cohort dataset in Sri Lanka.

Specific research questions may include:

1. What is the risk of suicide and self-harm in individuals who are exposed to these behaviours in family and community members?
2. Does the risk vary by the sex of the individual, the kinship relationship, and the timing of the exposure (especially in young people)?

Methodology

Secondary data analysis of key data available from a cohort study of 235,000 people in rural Sri Lanka (supervisors have access). Household and individual sociodemographic details were collected in 2011, and the cohort have been followed up for self-harm and suicide deaths until 2016. This dataset has prospectively collected educational outcome data for children within the cohort.

Methods will include:

• Deriving exposure variables to capture qualitatively different social relationships, and different strengths of exposure to these.
• To employ statistical methods that capture the relationship between exposure to self-harm behaviours and subsequent self-harm in the index individual.

The student will be able to attend methodological short courses delivered by Bristol Medical School, and from other groups in the university such as the Centre for Multilevel Modelling. In addition the student will benefit from the Suicide and Self-harm Research Group at Bristol.

The supervisory team has extensive expertise in global mental health and statistical modelling, with strong links to research networks in Sri Lanka and the UK. The student will learn ways in which to embed research impact into the design and delivery of their project. To enhance chances of impact generation, the student will be encouraged to undertake placements in Sri Lanka hosted by Prof Rajapakse.

Keywords

Global mental health, self-harm, suicide, quantitative methods, prospective cohort study.

How to apply for this project

This project will be based in Bristol Medical School - Population Health Sciences in the Faculty of Health Sciences at the University of Bristol.

Please visit the Faculty of Health Sciences website for details of how to apply