The main findings from the ADRC-NI project are now available SDAI ESRC report

Two project related conference presentations were made at the International Conference for Administrative Data Research, Queen’s University Belfast, 21-22nd June 2018.

1. Mogens Christoffersen, “Is the Prevention Paradox Useful in Suicide Prevention Theory and Strategies?”

2. Mark Shevlin, “Prevalence and predictors of antidepressant prescribing in Northern Ireland”

Dr Christoffersen’s presentation described the extensive Danish registries and outlined how they can be used to test complex social science hypotheses. There was an extensive discussion about how registry data is accessed and how the associated privacy concerns were addressed. He also met with post-graduate research students and discussed the possibility of collaborative research. The discussion after Mark Shevlin’s presentation was around what other data resources could be used through the ADRC-NI. These were described and those who were interested were directed to the ADRN/ADRC-NI website.

Conference website

An episode of File on 4 examined the rates of antidepressant prescribing in the UK, particularly looking at the increase rates for young people.

“More antidepressants than ever before are being prescribed to young people in Britain, despite fears that they can cause harm in some cases.

What are the driving factors behind the increase? Is there any merit to claims the drugs are ineffective – and, in some cases, have serious side effects in children? And is the NHS providing the proper support to young people affected by mental illness who are turning to medication to cope?

This, however, is not the first time a surge in the rate of antidepressants being prescribed to young people has been deemed a cause for concern. In 2005, in response to public concern, prescription guidelines were introduced. They included step-by-step instructions for medical professionals who treat patients under 18 years of age; providing, for the first time, standard treatment protocols. In turn, the number of antidepressants being prescribed across the UK declined for a period. But, now, some thirteen years later, the numbers have surpassed pre-NICE guidelines levels – and show no signs of slowing. And there’s evidence that the guidelines themselves are being ignored in some cases.

Paul Connolley investigates the causes and risks of an increasing reliance on medication.”

Listen to the programme here

**The producer of the programme contacted Mark Shevlin and was provided with details of the project findings.

Recently, Ian Craig from the Research Support Unit (RSU) at NISRA kindly accepted our request to answer a few questions. We thought it might be interesting to do a profile on a Research Support Officer, and get their perspective on administrative data research. Ian and his colleagues are constantly liaising with researchers, ADRC-NI staff, data controllers… they really are right in the thick of it. Ian’s answers are genuine and to the point, which is characteristic of the RSU staff.

1. How did you end up working at NISRA and how long have you been working here?

I returned to Belfast after working in England for a number of years. I worked in two organisations based in Belfast prior to joining NISRA. I have been working in NISRA for eight years.

2. What is your involvement (role and responsibilities) in ADRC-NI?

I am a Research Support Officer within the NISRA Research Support Unit. My role is to provide support for ADRC-NI projects from concept to the provision of data in the secure environment. I am also responsible for clearing outputs (intermediate and final) and monitoring the activities of the secure environment.

3. What do you think are the greatest benefits of using population data linkage?

In my opinion the greatest benefit of using population data linkage is to aid policy makers make informed decisions. It also provides an opportunity to link datasets together that traditionally would not have been linked and hence provide an insight into population trends and possible concerns.

4. What do you think are the obstacles to more widespread use of administrative data through the ADRC-NI?

Time. It takes a lot of time from concept to providing the data in the secure environment. It also involves a lot of effort to secure legal access to the data.

5. What would you change (if anything) about the current process of using administrative linked data in Northern Ireland?

I would not change anything but would enhance the current process by providing the legal rights for RSU to house data from data controllers. This would reduce the time to provide the data to researchers.

6. Any other comments?

ADRC-NI is very young and hence will require time to develop. Have patience.

On behalf of myself and the rest of the ADSoPP team, I would like to extend thanks for this interview to Ian, NISRA-RSU and ADRC-NI.

Stephanie

This months must-read is quite simply, major. On February 21st, The Lancet published a meta-analysis of Randomised Control Trials (RCTs) addressing antidepressant use that generated widespread media coverage across the world. This meta-analysis, which psychiatrists from the Royal College of Psychiatrists (RCPsych) participated in creating, reports that ”antidepressants work”. Unfortunately, that is probably the sum of information the public will retain from this research. The full details of the research don’t fit nice and neatly into an attention-grabbing headline. If I were to try and create a reasonable headline for the work, it would probably look something like this:

There appear to be very small to moderate effects for antidepressant use over placebo, suggesting they may be of slight benefit for a small sub-set of patients who are undergoing short-term treatment. However, a cost-benefit analysis for improvement in symptoms versus adverse effects must be conducted. Also, as only average response rate was analysed, the effects for a specific age group, gender, social class, clinical presentation etc. cannot be determined. Please take caution when interpreting these results as specific adverse effects occur over a prolonged period of usage, and this work has only sampled short-term RCTs (<8 weeks). Lastly, note that RCTs in psychopharmacology, such as those sampled in this work, tend to be funded by industry, i.e. big pharmaceutical companies who have vested interests in selling these drugs.

