NHS Digital Data Release Register - reformatted

Royal College Of Surgeons In Ireland projects

14 data files in total were disseminated unsafely (information about files used safely is missing for TRE/"system access" projects).

Psychotic experiences as risk markers for suicidal behaviour in high risk groups — DARS-NIC-165460-G2C3R

Type of data: information not disclosed for TRE projects

Opt outs honoured: Anonymised - ICO Code Compliant (Does not include the flow of confidential data)

Legal basis: Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 – s261(2)(b)(ii)

Purposes: No (Academic)

Sensitive: Non-Sensitive

When:DSA runs 2019-01-21 — 2022-01-20

Access method: One-Off


Sublicensing allowed: No


  1. Adult Psychiatric Morbidity Survey
  2. Adult Psychiatric Morbidity Survey (APMS)


‘On average, 13 people kill themselves every day in England. The death of someone by suicide has a devastating effect on families, friends, workplaces, schools and communities, as well as an economic cost. If we want to improve the life chances of future and current generations, we need to address this shocking reality and do more to prevent suicides.’ - Ministerial Foreword, ‘Preventing suicide in England: Third progress report’ (UK Department of Health, 2017).

The Royal College of Surgeons in Ireland (RCSI), who are the sole data controller who also process data, requires the Adult Psychiatric Morbidity Survey 2014 (APMS 2014) data in support of a RCSI PhD Project. The objective of the study is to explore whether psychotic experiences (PE) in the general population (English adults, aged 16 and over) are risk markers for suicidal behaviour.

There has been extensive research on psychotic experiences in the general population over the past two decades. These are hallucinatory experiences and delusional beliefs, similar to the classic positive symptoms of schizophrenia, but typically associated with at least some degree of intact reality testing (i.e. they do not necessarily imply mental disorder). Psychotic experiences are reported by 5% to 8% of the general adult population. Research has demonstrated that psychotic experiences are associated with high risk for a broad range of mental disorders and poor mental health outcomes in general. More recently, psychotic experiences have been shown to be associated with suicidal thoughts and behaviour (from now ‘suicidality’); individuals with PE are 2-fold more likely to experience suicidal ideation and up to 11-fold more likely to attempt suicide compared to those without psychotic experiences.

Previous research has shown associations between a number of physical health conditions and psychotic disorder. For example, meta-analytic results showed the rate of psychosis among people with epilepsy to be 7.8 times higher than in people without epilepsy. However, research is yet to look at the same conditions with the broader phenomena of psychotic experiences.

Research has also shown individuals with certain physical health conditions to be at increased risk of suicidality compared to individuals without these physical health conditions. For example, individuals with epilepsy are at 2-fold increased odds of suicidal ideation and 4.5- fold increased odds of suicide attempt compared to individuals without epilepsy. It is unknown whether having both a physical health condition in addition to having psychotic experiences increases the risk of suicidality more so than either one in isolation. In this instance, psychotic experiences would be a ‘risk marker’ for suicidality.

Other groups at ‘high risk’ for psychotic experiences and suicidal thoughts and behaviour include individuals with asthma, individuals who have had a stroke, LGBTQ groups, individuals exposed to trauma and individuals with mental health conditions.

A number of papers have been published on previous APMS data (1993, 2000 and 2007), looking at suicidal behaviours and psychotic experiences separately. However, to RCSI'S knowledge, only two studies to date have looked specifically at the association between psychotic experiences and risk for suicidal thoughts and behaviour in the APMS datasets, of which both showed an increased risk for suicidal ideation and suicide attempt in individuals who had reported psychotic experiences. No research to date has used the APMS datasets to explore psychotic experiences as a ‘risk marker’ for suicidality within subgroups known to be at increased risk.

This PhD project aims to:
• Determine prevalence of psychotic experiences in groups known to be at high risk for suicidality (physical health conditions, mental health conditions and minority groups).
• Compare prevalence of psychotic experiences over time, using APMS datasets from 1993, 2000, 2007 and 2014
• Explore whether individuals from high risk groups are at even more increased risk of suicidality if they also report psychotic experiences
• Determine whether associations between psychotic experiences and suicidality in high risk groups are explained by co-occurring mental health conditions, cognitive variables or demographic variables.

Data from the APMS datasets will be analysed using Stata software. Statistical analysis will be performed using logistic regressions to determine and quantify risk of suicidality in high risk groups using psychotic experiences as risk markers. The data will not be used for commercial purposes, not provided in record level form to any third party and not used for direct marketing.


The following outputs will be produced:

• Reports of interim results will be provided to RCSI internal PhD examiners annually in the form of a ‘mini-viva’. These will be competed each October (2018, 2019, 2020).

• Final report of results will be submitted to RCSI examiners and one external examiner at the end of the PhD, due to be completed in October 2021. This will cover all findings of individual studies, including, but not limited to:

• The association between Epilepsy, PE and suicidality
• The association between Asthma, PE and suicidality
• The association between Stroke, PE and suicidality
• The association between trauma, PE and suicidality
• The association between LGBTQ, PE and suicidality

Adjustments for mental health conditions, cognitive variables and demographic variables will be made to see whether these influence the relationship between these phenomena.

