Epidemiology of non-fatal self-harm, suicide and other causes of premature death following discharge from inpatient psychiatric care

Published studies have previously reported markedly elevated suicide risk shortly after discharge from inpatient psychiatric care, although these investigations have mostly been conducted in other countries using national registry datasets without linkage to subsequent routine general practice consultations and treatment or to care provided by specialist community mental health services. The proposed project for this PhD studentship will entail investigation of a nationally representative UK primary care patient cohort, with linkage to additional routinely collected clinical datasets and to national mortality records - a unique platform for tackling this important research question in a novel way. The work will be undertaken using the Clinical Practice Research Datalink (www.cprd.com) in which anonymised clinical records from a large sample of general practices in England are linked to Hospital Episode Statistics (HES) records and to Office for National Statistics (ONS) mortality records. Additional linkage to the Mental Health Data Set (MHDS) has also recently become available to researchers for the first time. This newly linked data source captures information on outpatient and community mental health services episodes, with linkage between the MHDS and HES enabling delineation of a study cohort of persons discharged from inpatient psychiatric care. Frequency of contact with general practitioners, community mental health services and outpatient departments, and psychotropic medication prescribing patterns will be assessed, and risks for non-fatal self-harm, suicide and other causes of premature death will be estimated. The planned project is funded by the NIHR Greater Manchester Patient Safety Translational Research Centre. The appointed PhD student will be supervised by experts who specialise in conducting epidemiological research using routinely collected datasets, and she/he will have an excellent opportunity to generate peer reviewed academic papers. The translational evidence generated could also influence national guidelines such as those issued by the National Institute for Health and Care Excellence (NICE).

Excellent specialised training for examining large routinely collected datasets will be provided. Supervisors Webb and Ashcroft have jointly conducted many CPRD-based studies, and their teams of postdoctoral researchers and PhD students in the Centres for Mental Health & Safety and Pharmacoepidemiology & Drug Safety will provide additional ad hoc advice and support. The successful candidate would also attend epidemiological/statistical courses at the University, including modules from the online Masters in Public Health, as well as short courses in the Faculty of Biology Medicine and Health (e.g. course run by Dr Mark Lunt - Division of Musculoskeletal & Dermatological Sciences) and in the Faculty of Humanities (i.e. courses hosted by the Cathie Marsh Institute for Social Research). The successful candidate would be expected to regularly attend meetings of the CPRD User Group and Pharmacoepidemiology Journal Club. Funding for attending external courses and/or presenting research findings at conferences will also be available.