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

Dougall, Nadine; Savinc, Jan; Maxwell, Margaret; Karatzias, Thanos; O'Connor, Rory C.; Williams, Brian; Grandison, Graeme; John, Ann; Cheyne, Helen; Fyvie, Claire; Bisson, Jonathan I.; Hibberd, Carina; Abbott-Smith, Susan; Nolan, Liz


Margaret Maxwell

Rory C. O'Connor

Brian Williams

Graeme Grandison

Ann John

Helen Cheyne

Claire Fyvie

Jonathan I. Bisson

Carina Hibberd

Liz Nolan


Suicide 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.

This 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.

ICD 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.

There 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.

Journal Article Type Article
Acceptance Date Mar 5, 2020
Online Publication Date Apr 2, 2020
Publication Date Apr 2, 2020
Deposit Date Apr 3, 2020
Publicly Available Date Apr 3, 2020
Print ISSN 2399-4908
Publisher Swansea University
Peer Reviewed Peer Reviewed
Volume 5
Issue 1
Keywords Childhood Adversity, Adverse Childhood Experiences, Mental Health, Self-harm, Suicide, Suicidality, Violence, Hospital episodes, Routine Data, Data Linkage, Study Protocol,
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