The views and opinions expressed in this paper are those of the authors and do not necessarily reflect those of the National Institute for Health Research (NIHR), the NHS or the Department of Health. The NIHR and Department of Health had no role in study design, the collection, analysis and interpretation of data, the writing of the report and the decision to submit the paper for publication.
Avon and Wiltshire Mental Health Partnership NHS Trust hosted the research programme.
Keith Hawton, David Gunnell and Jenny Donovan are NIHR Senior Investigators. Keith Hawton is also supported by Oxford Health NHS Foundation Trust and Nav Kapur by the Manchester Mental Health and Social Care Trust.
We would like to thank the following people for their invaluable help with undertaking components of this programme of work.
Study to investigate the influence of changes in coroners' practices on the validity of national suicide rates in England
We thank the coroners who allowed us access to their files, their staff and Record Office staff who assisted us, and the following researchers: Robert Carroll, Dr Emily Klineberg, Cathryn Rodway, Sarah Steeg and Lesley Sutton.
Oxford-based study of toxicity of antidepressants
Dr Helen Bergen and Keith Waters.
Oxford-based evaluation of co-proxamol withdrawal
Dr Helen Bergen, Anita Brock, Clare Griffiths, Ester Romeri, Claudia Wells, Karen Smith of the Centre for Statistics in Medicine, Oxford, for statistical advice, the Contact Centre Team at the NHS Health and Social Care Information Centre (England) and Sandra Hennefer at the Prescribing Services Partneriaeth Cydwasanaethau GIG Cymru (Wales) for supplying the prescription data.
Oxford-based evaluation of the 1998 UK legislation restricting pack sizes of analgesics
Long-term evaluation
Dr Helen Bergen, Dr Sue Dodd, Dr Phil Pocock, Dr William Bernal and Claudia Wells.
Interview study
Fiona Brand, Sheryl Denman Taylor, Karen Lascelles, Jacklyn Patzsanda, John Ryall, Dr Kate Saunders and Linda Whitehead for their help in identifying patients for the study and conducting some of the interviews; Dorothy Rutherford for assistance in extracting data from the Oxford Monitoring System for Attempted Suicide; and Dr Helen Bergen and Deborah Casey for support and advice on analyses.
Anglo-Irish comparison
Dr Helen Bergen, Dr Ella Arensman, Dr Paul Corcoran and Keith Waters.
Non-steroidal anti-inflammatory drug prescribing and gastrointestinal consequences
Ly-Mee Yu, Omar Omar, Phillip Gichuru, Peter Stephens of IMS Health for organising the provision of prescription data and Dr Ben Wheeler for providing data on trends in hospital admissions for gastrointestinal haemorrhage in England.
Variation in self-harm services study
Dr Matthew Lowe, Iain Donaldson, Rita Jordan, Kelly Wild and clinical studies officers and research staff from the Mental Health Research Network and Comprehensive Local Research Networks.
Manchester-based self-harm intervention study
Dr Sarmad Nadeem, Dr Samer Khalil, Dr Cheryl Hunter, Dr Amanda Owen-Smith, Iain Donaldson, Victoria Matthews, Sarah Steeg, Rita Jordan and Clive Turpin (Self-harm Assessment, Follow-up, Engagement; SAFE team), and Professor Kevin Mackway-Jones.
Bristol-based pilot study of an intervention to prevent post-discharge suicide
Jerome Motto for information on the content of the letters sent to participants in his contact-based study that contributed to the development of our study; staff on the intervention wards and from the Mental Health Research Network for their assistance in administering the mailing of the letters, in particular Davina Chauhan, Nicola Cook and Genevieve Riley who collected data on patient participation and retention and outcome data on community contacts; staff in the Avon and Wiltshire Partnership NHS Trust Information Department for providing anonymised outcome data on admissions and readmissions; and steering group members and researchers Rosie Davies, Dr Sarah Greef, Keith Hall, Davidson Ho, Stephen Hoddell (Samaritans), Dr Will Hollingworth, Dr Amanda Owen-Smith and Dr Sangeetha Paramasivan.