The results from analyses using the APMS 2014 dataset will be published in peer-reviewed academic journals, as well as disseminated in presentations where possible. It will also be written up as part of a PhD thesis (by October 2021). Academic papers will be published in high impact factor, peer reviewed journals on the prevalence of psychotic experiences in individuals with physical and mental health conditions, as well as the association between high risk groups, PE and suicidality.

Journals aimed for include: Schizophrenia Bulletin, British Journal of Psychiatry, Psychological Medicine and Psychiatry Research, amongst others.

For each paper published, a short presentation will be developed to summarise overall findings and disseminated in academic meetings within RCSI, as well as externally at conferences. Conferences aimed at to submit research to include the International Association for Youth Mental Health conference, the Schizophrenia International Society conference and the MQ’s Mental Health Science Meeting in London, which focuses specifically on self-harm and suicide in 2019. All publications and conference presentations are promoted on twitter, via professional twitter accounts for the individual for whom this PhD project this relates to, and their PhD Supervisor (>1500 followers).

The intended target audience for these results are the scientific and clinical community including specifically clinicians and researchers working in the field of mental health.

APMS low numbers and suppression:
In order to protect patient confidentiality in publications resulting from analysis of APMS data users must:
• guarantee that any outputs made available to anyone other than those with whom this agreement is made, will meet required standards, including the guarantee, methods and standards contained in the Code of Practice for Official Statistics (http://www.statisticsauthority.gov.uk/assessment/code-of-practice/index.html) and the ONS Statistical Disclosure Control (https://gss.civilservice.gov.uk/statistics/methodology-2/statistical-disclosure-control/) for tables produced from surveys;
• apply methods and standards specified in the Microdata Handling and Security Guide to Good Practice (http://www.data-archive.ac.uk/media/132701/UKDA171-SS-MicrodataHandling.pdf) for disclosure control for statistical outputs.


The UK Data Service (UKDS) will grant system access to pseudonymised APMS data to the Royal College of Surgeons in Ireland, where it will be downloaded and stored securely on an internal U drive, and the core dataset will be accessed on site only by members of the RCSI Psychiatry department (four individuals) who have PhD studentships or are substantive employees.

Prevalence of psychotic experiences within the general population will be looked at within the APMS 2014 dataset. This will be compared with previous APMS datasets (1993, 2000 and 2007) to see whether the prevalence of hallucinations has changed over time. RCSI already holds copies of previous APMS datasets. As the data is cross-sectional, it cannot be linked to previous individuals from previous APMS datasets, only combined with datasets to provide more observations (and therefore increase total numbers, especially when prevalence for certain disorders is low). The APMS 2014 dataset will also be combined with the previous 2007 APMS dataset (and the APMS 2000 dataset, where possible) in order to enlarge sample sizes in disorders where prevalence is low. This will be done using the ‘merge’ function in Stata.

The relationship between psychotic experiences and suicidal behaviour will be explored in groups considered to be at high risk of suicidal behaviour; those with physical health illnesses such as epilepsy and asthma, and mental health illnesses such as depression and social phobia. Adjustments for other mental health disorders and demographic variables will be made to see if the relationship is partly explained by these variables.

This data will be analysed on Stata software to explore the associations between psychotic experiences and suicidality.

Logistic regressions will be conducted to see whether there is an increased risk of:
• Suicidality outcomes:
• Suicidal ideation and attempt (separately) in individuals reporting psychotic experiences
• Suicidal ideation and attempts (separately) in individuals with physical health conditions (all physical health conditions looked at in the APMS will be explored for completeness, but groups known to be at risk for psychotic disorder such as epilepsy, asthma, stroke)
• Suicide ideation and attempts in individuals reporting mental health conditions (all mental health conditions assessed in the APMS surveys)

• PE Outcomes:
• PE in individuals with physical health conditions
• PE in individuals with mental health conditions

• PE and Suicidality outcomes:
• Suicidal ideation in individuals with physical health conditions who also experience PE
• Suicide attempt in individuals with physical health conditions who also experience PE
• Suicidal ideation in individuals with mental health conditions who also experience PE
• Suicide attempt in individuals with mental health conditions who also experience PE

Flows of data and the APMS 2014 dataset will not be made available to any third part except in the form of aggregated outputs with small numbers suppressed. There will be no requirement, nor attempt, to re-identify individuals from the data.

The 2014 APMS dataset (English adult population (aged 16 and over) is held on behalf of NHS Digital by the UK Data Service (UKDS) (www.ukdataservice.ac.uk ) and UKDS are responsible for dissemination under direction by NHS Digital. RCSI will get the whole dataset; there is no facility to select individual variables. They will be able to download the dataset from UKDS for the period specific within the DSA and they must securely destroy all local copies of the dataset when the DSA expires and notify DARS in line with standard procedures. This 2014 version of the dataset available via DARS has been redacted on Disclosure Control Procedure advice to minimise the likelihood of individuals being able to identify anyone taking part in the survey.

NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data).