Towards a Meaningful Understanding of Mental Health in Northern Ireland

Transcription

1 Towards a Meaningful Understanding of Mental Health in Northern Ireland Siobhan O Neill MPsychSc, PhD Professor of Mental Health Sciences University of Ulster

2 The story: 4 chapters 1. World Mental Health Survey- NI Study of Health and Stress. 2. Conflict, trauma and Post-Traumatic Stress Disorder in NI. 3. Stress, mental health and physical health (cancer). 4. Conflict, trauma and suicidal behaviour. Talk Meanings

3 Prof Ron Kessler Prof Brendan Bunting Providence, 2011

4 WORLD MENTAL HEALTH The NI Study of Health and Stress Standardised interviews in > 40 countries with >100,000 participants worldwide. Coordinated by Harvard and the World Health Organisation. Computerised interview methods developed at the Survey Research Centre University of Michigan (training certification). Trained lay interviewers from RES & MORI. Clustered random sample. 68% response rate, 4340 participants. Funded by: NI Public Health Agency, Research & Development Division

5 Rates of Mental Disorders LIFETIME 12-MONTH Any mental disorder 39.1%, joint 3 rd 23.1% Any anxiety disorder 22.6%, 4 th highest 14.6% Any mood disorder 18.8%, 4 th highest 9.6% Any substance disorder 14.1%, 3 rd highest 3.5% Post Traumatic Stress Disorder 8.8%, highest 5.1% Females: anxiety & mood disorders (internalising disorders) Males: impulse-control & substance disorders (externalising disorders).

6 Dr Sam Murphy Mackinac Island, 2013

7 Understanding PTSD in NI Featuring: The Initiative for Conflict Related Trauma & Dr Finola Ferry Sponsored by: The Big Lottery Fund, Atlantic Philanthropies, The Lupina Foundation of Canada

8 Ferry, Bolton, Bunting, Devine, O Neill, Murphy 2008

9 Qualitative Research Understanding the characteristics of PTSD among people who have had conflict related traumatic events. Interpretative Phenomenological Analysis. Person s interpretation (meaning making). Psychologist s interpretation of the person s interpretation. Ferry, Bolton, Bunting, Devine, O Neill, Murphy, 2008 Trauma, Health and Conflict in Northern Ireland

10 Index event We were all playing and the next thing there was a bang and a shot rang out, and one of these big lads just fell down. He had been shot in the head, and as an eight year old you look, and it was just extremely unpleasant.

11 Re-experiencing (intrusive memories) I remembered so much detail about it [describes dismembered bodies]. It sticks with you, you know, it s not something you re going to forget [ ] like the wee bits and pieces, like your man s leg, that have just stuck with me. Flashbacks Reliving Nightmares

12 Hyper-vigilance (safety behaviours) *She was very nervous around vans. For example if she sensed a van coming up behind her she would stand in a doorway until it passed. She was also very nervous travelling and didn t drive for three years after the event. She was a nervous wreck if she had to travel anywhere. This lasted approximately five years.* Hyper arousal Increased startle response

13 Avoidance and numbing of responsiveness I couldn t be bothered. Even at weddings I have a couple of drinks and come on home again. I just can t be bothered with crowds, that sort of thing [ ] I never bother much with anything. Sense of foreshortened future Unable to feel loving feelings

14 Comorbidities My depression got that bad there, that I couldn t get out of bed. Literally hadn t the energy to get off that bed. I wasn t feeling sorry for myself [ ] or anything, I was fucking exhausted. It was doing my head in. I was maybe feeling good and I wanted to get up but I was like, I ll get up in a wee minute but I was back to sleep again. Awake asleep, awake asleep, it was nuts. I drove into a tree [ ] I had just had enough and I was full of drink and I had started taking anti-depressants.

15 Categorising traumatic experiences PTSD section asks about 29 event types. 60.6% had at least one trauma. 39% of the population have had a conflict related trauma. 17% (524,000) witnessed someone killed or seriously injured. 26% of PTSD is conflict related. Conflict is associated with more severe & enduring PTSD. Only 26% received treatment that they found effective. Sudden death/ trauma to a loved one 21% Domestic/ sexual violence 12% Other/ private 6% Accident/ natural disaster 15% War, conflict & man made disaster 46% 1. Bunting, Ferry, Murphy, O Neill, Bolton 2013 Journal of Traumatic Stress 2. Ferry, Bunting, Murphy, O Neill, Stein, Koenen 2014 Social Psychiatry and Psychiatric Epidemiology

