How do the prevalence and relative risk of non-suicidal self-injury and suicidal thoughts vary across the population distribution of common mental distress (the p-factor)?: Observational analyses replicated in two independent UK cohorts of young people

Ela Polek; Sharon Neufeld; Paul Wilkinson; Ian M Goodyer; Michelle St Clair; Gita Prabhu; Raymond J. Dolan; Edward T Bullmore; Peter Fonagy; Jan Stochl; Peter B  Jones

doi:10.1136/bmjopen-2019-032494

How do the prevalence and relative risk of non-suicidal self-injury and suicidal thoughts vary across the population distribution of common mental distress (the p-factor)? Observational analyses replicated in two independent UK cohorts of young people

Ela Polek, Sharon Neufeld, Paul Wilkinson, Ian M Goodyer, Michelle St Clair, Gita Prabhu, Raymond J. Dolan, Edward T Bullmore, Peter Fonagy, Jan Stochl, Peter B Jones

Department of Psychology

Research output: Contribution to journal › Article › peer-review

12 Citations (SciVal)

Abstract

Objectives To inform suicide prevention policies and responses to youths at risk by investigating whether suicide risk is predicted by a summary measure of common mental distress (CMD (the p factor)) as well as by conventional psychopathological domains; to define the distribution of suicide risks over the population range of CMD; to test whether such distress mediates the medium-term persistence of suicide risks. Design Two independent population-based cohorts. Setting Population based in two UK centres. Participants Volunteers aged 14-24 years recruited from primary healthcare registers, schools and colleges, with advertisements to complete quotas in age-sex-strata. Cohort 1 is the Neuroscience in Psychiatry Network (n=2403); cohort 2 is the ROOTS sample (n=1074). Primary outcome measures Suicidal thoughts (ST) and non-suicidal self-injury (NSSI). Results We calculated a CMD score using confirmatory bifactor analysis and then used logistic regressions to determine adjusted associations between risks and CMD; curve fitting was used to examine the relative prevalence of STs and NSSI over the population distribution of CMD. We found a dose-response relationship between levels of CMD and risk of suicide. The majority of all subjects experiencing ST and NSSI (78% and 76% in cohort 1, and 66% and 71% in cohort 2) had CMD scores no more than 2 SDs above the population mean; higher scores indicated the highest risk but were, by definition, infrequent. Pathway mediation models showed that CMD mediated the longitudinal course of both ST and NSSI. Conclusions NSSI and ST in youths reflect CMD that also mediates their persistence. Universal prevention strategies reducing levels of CMD in the whole population without recourse to screening or measurement may prevent more suicides than approaches targeting youths with the most severe distress or with psychiatric disorders.

Original language	English
Article number	e032494
Journal	BMJ Open
Volume	10
Issue number	5
DOIs	https://doi.org/10.1136/bmjopen-2019-032494
Publication status	Published - 11 May 2020

Bibliographical note

Funding Information:
Funding The ROOTS study was supported by a Wellcome Trust Grant (Grant No 074296) to IG and PJ, the NIHR Collaborations for Leadership in Applied Research and Care (CLAHRC) East of England, and the NIHR Cambridge Biomedical Research Centre. The NSPN study was supported by the Wellcome Trust Strategic Award (095844/Z/11/Z) to IG, ETB, PJ, RD and PF. Disclaimer The funding sources had no role in the design and conduct of the study; collection, management, analysis and interpretation of data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

Funding Information:
Competing interests ETB and PF are in receipt of National Institute for Health Research (NIHR) Senior Investigator Awards (NF-SI-0514-10157 and NF-SI-0514-10117). PF was in part supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Barts Health NHS Trust. PW has recent/current grant support from NIHR, Cambridgeshire County Council and CLAHRC East of England. PW discloses consulting for Lundbeck and Takeda. PJ is supported by the NIHR Applied Research Collaboration East of England and discloses consulting for Janssen and Ricordati. At the time of the study ETB was employed half time by the University of Cambridge and half time by GlaxoSmithKline in which he holds stock. EP, SASN, IG and JS have no competing interests.

Publisher Copyright:
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

Keywords

child & adolescent psychiatry
epidemiology
public health
suicide & self-harm

ASJC Scopus subject areas

General Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Polek, E., Neufeld, S., Wilkinson, P., Goodyer, I. M., St Clair, M., Prabhu, G., Dolan, R. J., Bullmore, E. T., Fonagy, P., Stochl, J., & Jones, P. B. (2020). How do the prevalence and relative risk of non-suicidal self-injury and suicidal thoughts vary across the population distribution of common mental distress (the p-factor)? Observational analyses replicated in two independent UK cohorts of young people. BMJ Open, 10(5), Article e032494. https://doi.org/10.1136/bmjopen-2019-032494

How do the prevalence and relative risk of non-suicidal self-injury and suicidal thoughts vary across the population distribution of common mental distress (the p-factor)? Observational analyses replicated in two independent UK cohorts of young people. / Polek, Ela; Neufeld, Sharon; Wilkinson, Paul et al.
In: BMJ Open, Vol. 10, No. 5, e032494, 11.05.2020.

