Social and Economic Predictors of the Severe Mental Disorders: The SEP-MD Data Linkage Study
There has been limited research on the impacts of social and environmental conditions on psychoses and other severe mental health conditions, and few studies have focused specifically on the experiences of minority ethnic groups.
Routinely collected data such as census from England, has the potential to provide insight on the relationship between severe mental illnesses and social indicators such as migration status, housing, education and employment.
Our project links data from the Census with clinical records from one of Europe’s largest secondary mental health providers, South London and Maudsley NHS Foundation Trust, which provides mental health care to an ethnically diverse, urbanised location in South East London, with a catchment area of 1.3 million people.
This data linkage is unique because it provides details on social and economic conditions which are often not included, missing or captured inadequately in standard electronic health record systems.
Through advanced statistical methods and informatics, we can analyse the data to better understand relationships between mental health, employment, ethnicity and overlapping forms of disadvantage. This can inform current service, treatment and policy concerns relating to the severe mental illnesses.
Data linkage
South London and Maudsley NHS Foundation Trust allows access to anonymised health records through the Clinical Record Interactive Search (CRIS) system. The clinical dataset includes the records of individuals with a diagnosis of severe mental health conditions, including Schizophrenia-spectrum disorders, Bipolar Affective Disorders and non-organic psychoses.
In the SEP-MD podcast 'The Big Ideas' researchers discuss the data linkage between CRIS and the Census and what it involved.
Social indicators are provided by the linked Census datasets. Individual-level Census records from 2011 were linked to records from CRIS and to death registrations
Through this data linkage we are exploring how neighbourhood and individual-level factors are related to mortality, in-patient admissions, disability and long-term worklessness in people with severe mental health conditions. We will also study ethnic inequalities to deepen our understanding of disparities in outcomes. In the future, we plan to expand our analyses to understand social and economic determinants for other mental health conditions.
SEP-MD Podcast: The Big Ideas
The Big Ideas is the SEP-MD's podcast series explores how data shapes our understanding of health and inequalities and how to make the collection and use of data more inclusive to inspire a more equitable future.
There are four episodes:
1) Making the most of existing data
2) Severe mental health disorders: the initial findings
Outcomes & Impact
After working with the Office for National Statistics to link the mental health records to Census 2011, the team have developed a number of key investigations.
Initially, the team explored reasons for non-linkage of census data to electronic mental health records (CRIS). Using the linked data, the team are currently exploring social and economic determinants of long-term worklessness, poorer self rated health, disability and mortality in people with mental disorders.
The linked data is also being used to support a number of PhD projects, including a study of urbanicity and onset of mental health conditions, and a study of inequalities in access to NHS Talking Therapies.
Some of the insights from this work are featured in the SEP-MD podcast episode on 'Severe mental health disorders: the initial findings'.
Our SEP-MD Service User and Carer Advisory Group (SUCAG) has worked closely with us, helping to design the studies, interpret the findings and share our results with the wider public.
You can hear more about the SUCAG on our project video which introduces the different aspects of SEP-MD and in our podcast episode 'Tackling systemic mental health inequalities' which also discusses the patient and carer race equality framework (PCREF).
The study is also now listed on the Catalogue of Mental Health Measures, an easy-access interactive catalogue of mental health and wellbeing measures in British cohort and longitudinal studies.
Project Team
Professor of Social & Psychiatric Epidemiology
Emeritus Professor of Statistical Epidemiology
PhD Student
Professor of Social Epidemiology
Professor of Psychiatric Epidemiology & Clinical Informatics
Research Assistant
Effective start/end date: 01/01/2020 - 30/06/2023
Project Phases
In Phase 1, we completed ethics applications and established a linkage of Census 2011 records to electronic health records of service users from South London & Maudsley Trust (though the NIHR Maudsley BRC Clinical Record Interactive Search (CRIS) system). This has led to a linked cohort of more than 20,000 people with severe mental health conditions such as schizophrenia, bipolar affective disorders, and major depression. Each case was matched to 5 population controls, who did not have these conditions. The linkage will enable us to examine the social determinants of onset, course, and outcomes (admissions, worklessness and mortality) in people living with severe mental health conditions. We also developed a network of individuals from universities, commissioners, policymakers and third sector organisations to increase the reach and impact of our work.
