Suicide within the UK Central & Eastern European (CEE) community: what is known and what do we need to know?

Conference:

SAPC ASM 2018 - London

Talk Code:

P1.36

Presenter:

Aaron Poppleton

Twitter:

@AaronPoppleton

Co-authors:

Nadeem Gire(1,2), Paula Brindas(3), Iulian Ionescu(4), Nusrat Husain(2)

Author institutions:

1. University of Central Lancashire, School of Health & Wellbeing, 2. Global Mental Health and Cultural Psychiatry Research Group, University of Manchester, 3. Isle of Wight NHS trust, 4. Greater Manchester Mental Health NHS Foundation Trust.

Problem

The population of UK resident CEE communities has increased significantly since 2004/2007 EU expansion. CEE nationals face a ‘double health inequality’ with migration related psychological strain and residual home nation mental health burden. UK resident CEE nationals experience a higher prevalence of affective disorders, alcohol misuse, mental health stigma, and death through suicide, with help seeking behaviour and primary care usage differing to the UK majority population. Brexit is largely believed to have further increased socioeconomic stress and uncertainty. Understanding variations in psychiatric presentations and morbidity within ethnic minority groups can direct cultural adaptation of treatment approaches. No systematic evaluation of UK resident CEE nationals’ mental health has been undertaken to date. More specifically, little is known of the perception of suicide, its predisposing factors, and potential interventions within this community. Our research group intends to evaluate this knowledge gap, permitting appropriate and acceptable cultural adaptation of risk stratification and prevention strategies for suicidal behaviour.

Approach

We undertook a literature database (MedLine, PubMed, PsychINFO, Web of Science, SCOPUS) for studies exploring common mental health complaints in adult UK resident CEE nationals. Published literature suggest some exploration of UK CEE mental health themes including: distress, mental health help seeking, depression, anxiety, suicide, and alcohol misuse. No studies considered psychosis. Study numbers were limited (n=12). Data/subpopulation heterogeneity and generally low research quality was noted. A Google/Scholar and ‘Grey literature’ search returned multiple relevant small scale surveys, qualitative reviews, and policy documents. Subsequent RDS funded Public and Patient Involvement (PPI) Initiatives were held within the Romanian and Lithuanian communities in Lancashire. Themes discussed included: perceptions of primary care, mental health, distress, and suicide. Opinions on study topics, design, recruitment, and potential facilitators/barriers to participation and discussion were sought, in addition to identification of community leaders.

Findings

Public and Patient Involvement Initiatives within primary care highlighted significant perceived stigma relating to mental health and suicide. Participants felt qualitative evaluation of mental health beliefs (including suicide) and health service usage in relation to life stressors, anxiety and depression would be acceptable. Personal invitation by a community leader to a one-on-one interview was the advised recruitment/exploration strategy. We intend to undertake a full scoping review on the mental health of UK CEEs, in line with publications for other migrant communities.

Consequences

Rapidly mapping all available evidence and key concepts within this novel area will inform further translational research within primary care. Ongoing PPI group meetings and discussion will evaluate proposals and build trust within the community. Knowledge generated will direct development of a formal qualitative interview schedule for subsequent in-depth exploration of knowledge gaps and perceptions/evaluation of a culturally adapted risk stratification tool for depression and self-harm/suicidal intent suitable for use within general practice.

Submitted by:

Aaron Poppleton

Funding acknowledgement:

We declare no competing interests. AP and NG gratefully acknowledge the support and funding of the National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care North West Coast. AP is also funded by the NHS CCG for East Lancashire.