Research output: Contribution to journal › Article › peer-review

Polek, E, Neufeld, S, Wilkinson, P, Goodyer, IM, St Clair, M, Prabhu, G, Dolan, RJ, Bullmore, ET, Fonagy, P, Stochl, J & Jones, PB 2020, 'How do the prevalence and relative risk of non-suicidal self-injury and suicidal thoughts vary across the population distribution of common mental distress (the p-factor)? Observational analyses replicated in two independent UK cohorts of young people', BMJ Open, vol. 10, no. 5, e032494. https://doi.org/10.1136/bmjopen-2019-032494

Polek E, Neufeld S, Wilkinson P, Goodyer IM, St Clair M, Prabhu G et al. How do the prevalence and relative risk of non-suicidal self-injury and suicidal thoughts vary across the population distribution of common mental distress (the p-factor)? Observational analyses replicated in two independent UK cohorts of young people. BMJ Open. 2020 May 11;10(5):e032494. doi: 10.1136/bmjopen-2019-032494

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abstract = "Objectives To inform suicide prevention policies and responses to youths at risk by investigating whether suicide risk is predicted by a summary measure of common mental distress (CMD (the p factor)) as well as by conventional psychopathological domains; to define the distribution of suicide risks over the population range of CMD; to test whether such distress mediates the medium-term persistence of suicide risks. Design Two independent population-based cohorts. Setting Population based in two UK centres. Participants Volunteers aged 14-24 years recruited from primary healthcare registers, schools and colleges, with advertisements to complete quotas in age-sex-strata. Cohort 1 is the Neuroscience in Psychiatry Network (n=2403); cohort 2 is the ROOTS sample (n=1074). Primary outcome measures Suicidal thoughts (ST) and non-suicidal self-injury (NSSI). Results We calculated a CMD score using confirmatory bifactor analysis and then used logistic regressions to determine adjusted associations between risks and CMD; curve fitting was used to examine the relative prevalence of STs and NSSI over the population distribution of CMD. We found a dose-response relationship between levels of CMD and risk of suicide. The majority of all subjects experiencing ST and NSSI (78% and 76% in cohort 1, and 66% and 71% in cohort 2) had CMD scores no more than 2 SDs above the population mean; higher scores indicated the highest risk but were, by definition, infrequent. Pathway mediation models showed that CMD mediated the longitudinal course of both ST and NSSI. Conclusions NSSI and ST in youths reflect CMD that also mediates their persistence. Universal prevention strategies reducing levels of CMD in the whole population without recourse to screening or measurement may prevent more suicides than approaches targeting youths with the most severe distress or with psychiatric disorders.",

keywords = "child & adolescent psychiatry, epidemiology, public health, suicide & self-harm",

author = "Ela Polek and Sharon Neufeld and Paul Wilkinson and Goodyer, {Ian M} and {St Clair}, Michelle and Gita Prabhu and Dolan, {Raymond J.} and Bullmore, {Edward T} and Peter Fonagy and Jan Stochl and Jones, {Peter B}",

note = "Funding Information: Funding The ROOTS study was supported by a Wellcome Trust Grant (Grant No 074296) to IG and PJ, the NIHR Collaborations for Leadership in Applied Research and Care (CLAHRC) East of England, and the NIHR Cambridge Biomedical Research Centre. The NSPN study was supported by the Wellcome Trust Strategic Award (095844/Z/11/Z) to IG, ETB, PJ, RD and PF. Disclaimer The funding sources had no role in the design and conduct of the study; collection, management, analysis and interpretation of data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication. Funding Information: Competing interests ETB and PF are in receipt of National Institute for Health Research (NIHR) Senior Investigator Awards (NF-SI-0514-10157 and NF-SI-0514-10117). PF was in part supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Barts Health NHS Trust. PW has recent/current grant support from NIHR, Cambridgeshire County Council and CLAHRC East of England. PW discloses consulting for Lundbeck and Takeda. PJ is supported by the NIHR Applied Research Collaboration East of England and discloses consulting for Janssen and Ricordati. At the time of the study ETB was employed half time by the University of Cambridge and half time by GlaxoSmithKline in which he holds stock. EP, SASN, IG and JS have no competing interests. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.",

year = "2020",

month = may,

day = "11",

doi = "10.1136/bmjopen-2019-032494",

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T1 - How do the prevalence and relative risk of non-suicidal self-injury and suicidal thoughts vary across the population distribution of common mental distress (the p-factor)?