Phase 2 is dedicated to data analysis using advanced statistical methods. We will engage community members and partners around the methods of analysis and accessibility of research processes. Our findings will be shared in collaboration with our partners, through email, social media, meetings, and conferences.
Publications
Papers
Blogs
- The story of the SEP-MD study: Why link data?
- Linking data to understand severe mental illness: what have we learned so far?
- Bringing data together to understand employment, disability and health among people with severe mental illness
Poster presentations
- Social isolation, Ethnicity and Adverse Outcomes in Schizophrenia and Bipolar Disorder, Cybulski, L. et al. Congress of the Schizophrenia International Research Society (SIRS), 11-15 May 2023, Toronto Canada
- How is City Living Associated with Psychosis? Findings from a novel data linkage of 612,988 people from urban, ethnically diverse area, Hildersley R. et al. Congress of the Schizophrenia International Research Society (SIRS), 11-15 May 2023, Toronto Canada
Other
- UKRI Abstract and Impact Statement: https://gtr.ukri.org/projects?ref=ES%2FS002715%2F1#/tabOverview
Podcasts
News
Centre for Society Mental Health conference - five years of interdisciplinary research
The ESRC Centre for Society Mental Health showcased a range of research findings and insights at its conference on 1 October at the Science Gallery London.
Project Team
Professor of Social & Psychiatric Epidemiology
Emeritus Professor of Statistical Epidemiology
PhD Student
Professor of Social Epidemiology
Professor of Psychiatric Epidemiology & Clinical Informatics
Research Assistant
Effective start/end date: 01/01/2020 - 30/06/2023
Project Phases
In Phase 1, we completed ethics applications and established a linkage of Census 2011 records to electronic health records of service users from South London & Maudsley Trust (though the NIHR Maudsley BRC Clinical Record Interactive Search (CRIS) system). This has led to a linked cohort of more than 20,000 people with severe mental health conditions such as schizophrenia, bipolar affective disorders, and major depression. Each case was matched to 5 population controls, who did not have these conditions. The linkage will enable us to examine the social determinants of onset, course, and outcomes (admissions, worklessness and mortality) in people living with severe mental health conditions. We also developed a network of individuals from universities, commissioners, policymakers and third sector organisations to increase the reach and impact of our work.
Phase 2 is dedicated to data analysis using advanced statistical methods. We will engage community members and partners around the methods of analysis and accessibility of research processes. Our findings will be shared in collaboration with our partners, through email, social media, meetings, and conferences.
Publications
Papers
Blogs
- The story of the SEP-MD study: Why link data?
- Linking data to understand severe mental illness: what have we learned so far?
- Bringing data together to understand employment, disability and health among people with severe mental illness
Poster presentations
- Social isolation, Ethnicity and Adverse Outcomes in Schizophrenia and Bipolar Disorder, Cybulski, L. et al. Congress of the Schizophrenia International Research Society (SIRS), 11-15 May 2023, Toronto Canada
- How is City Living Associated with Psychosis? Findings from a novel data linkage of 612,988 people from urban, ethnically diverse area, Hildersley R. et al. Congress of the Schizophrenia International Research Society (SIRS), 11-15 May 2023, Toronto Canada
Other
- UKRI Abstract and Impact Statement: https://gtr.ukri.org/projects?ref=ES%2FS002715%2F1#/tabOverview
Podcasts
News
Centre for Society Mental Health conference - five years of interdisciplinary research
The ESRC Centre for Society Mental Health showcased a range of research findings and insights at its conference on 1 October at the Science Gallery London.
Our Partners
UKRI ESRC
NIHR Maudsley Biomedical Research Centre
Principal Investigator
Professor of Social & Psychiatric Epidemiology
Investigators
Professor of Psychiatric Epidemiology & Clinical Informatics
Professor of Social Epidemiology
Emeritus Professor of Statistical Epidemiology
Affiliations
Funding
Funding Body: Economic and Social Research Council (ESRC)
Amount: £200,000
Period: January 2020 - June 2023