Multiple successes for GM PSTRC research at NIHR CRN Greater Manchester Evening of Excellence 2021

The NIHR Clinical Research Network (CRN) Greater Manchester hosted an Evening of Excellence on 18th November 2021 to celebrate the valuable achievements made in the delivery of research last year across Greater Manchester, East Cheshire and East Lancashire. The NIHR Greater Manchester Patient Safety Translational Research Centre (GM PSTRC) submitted three entries which are highlighted below and all of these were selected for presentation at the event.

PPIE work with Mutual Support for Mental Health Research (MS4MH-R) around suicide and self-harm

Featured in the Inspiring Inclusive Involvement category

NIHR GM PSTRC mental health researchers, Leah Quinlivan, Louise Gorman and Donna Littlewood, have been featured in the Inspiring Inclusive Involvement category of the CRN Evening of Excellence 2021 for their Patient and Public Involvement and Engagement (PPIE) work in mental health research.

Carrying out PPIE work is particularly challenging when people have lived experience of self-harm or suicide. Patients’ and carers’ voices are often missing from research because of a widely held belief that talking about these distressing experiences can lead to further harm or increased risk.

The GM PSTRC research team set up and developed the Mutual Support for Mental Health Research (MS4MH-R) group, which includes 23 active members from a range of social backgrounds and diverse communities. All members have lived experience of self-harm or suicide and have encountered mental health services either as patients or carers. To promote equal access to the group, the research team recruited members in various ways, including poetry events, public engagement events, social media, and through charity and healthcare networks.

An innovative approach to the wellbeing of group members helps to ensure people can contribute safely. The research team co-designs wellbeing plans with group members, working around fluctuations in wellness, and reassuring temporarily absent members that their place will always be there after they’ve recovered.

The team also provides research training and opportunities for further development. Several public contributors have taken on more senior PPIE roles, and others have spoken at conferences about the MS4MH-R’s innovative and inclusive approach to PPIE.

Members of the MS4MH-R group have provided invaluable input into our work on        

• the impact of the COVID-19 pandemic on population mental health
• psychosocial assessments following self-harm
• family involvement in crisis resolution and home treatment services
• suicide in middle-aged men.

MS4MH-R is now widely recognised as the ‘go-to’ group for PPIE in self-harm and suicide prevention research.

The mental health team consists of: Dr Leah Quinlivan, Dr Louise Gorman, Dr Donna Littlewood 

Accelerating research with the Greater Manchester Care Record

Featured in the Community Catalyst category

Richard Williams, Research Fellow in the NIHR GM PSTRC, nominated the Greater Manchester Care Record team for the ‘Community Catalyst’ category of the NIHR CRN Greater Manchester Evening of Excellence 2021.

The Greater Manchester Care Record (GMCR) collects anonymised data from various NHS services, such as GPs and hospitals. The data is made accessible to clinicians across GM in order to improve their decisions when treating patients. In the face of the COVID-19 pandemic, the GMCR was developed into the advanced system that operates today.

Although the main purpose of the GMCR is to improve patient care, the data is also a fantastic resource for researchers – and, of course, research has been vital in the pandemic response. A way for researchers to access the data was quickly established, so they could use it to answer important research questions, while ensuring data security and good information governance.

Work that has taken place using the GMCR so far includes:

• an analysis of the reduction in diagnoses in primary care
• the equity of the vaccine rollout
• the effect of the pandemic on mental health and the incidence of self-harm.

We’re delighted to be recognised for all the hard work of so many people over the last 18 months.

The GMCR team consists of: the NIHR Greater Manchester Patient Safety Translational Research Centre (GM PSTRC), NIHR Manchester Biomedical Research Centre (BRC), NIHR Applied Research Collaboration Greater Manchester (ARC-GM), GM Population Research Resource, The University of Manchester, the Greater Manchester Academic Health Science Network (AHSN), Health Innovation Manchester, Graphnet, and the Greater Manchester Health and Social Care Partnership. 

Partnership working to understand access to primary care for people experiencing homelessness during COVID-19

Featured in the Inspiring Inclusive Involvement category  

The COVID-19 pandemic and the required social distancing measures caused huge disruption and changes to the organisation of primary care, particularly for people experiencing homelessness. Remote consultations became the ‘default’ approach, with patients needing to have access to a phone and a suitable space to have their consultation.

Against this backdrop, a number of questions were raised. For example, would the changes to primary care during the pandemic make health and care outcomes for people experiencing homelessness better or worse?

Groundswell and the NIHR Greater Manchester Patient Safety Translational Research Centre have been working together to evaluate the impact of the changes to primary care on people who are experiencing homelessness. This involved asking for the experiences and opinions of healthcare professionals and key stakeholders, as well as people experiencing homelessness.

The project has been an academic and community partnership, bringing together people with experiences of homelessness, as well as those that support them, across 3 primary care sites in Greater Manchester.

The team working on homelessness consists of: Dr Kelly Howells, Prof Caroline Sanders, Groundswell, Urban Medical Practice, Salford Primary Care Together, and Bolton Homeless and Vulnerable Adults Service. 

Researchers confirm link between testing positive for COVID-19 and fatigue and sleep problems

Those who tested positive for COVID-19 (confirmed by a PCR test) had an increased risk of mental illness, fatigue and sleep problems, finds a new study which analysed the electronic primary care health care records of 226,521 people from across the UK between February 2020 and December 2020. 