16 What is the cost of doing nothing about PTSD in NI? 175 million. ANNUALLY. Ferry, Bunting, Murphy, O Neill, 2014 Under Review

17 Chapter 3: Stress, mental health and physical health

18 Physiological response to stress

19 Mental Health and Cancer Biggest causes of cancer- old age, smoking, other lifestyle factors. But what about mental health? Looking at cancer AFTER first symptoms of mental disorders in 52,019 people worldwide. Discrete-time survival analyses tested sequential associations between first onset of mental disorders and any subsequent cancer (self-report). O Neill et al., 2014 Journal of Psychosomatic Research

20 Results Adjusted for smoking status, co-morbidity, age, sex and education level. Panic disorder, specific phobia and alcohol abuse disorders cancer. Association between number of mental disorders and likelihood of reporting a subsequent cancer diagnosis. Depression is more strongly associated with cancers diagnosed early in life and in women. PTSD is associated with cancers diagnosed early in life. O Neill et al., 2014 Journal of Psychosomatic Research

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22 Suicidal Behaviour in Northern Ireland Suicide rates are high and rising in NI (300 a year). Associated with mental illness (>90%). Behaviour: most people who have mental disorders do not die by suicide. Need to look at other factors. NI Study of Health and Stress Ideation: Seriously considered suicide. Made a plan for suicide. Suicide attempt.

23 Logistic regression analyses of socio-demographic and conflict related trauma correlates of suicidal ideation, plans and attempt ODDS RATIOS Ideation 8.6* 1.8* 2.3* Plan 15.8* 2.2* Attempt 15.2* 2.6* O'Neill S, Ferry F, Murphy S, Corry C, et al. (2014) Patterns of Suicidal Ideation and Behavior in Northern Ireland and Associations with Conflict Related Trauma. PLoS ONE 9(3): e doi: /journal.pone

24 WHY? Conflict experience is protective. OR Conflict associated with increased likelihood of death on first attempt.

25 Why do people die by suicide?

26 Why do people die by suicide? Suicide is a goal directed behaviour to address unbearable pain. Pain + Hopelessness thoughts of suicide (ideation). Connectedness prevents enaction. If pain > connectedness plan. Whether this leads to death is dependent upon capability or access to means. If total capability > fear of attempting attempt.

27 Emotions Entrapment Shame Guilt Failure Loneliness Isolation Burdensomeness UNBEARABLE PAIN

28 Extracts from a suicide note: Simon Comer The illness I have has caused me pain that not even the strongest medicines could dull, and there is no cure. All day, every day a screaming agony in every nerve ending in my body. It is nothing short of torture. My mind is a wasteland, filled with visions of incredible horror, unceasing depression, and crippling anxiety. PTSD Flashbacks Depression Pain

29 PTSD Numbing During my first deployment, I was made to participate in things, the enormity of which is hard to describe [ ] there are some things that a person simply can not come back from. Simple things that everyone else takes for granted are nearly impossible for me. I can not laugh or cry. I can barely leave the house. I derive no pleasure from any activity. Everything simply comes down to passing time until I can sleep again. Now, to sleep forever seems to be the most merciful thing.

30 Habituation & expertise This is what brought me to my actual final mission. Not suicide, but a mercy killing. I know how to kill, and I know how to do it so that there is no pain whatsoever. It was quick, and I did not suffer. And above all, now I am free. I feel no more pain. I have no more nightmares or flashbacks or hallucinations. I am no longer constantly depressed or afraid or worried. I am free.

31 The Northern Ireland Context Conflict increases connectedness. Post conflict: reduced connectedness. Experiences have different meanings increased risk. Exposure to pain habituation (less fear/ more expertise). Cognitive access to means: Information.

32 NI Suicide study Characteristics of the deceased (N=1667) 77% male. Rates high from years. The highest proportion were single (39.1% women & 48.3% men). The most frequent adverse event noted was relationship difficulties. Other common events were bereavement, illness, financial crisis, employment difficulties and police or legal problems. O Neill, Corry, Murphy, Bunting (under review)

33 Suicide and Health Diagnoses Increase in use of services by females. Decrease in service use for males. Women were more likely than men to have a recorded mental health condition. Men were more likely to report only physical health problems (pain). None 30% Physical 12% Both 22% Mental 36% O Neill, Corry, Murphy, Bunting (under review)

34 Understanding mental health in NI: The next steps Creating a culture of social integration and connectedness. LGBT. Victims. Reaching out to vulnerable people. Seeking help is a sign of strength. Evidence based treatments for mental disorders esp. PTSD. Improving the validity of the data on suicide.

35 Joseph Addison