Childhood adversity, mental health and suicide (CHASE): a protocol for a longitudinal case-control linked data study

Abstract

IntroductionSuicide is a tragic outcome with devastating consequences. In 2018, Scotland experienced a 15% increase in suicide from 680 to 784 deaths. This was marked among young people, with an increase of 53% in those aged 15-24, the highest since 2007. Early intervention in those most at risk is key, but identification of individuals at risk is complex, and efforts remain largely targeted towards universal suicide prevention strategies with little evidence of effectiveness.
 Recent evidence suggests childhood adversity is a predictor of subsequent poor social and health outcomes, including suicide. This protocol reports on methodology for harmonising lifespan hospital contacts for childhood adversity, mental health, and suicidal behaviour. This will inform where to 1) focus interventions, 2) prioritise trauma-informed approaches, and 3) adapt support avenues earlier in life for those most at risk.
 MethodsThis study will follow a case-control design. Scottish hospital data (physical health SMR01; mental health SMR04; maternity/birth record SMR02; mother’s linked data SMR01, SMR04, death records) from 1981 to as recent as available will be extracted for people who died by suicide aged 10-34, and linked on Community Health Index unique identifier. A randomly selected control population matched on age and geography at death will be extracted in a 1:10 ratio. International Classification of Disease (ICD) codes will be harmonised between ICD9-CM, ICD9, ICD10-CM and ICD10 for childhood adversity, mental health, and suicidal behaviour.
 ResultsICD codes for childhood adversity from four key studies are reported in two categories, 1) Maltreatment or violence-related codes, and 2) Codes suggestive of maltreatment. ‘Clinical Classifications Software’ ICD codes to operationalise mental health codes are also reported. Harmonised lifespan ICD categories were achieved semi-automatically, but required labour-intensive supplementary manual coding. Cross-mapped codes are reported.
 ConclusionsThere is a dearth of evidence about touchpoints prior to suicide. This study reports methods and harmonised ICD codes along the lifespan to understand hospital contact patterns for childhood adversity, which come to the attention of hospital practitioners.

Defining suspected child maltreatment using International Classification of Diseases codes: A scoping literature review

“…Among the included studies which focused on multiple maltreatment, the most common research objective (11 studies) was to determine the incidence or the trends of maltreatment-related injuries (Ben-Arieh & McDonell, 2009; Gonzalez-Izquierdo et al, 2010; Guthridge et al, 2014; Hunter & Bernstein, 2019; King et al, 2015; Lee et al, 2012; Lindberg et al, 2015; McDonell et al, 2015; Schilling et al, 2020; Somji et al, 2011; Wheeler et al, 2017). Four articles described the demographic and clinical characteristics of patients suspected for maltreatment (King et al, 2015; Kuang et al, 2018; Somji et al, 2011; Sonderman et al, 2018), two studies validated the ICD codes for maltreatment related injuries or circumstances (McKenzie et al, 2011; Raghavan et al, 2014), three focused on the process of identifying a set of ICD codes suggestive of maltreatment (Ben-Arieh & McDonell, 2009; McKenzie & Scott, 2011; Schnitzer et al, 2011), and three examined the relationships between maltreatment related injuries and child outcomes (e.g., child maltreatment fatalities; mental health, suicidal behavior, and out-of-home care; Dougall et al, 2020; Högberg et al, 2019; Kennedy et al, 2020).…”

“…The coding scheme of suggestive maltreatment based on precedent from Schnitzer et al (2011) was applied by seven articles (Dougall et al, 2020; Hunter & Bernstein, 2019; Kennedy et al, 2020; King et al, 2015; Kuang et al, 2018; Schilling et al, 2020; Wheeler et al, 2017), making it a seminal study in the research on ICD codes for suspected maltreatment. This study first compiled a comprehensive list of ICD codes suspicious for child maltreatment using literature review and consultation with an advisory panel of experts on child maltreatment.…”

“…The coding scheme of suggestive maltreatment based on precedent from Schnitzer et al (2011) was applied by seven articles (Dougall et al, 2020;Hunter & Bernstein, 2019;Kennedy et al, 2020;King et al, 2015;Kuang et al, 2018;Schilling et al, 2020;Wheeler et al, 2017), making it a seminal study in the research on ICD codes for suspected maltreatment.…”

Childhood adversity and mental health admission patterns prior to young person suicide (CHASE): a case-control 36 year linked hospital data study, Scotland UK 1981–2017

“…This analysis aimed to report to three pre-specified research questions (RQ) in the study protocol: 14 (1) What is the relationship between number and type of childhood adversities and suicide, stratified by age and sex (assigned at birth)? ( 2) What is the relationship between type and number of childhood adversities, subsequent mental health and self-harm admissions prior to suicide?…”

“…As defined in the protocol, 14 adverse events were identified in hospital admissions occurring before age 18 years, based on International Classification of Disease (ICD) coded diagnoses (ICD-10 was in use from 1 April 1997, and prior to that ICD-9; see Supplementary Table 1). All recorded diagnoses were used to code admissions, including the 'main' and up to five 'other' diagnoses, as well as diagnoses at admission, or discharge, in psychiatric records.…”