Contribution of authors
Professor David Gunnell (Professor of Epidemiology) was co-principal investigator on the programme grant, led the Bristol-based components of the research (coroner study and Bristol-based intervention pilot study) and contributed methodological and practical advice to all other components of the research programme and publications arising from the research.
Professor Keith Hawton (Professor of Psychiatry) was co-principal investigator on the Programme Grant, led the Oxford-based components of the research (pharmacoepidemiological studies) and contributed methodological and practical advice to all other components of the research programme and publications arising from the research.
Professor Nav Kapur (Professor of Psychiatry and Population Health) was co-principal investigator on the Programme Grant, led the Manchester-based components of the research (the self-harm intervention study and variations in self-harm services) and contributed methodological and practical advice to all other components of the research programme and publications arising from the research.
Olive Bennewith (Research Associate) was the lead Bristol-based researcher. She convened research meetings and developed and implemented research protocols for the Bristol-based intervention pilot study of an intervention to reduce self-harm following hospital discharge and the study of coroners' records. She analysed quantitative data arising from these projects and wrote first drafts of the reports of these studies. She also assisted with data collection from a number of centres in the Manchester-led study of self-harm services.
Dr Jayne Cooper (Senior Research Fellow) was the lead Manchester-based researcher and had key roles in the design, writing and implementation of research protocols for the Manchester-based contact intervention for self-harm and the multisite national observational study of self-harm services. She analysed qualitative and quantitative data arising from these projects and contributed to writing the reports of these studies. She also assisted with the study of coroners' records and supervision of junior staff.
Sue Simkin (Research Associate) was the lead Oxford-based researcher. She contributed to the design of the interview study of patients who took large paracetamol overdoses, conducted most of the interviews, analysed the data and wrote the first draft of the paper. She contributed to all of the other Oxford-led studies, including to their design, data collection and writing of papers for publication. She also assisted with data collection for the Bristol-led coroner study and wrote the first draft of an editorial on use of coroners' records for research.
Dr Damien Longson (Consultant in Psychiatry) was a co-applicant on the research programme and provided clinical and self-harm research expertise to the Manchester-based self-harm intervention study, as well as helping to oversee and facilitate recruitment and data collection by clinical teams.
Jenny Donovan (Professor of Social Medicine) was a co-applicant on the research programme and contributed qualitative research expertise and expertise in clinical trial design to the self-harm intervention pilot studies in Bristol and Manchester and supervised qualitative researchers working on these studies.
Jonathan Evans (Senior Lecturer in Psychiatry) was a co-applicant on the research programme and provided clinical and self-harm research expertise to the steering group of the Bristol-based intervention pilot study of an intervention to reduce self-harm following hospital discharge.
Susan O'Connor (Consultant Psychiatrist and former Medical Director of the Avon and Wiltshire Partnership NHS Trust) was a co-applicant on the research programme, provided clinical and self-harm research expertise to the steering group of the Bristol-based intervention pilot study of an intervention to reduce self-harm following hospital discharge and helped engage local wards in participating in the research pilot.
Disclaimers
This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, CCF, NETSCC, PGfAR or the Department of Health.
Peer-reviewed publications arising from the research programme
Chen YY, Bennewith O, Hawton K, Simkin S, Cooper J, kapur N, et al. Suicide by burning barbecue charcoal in England. J Public Health 2013;35:223–7.
Gunnell D, Hawton K, Ho D, Evans J, O'Connor S, Potokar J, et al. Hospital admissions for self-harm following psychiatric hospital discharge: cohort study. BMJ 2008;337:1331–4.
Hawton K, Bergen H, Simkin S, Cooper J, Waters K, Gunnell D, et al. Toxicity of antidepressants: rates of suicide relative to prescribing and non-fatal overdose. Br J Psychiatry 2010;196:354–8.