The research, ‘Association of SARS-CoV-2 Infection With Psychological Distress, Psychotropic Prescribing, Fatigue, and Sleep Problems Among UK Primary Care Patients‘ was published in The Journal of the American Medical Association Network Open (JAMA Network Open) today, and was funded by the National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC). The Centre is a partnership between The University of Manchester and The Northern Care Alliance NHS Foundation Trust.  

The study found there was an almost six-fold increase in the likelihood of reporting fatigue to a GP following a positive PCR test and a threefold increase in the risk of sleep problems compared to those without a positive test, for people who haven’t previously visited their GP for any of these reasons in the past.  

There was also an 83% increase in mental illness following a positive PCR test. However, there was also a 71% increase in the risk of mental illness for people who received a negative PCR test compared to the general population. Researchers believe this throws some doubt about whether COVID-19 is directly causing mental illness, because it is clear that those who get a test are more likely to have risk factors for mental illness, for example pandemic-related anxieties.  

Dr Matthias Pierce, researcher at The University of Manchester who led the work, said: “When we began this research project we wanted to investigate whether we could find any evidence in primary health care records that COVID-19 was linked to an increased risk of mental health illness, sleep and fatigue problems.   

“While fatigue is clearly a consequence of COVID-19 the risk of experiencing sleep problems is also very high. However, we are sceptical regarding the extent that COVID-19 is directly causing people to become mentally ill, or whether those with a predisposition to mental illness are more likely to get tested.” 

Professor Roger Webb, from The University of Manchester, who co-leads the Mental Health research programme at the NIHR GM PSTRC, said: “Our findings align with those generated by investigations conducted in other countries in revealing elevated risks of mental illness, self-harm, fatigue, and disrupted sleep patterns among people testing positive for infection during the pandemic. Establishing the mechanisms that have caused these outcomes to occur is the next major challenge for researchers in our field.”     

Professor Carolyn Chew-Graham, a co-author on the paper, Professor of General Practice Research at Keele University and a General Practitioner, said “It is vital that general practitioners recognise the long-term impact of COVID-19 infection on their patient population. Offering follow-up to people who test positive for COVID-19 infection may help identify persisting symptoms, and sign-post people to the Your COVID Recovery website. The increased risk of developing mental health problems in people who tested negative may be due to health anxiety in these patients, and primary care has a role in identifying and supporting such patients.”

New research reveals concerning trends around self-harm across Greater Manchester

The number of people seeking help for self-harm in primary care (for example from their GP), dropped sharply during the first UK lockdown in 2020. By May 2021 this deficit had not returned to pre-pandemic levels, according to new research that analysed the electronic health care records in primary care of 2.8 million people across Greater Manchester.   

Researchers analysed a new de-identified database that pulls together healthcare information from general practices across Greater Manchester to identify trends around self-harm by sex, age group, ethnicity and deprivation. They found a potentially concerning treatment gap for self-harm among men and people living in the most deprived areas.  

The study’s findings ‘Temporal trends in primary care-recorded self-harm during and beyond the first year of the COVID-19 pandemic: time series analysis of electronic healthcare records for 2.8 million patients in the Greater Manchester Care Record‘ were published in EClinicalMedicine today. The investigation was funded by the UK Research and Innovation (UKRI) and the National Institute of Health Research (NIHR) COVID-19 rapid response call. It was also supported by additional funding and researchers from the NIHR Greater Manchester Patient Safety Translational Research Centre (GM PSTRC) – a partnership between The Northern Care Alliance NHS Foundation Trust (NCA) and The University of Manchester.  

Dr Sarah Steeg, Presidential Fellow in mental health epidemiology at The University of Manchester, who worked with researchers from the GM PSTRC on this study, said: “We believe the fact the number of people accessing healthcare for self-harm didn’t return to pre-pandemic levels by May 2021 is unlikely to be because these people aren’t harming themselves. It is more likely to be because people aren’t seeking help or aren’t seeking help in the same way as they did before the pandemic.” 

There has been research that’s looked at self-harm during the first wave of the pandemic. However, despite further waves of COVID-19 and ongoing national and regional restrictions that affected Greater Manchester into the autumn/winter of 2020 and the spring of 2021, little was known about how many people were visiting their GP after harming themselves during that time.  

Dr Steeg, continued: “The findings of our study are concerning as the deepening health inequalities we observed during the first wave of the pandemic, in 2020, didn’t recover by the spring of 2021. This could reflect a hesitance to seek help from health services in the way people did before the pandemic.” 

Researchers believe the potential treatment gap among men is particularly concerning due to the increased risk of suicide for men if they have harmed themselves. 

This is the first study to be published that used the Greater Manchester Care Record, which brings together healthcare and social care information. It meant researchers could examine the number of times self-harm was recorded across primary care (for example, general practices) every month until May 2021. 

Professor Niels Peek, lead of the Safety Informatics theme at the GM PSTRC, who was also part of the team that created the Greater Manchester Care Record, said: “This is an important milestone for the Integrated Care System in Greater Manchester. It tells us that we can use data from the Greater Manchester Care Record to accurately assess the impact of the pandemic on the Manchester population.”