T2 - Observational analyses replicated in two independent UK cohorts of young people

AU - Polek, Ela

AU - Neufeld, Sharon

AU - Wilkinson, Paul

AU - Goodyer, Ian M

AU - St Clair, Michelle

AU - Prabhu, Gita

AU - Dolan, Raymond J.

AU - Bullmore, Edward T

AU - Fonagy, Peter

AU - Stochl, Jan

AU - Jones, Peter B

N1 - Funding Information: Funding The ROOTS study was supported by a Wellcome Trust Grant (Grant No 074296) to IG and PJ, the NIHR Collaborations for Leadership in Applied Research and Care (CLAHRC) East of England, and the NIHR Cambridge Biomedical Research Centre. The NSPN study was supported by the Wellcome Trust Strategic Award (095844/Z/11/Z) to IG, ETB, PJ, RD and PF. Disclaimer The funding sources had no role in the design and conduct of the study; collection, management, analysis and interpretation of data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication. Funding Information: Competing interests ETB and PF are in receipt of National Institute for Health Research (NIHR) Senior Investigator Awards (NF-SI-0514-10157 and NF-SI-0514-10117). PF was in part supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Barts Health NHS Trust. PW has recent/current grant support from NIHR, Cambridgeshire County Council and CLAHRC East of England. PW discloses consulting for Lundbeck and Takeda. PJ is supported by the NIHR Applied Research Collaboration East of England and discloses consulting for Janssen and Ricordati. At the time of the study ETB was employed half time by the University of Cambridge and half time by GlaxoSmithKline in which he holds stock. EP, SASN, IG and JS have no competing interests. Publisher Copyright: © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

PY - 2020/5/11

Y1 - 2020/5/11

N2 - Objectives To inform suicide prevention policies and responses to youths at risk by investigating whether suicide risk is predicted by a summary measure of common mental distress (CMD (the p factor)) as well as by conventional psychopathological domains; to define the distribution of suicide risks over the population range of CMD; to test whether such distress mediates the medium-term persistence of suicide risks. Design Two independent population-based cohorts. Setting Population based in two UK centres. Participants Volunteers aged 14-24 years recruited from primary healthcare registers, schools and colleges, with advertisements to complete quotas in age-sex-strata. Cohort 1 is the Neuroscience in Psychiatry Network (n=2403); cohort 2 is the ROOTS sample (n=1074). Primary outcome measures Suicidal thoughts (ST) and non-suicidal self-injury (NSSI). Results We calculated a CMD score using confirmatory bifactor analysis and then used logistic regressions to determine adjusted associations between risks and CMD; curve fitting was used to examine the relative prevalence of STs and NSSI over the population distribution of CMD. We found a dose-response relationship between levels of CMD and risk of suicide. The majority of all subjects experiencing ST and NSSI (78% and 76% in cohort 1, and 66% and 71% in cohort 2) had CMD scores no more than 2 SDs above the population mean; higher scores indicated the highest risk but were, by definition, infrequent. Pathway mediation models showed that CMD mediated the longitudinal course of both ST and NSSI. Conclusions NSSI and ST in youths reflect CMD that also mediates their persistence. Universal prevention strategies reducing levels of CMD in the whole population without recourse to screening or measurement may prevent more suicides than approaches targeting youths with the most severe distress or with psychiatric disorders.

AB - Objectives To inform suicide prevention policies and responses to youths at risk by investigating whether suicide risk is predicted by a summary measure of common mental distress (CMD (the p factor)) as well as by conventional psychopathological domains; to define the distribution of suicide risks over the population range of CMD; to test whether such distress mediates the medium-term persistence of suicide risks. Design Two independent population-based cohorts. Setting Population based in two UK centres. Participants Volunteers aged 14-24 years recruited from primary healthcare registers, schools and colleges, with advertisements to complete quotas in age-sex-strata. Cohort 1 is the Neuroscience in Psychiatry Network (n=2403); cohort 2 is the ROOTS sample (n=1074). Primary outcome measures Suicidal thoughts (ST) and non-suicidal self-injury (NSSI). Results We calculated a CMD score using confirmatory bifactor analysis and then used logistic regressions to determine adjusted associations between risks and CMD; curve fitting was used to examine the relative prevalence of STs and NSSI over the population distribution of CMD. We found a dose-response relationship between levels of CMD and risk of suicide. The majority of all subjects experiencing ST and NSSI (78% and 76% in cohort 1, and 66% and 71% in cohort 2) had CMD scores no more than 2 SDs above the population mean; higher scores indicated the highest risk but were, by definition, infrequent. Pathway mediation models showed that CMD mediated the longitudinal course of both ST and NSSI. Conclusions NSSI and ST in youths reflect CMD that also mediates their persistence. Universal prevention strategies reducing levels of CMD in the whole population without recourse to screening or measurement may prevent more suicides than approaches targeting youths with the most severe distress or with psychiatric disorders.

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