Kapur N, Clements C, Bateman N, Foëx B, Mackway-Jones K, Huxtable R, et al. Advance directives and suicidal behaviour. BMJ 2010;341:590–1.
Kapur N, Cooper J, Bennewith O, Gunnell D, Hawton K. Postcards, green cards, and telephone calls: therapeutic contact with individuals following self-harm. Br J Psychiatry 2010;197:5–7.
Carroll R, Hawton K, Kapur N, Bennewith O, Gunnell D. Impact of the growing use of narrative verdicts by coroners on geographic variations in suicide: analysis of coroners' inquest data [published online ahead of print 15 November 2011]. J Public Health 2011. http://dx.doi.org/10.1093/pubmed/fdr091.
Cooper J, Hunter C, Owen-Smith A, Gunnell D, Donovan J, Hawton K, et al. ‘Well it’s like someone at the other end cares about you'. A qualitative study exploring the views of users and providers of care of contact-based interventions following self-harm. Gen Hosp Psychiatry 2011;33:166–76.
Hawton K, Bergen H, Simkin S, Arensman E, Corcoran P, Cooper J, et al. Impact of different pack sizes of paracetamol in the United Kingdom and Ireland on intentional overdoses: a comparative study. BMC Public Health 2011;11:460.
Hawton K, Bergen H, Waters K, Murphy E, Cooper J, Kapur N. Impact of withdrawal of the analgesic co-proxamol in the UK on non-fatal self-poisoning. Crisis 2011;32:81–7.
Gunnell D, Bennewith O, Kapur N, Simkin S, Cooper J, Hawton K. The use of the Internet by people who die by suicide in England: a cross sectional study. J Affect Disord 2012;141:480–3.
Gunnell D, Metcalfe C, While D, Hawton K, Ho D, Appleby L, et al. Impact of national policy initiatives on fatal and non-fatal self-harm after psychiatric hospital discharge: a time series analysis. Br J Psychiatry 2012;201:233–8.
Hawton K, Bergen H, Simkin S, Wells C, Kapur N, Gunnell D. Six-year follow-up of impact of co-proxamol withdrawal in England and Wales on prescribing and deaths: time-series study. PLoS Med 2012;9:e1001213.
Simkin S, Bennewith O, Cooper J. Investigating official records of suicides for research purposes: challenges and coping strategies. Crisis 2012;33:123–6.
Simkin S, Hawton K, Kapur N, Gunnell D. What can be done to reduce mortality from paracetamol overdoses? A patient interview study. Q J Med 2012;105:41–51.
Hawton K, Bergen H, Simkin S, Dodd S, Pocock P, Bernal W, et al. Reduced pack sizes of paracetamol: long-term evaluation of impacts on poisoning deaths and liver transplant activity in England and Wales. BMJ 2013;346:f403.
Bennewith O, Evans J, Donovan J, Paramasivan S, Owen-Smith A, Hollingworth W, et al. A contact-based intervention for people recently discharged from inpatient psychiatric care: a pilot study. 2013; in press.
Owen-Smith A, Bennewith O, Donovan J, Evans J, Hawton K, Kapur N, et al. ‘When you’re in the hospital, you're in a sort of bubble'. Understanding the high risk of self-harm and suicide following psychiatric discharge: qualitative study. Crisis 2013; in press.
Hawton K, Bergen H, Simkin S, Brock A, Griffiths C, Romeri E, et al. Effect of withdrawal of co-proxamol on prescribing and deaths from drug poisoning in England and Wales: time series analysis. BMJ 2009;338:b2270. http://dx.doi.org/10.1136/bmj.b2270
Kapur N, Gunnell D, Hawton K, Nadeem S, Khalil S, Longson D, J, et al. Messages from Manchester: pilot randomised controlled trial following self-harm. Br J Psychiatry 2013;203:73–4. doi: 10.1192/bjp.bp.113.126425.
