Collaborations in Mental Health Research: Bristol, UK and International

' BRBRISTOL RESEARCH ANDS INNOVATION SYMPOSIUM0 Burden of disease 2010

David Gunnell, Professor of Epidemiology University of Bristol

Prince et al. Lancet 2007 Contribution by different non-communicable diseases to disability-adjusted life-years worldwide in 2005

Mental Health research funding disparity Why is mental health research important?

• High burden and disproportionately under-funded

• Suicide is a major contributor to potential year of life lost in England (in men 2nd to heart disease)

• NIHR – prioritised mental health in first call for programme grants, established biomedical research centre for mental health, MHRN and through HTA supported a number of Bristol RCTs

• MRC planned investment in mental health (mental health and well-being one of its two current priority themes)

• Wellcome’s strategic plan (2010-12) “Understanding the brain (including…the interface between basic and clinical neuroscience, new insights into mental health disorders..)” is one of 5 major challenges

Projected increase in dementia 2006-2026 Research groups

• Prof Ricardo Araya – trials of interventions for depression in low income countries (UoB)

• Dr Rachael Churchill – Cochrane review group (depression, anxiety and neurosis) (UoB)

• Prof Norma Daykin - arts and health (UWE)

• Prof David Gunnell – suicide prevention (UoB)

• Dr Matthew Hickman – addiction research (UoB)

• Prof Glyn Lewis – common mental disorder / ALSPAC (UoB)

• Prof Nichola Rumsey – appearance research (UWE)

• Prof Debbie Sharp – primary care mental health(UoB)

Year

Jagger C et al Age and Ageing 2009 Lancetetc1.jpg

Lancetetc6.jpg Suicide and the East Asian economic crisis: 1998

Chang et al Soc Sci Med 2009 Chang et al Soc Sci Med 2009

Resources for mental health research in Bristol

• Strong links with local NHS trusts – esp. AWP / Bristol PCT • Mental Health Research network (MHRN)

Resources for mental health Recruitment to MHRN trials in SW research in Bristol

6,000 • Strong links with local NHS trusts – esp. AWP / Bristol PCT 5,000 • Mental Health Research network (MHRN)

4,000 • Multi-disciplinarity – psychiatry, sociol, geography, psychology, epidemiology, primary care, public health, economics, 3,000 anthropol, statistics …… 2,000 • Strong links with primary care and primary care research

1,000 network (PCRN) • Bristol Randomised Trials Collaboration (BRTC) 0

L E W N EA EM oE NE N S R H NW & L ping L n p S no ma in

2006-07 2007-08 2008-09 2009-10

EA EM HoE NE NL NW SL&SE W non LRN in mapping 2006‐07 670 68 517 120 343 488 607 625 66 0 2007‐08 749 3,068 1,347 474 2,474 2,626 1,045 1,308 2,232 48 2008‐09 2,396 5,024 2,377 1,743 4,639 3,440 3,582 3,915 620 283 2009‐10 2,556 2,778 2,514 710 3,656 1,407 3,388 4,988 345 488 Resources for mental health Mental Health Trials research in Bristol

• GP and Secondary care based trials of self-harm • Strong links with local NHS trusts – esp. AWP / Bristol PCT prevention (Sharp, Gunnell, Evans, Peters) • Mental Health Research network (MHRN) • Genetic predictors of depression response - Genpod • Multi-disciplinarity – psychiatry, sociol, geography, psychology, (Lewis, Sharp) epidemiology, primary care, public health, economics, anthropol, statistics • Internet based CBT (Kessler, Araya, Lewis, Peters) • Strong links with primary care and primary care research • TREAD - exercise and depression (Wiles, Lewis, Sharp) network (PCRN) • COBALT – CBT in treatment resistant depression (Wiles) • Bristol Randomised Trials Collaboration (BRTC) • Ante- and Post-natal depression (Sharp, Evans) • Avon Longitudinal Study of Parents and Children (ALSPAC) • Trials in Chile – school and community-based (Araya) • Trials of pesticide suicide prevention in Sri Lanka (Gunnell, Metcalfe)

Depressive symptom sum-scores at three Resources for mental health time-points across groups defined by timing of menarche (early, normative and late) research in Bristol

6.5 • Strong links with local NHS trusts – esp. AWP / Bristol PCT Early 6 Normal • Mental Health Research network (MHRN) Late • Multi-disciplinarity – psychiatry, sociol, geography, psychology, 5.5 epidemiology, primary care, public health, economics, anthropol, statistics 5 • Strong links with primary care and primary care research network (PCRN) 4.5

MFQ Score • Bristol Randomised Trials Collaboration (BRTC)

4 • Avon Longitudinal Study of Parents and Children (ALSPAC) • International collaborations: Chile, Scandinavia, Sri Lanka, 3.5 Brazil, Taiwan….. • Systematic reviews expertise 3 • MRC CAiTE centre (Causal Analyses in Translational Epidemiology) t1 (10.5yrs) t2 (13yrs) t3 (14yrs) Age • DECIPHer - Development and Evaluation of Complex F = 0.19 (p =0.823) F = 8.06 (p < 0.001) F = 11.97 (p < 0.001) Interventions for Public Health Improvement

Joinson C et al, submitted

Policy Links / funding bodies Developments and opportunities

• NICE – Lewis, Evans • BRIG-H Mental Health Strategy Development • NIHR – Lewis, Gunnell • Bristol self-harm register • Cochrane Collaboration - Churchill • Bristol’s Brain Imaging Centre • MHRA – Gunnell • Support for complex trials (BRTC, ConDuCT - COllaboration and iNnovation in DifficUlt and • MHRN - Lewis complex randomised Controlled Trials) • National Suicide Prevention – Gunnell • Integration of neuroscience into field epidemiology • Wellcome – Araya Potential new areas NIHR Suicide Prevention Program

• Old age psychiatry Multi-centre programme of clinical and public health • Psychosis and schizophrenia research in support of the National Suicide Prevention Strategy for England: 2007-2011

• Pilot studies for interventions • Pharmacoepidemiology studies • Coroners studies of validity of suicide statistics • Assessment of self-harm services in 32 trusts

Timing of admissions for self harm in 1. Pilot studies year after discharge from inpatient psychiatric care

(i) To develop and pilot a contact-based intervention aimed at reducing the incidence of repeat self-harm (ii) To develop and pilot a contact-based intervention aimed at reducing the incidence of self-harm after discharge from specialist psychiatric services

Mortality in England and Wales from analgesic poisoning (suicide and open verdicts), 1998-2007, for people aged 10 years and over (substances taken alone, with or without alcohol)

• Mental Health Strategy completion (Summer 2010) • Closer integration between universities and NHS partners (to benefit of both) • Increase Bristol’s mental health research profile nationally and internationally • Attract the next generation of mental health researchers to Bristol