Not exactly as catchy as “antidepressants work”, is it? And it is just the start. This pseudo-headline  I’ve cobbled together to provide a more balanced view of the research doesn’t even begin to cover the lengthy limitations of the meta-analysis, although Robert Whitaker and Dr. Peter Gøtzsche have written particularly good critiques for those who are interested (here and here). A particularly striking soundbite from Dr. Gøtzsche’s critique refers to the manipulation of results in industry-funded trials, and the participation in this meta-analysis of authors who have previously renounced such trials.

“Several of the authors of a 2018 network meta-analysis in the Lancet are well aware that published trial reports of depression pills cannot be trusted. I therefore do not understand why they are authors on this paper. Erick Turner, for example, has been a reviewer for the FDA (Food and Drug Administration) and he showed in 2008 that the effect of depression pills was 32% larger in published trials than in all trials in FDA’s possession” Dr. Peter Gøtzsche

The media storm the Lancet paper generated was furthered by a letter subsequently published in The Times newspaper, signed by Professor Wendy Burn and Professor David Baldwin, the President of RCPsych and the Chair of its Psychopharmacology Committee respectively. The letter stated that for the vast majority of patients, any withdrawal symptoms experienced following antidepressant discontinuation halted within two weeks of stopping treatment. This claim has caused considerable outrage with practitioners, academics and patients in the mental health community (including several psychiatrists), who find claim untrue and potentially dangerous. Thus, a formal complaint was compiled on behalf of several prominent professionals, and submitted to RCPsych by Professor John Read of the University of East London. The formal complaint details several counter-arguments to The Times letter claim, and brandishes it a danger to public health. Professor Read has subsequently been interviewed by James Moore on the subject. He is a renowned researcher with decades of experience in this field, and his responses are more pithy than anything I could write. I strongly recommend that you listen to his interview here.

To conclude, these developments are staggering. Having read the evidence, I can’t help but feel it further illustrates for the need for administrative data research to supplement RCTS such as these. Two critiques of the Lancet paper are that the RCTs sampled assess short-term usage and they fail to assess Global Functioning. Use of administrative data allows us to link data over longer periods of time, so that long-term recovery can be assessed. Global functioning can also be assessed using objective measures such as educational attainment or employment.  Our project in particular, the Antidepressant Social Prescribing Project, has linked antidepressant prescribing to socioeconomic, health and demographic factors. For those of you who are new, you can learn more about the Antidepressant Social Prescribing Project here.

Mark Shevlin, Stephanie Boyle and Jamie Murphy attend the ‘Mapping Population Data using QGIS’ workshop organised by the Northern Ireland Longitudinal Survey (NILS) Research Forum on Thursday 22nd March 2018.

Using settlement band data a map of antidepressant prescribing was produced. A prescribing map at the super output level is planned when the data is available.

 

 

“It’s Unlikely That ‘Antidepressants’ Have a True Effect on Depression”

https://www.madinamerica.com/2018/01/antidepressants-effect-depression/

The must-read this month was suggested by Mark, our chief investigator. It is an article by Dr. Peter Gøtzsche, a scientist who works as part of a team who complete systematic reviews of psychiatric drug trials at the Nordic Cochrane Centre. Dr. Gøtzsche’s argument that antidepressants lack effect in all populations (both those who are currently being treated with antidepressants and are “washed out”, and antidepressant-naïve patients with comorbidities) is compelling.

Stephanie

In ADRC-NI lingo, the data is now officially ‘in the room’, meaning we can access our de-identified database in the secure environment at the NISRA Research Support Unit. In actuality, the data has been accessible since the first week of December. However, there is a lot of work that goes into checking, cleaning and setting-up the database. Thankfully, Michael was able to lend his vast experience to the task, and was able to set-up our database for analysis in two weeks (check out my interview with Michael on the process – coming soon!).

The ADSoPP team with Ian Craig from the Research Support Unit at the at the NISRA secure environment. (Left-right: Dr. Michael Rosato, Stephanie Boyle, Dr. Mark Shevlin, Ian Craig and Dr. Jamie Murphy).

As a result of Michael’s hard work, the team were able to come to the NISRA secure environment this week and get started on analysis. Ian Craig, Research Support Officer at NISRA was on hand to induct the team into the secure environment, and provide advice and support throughout. It was a great experience for the team, and a second beginning for the project. I think I speak for us all when I say we look forward to many days such as these to come.