Adult Psychiatric Morbidity survey 2014

The Institute of Psychiatry, Psychology and Neuroscience within King’s College London (KCL) requires Adult Psychiatric morbidity survey 2014 data for an Economic and Social Research Council (ESRC) funded project.

Justification for the processing of the data is under Article 6(1)(e) of the GDPR, for the performance of a task in the public interest; and Article 9(2)(j) of the GDPR, where processing of the data is necessary for research purposes in the public interest. The ESRC have funded KCL to look at the increasing length of people’s lives and the health impacts of working longer or retiring earlier. Separate groups were established to look at physical health and mental health. The objectives of using 2014 adult psychiatric morbidity data (APMS) are to support improvements to mental health among non-employed and employed communities by analysing data and producing papers to be published in academic journals.

The 2014 adult psychiatric morbidity data will be used to investigate the trends in paid employment and common mental health disorders (CMD). Association between common mental health conditions (anxiety, depression, cognitive impairment) will also be investigated and associated with non-employment using 2014 adult psychiatric morbidity data.

King's College London (KCL) has previously used Adult Psychiatric Morbidity Survey data in 1993, 2000 and 2007 and has published a paper - "Paid employment and common mental disorders in 50-64 year olds: analysis of three cross sectional nationally representative survey samples in 1993, 2000 and 2007" Perera, G., Di Gessa, G., Corna, L. M., Glaser, K. & Stewart, R. 24 Aug 2017 In : Epidemiology And Psychiatric Sciences. There was feedback from Department for Work and Pensions that further analysis would be beneficial specifically including trends in strength of this association and strength of the association with other age groups.

Two members of Psychological Medicine department, Institute of Psychiatry, Psychology and Neuroscience at King’s College London will be leading this project. A consultant working in KCL's Department of Old Age Psychiatry is the academic lead for this project and an epidemiologist will be analysing the APMS data. Only these two members of the of Psychiatry, Psychology and Neuroscience will have access to APMS data.

The aim of this study is to explore changes in relationship between employment status, adverse life events and psychological health. KCL will be using ONS Psychiatric Morbidity Surveys: 1993, 2000, 2007 and 2014 data. Key outcomes included detailed psychological measures using Common mental disorder ascertained using the revised Clinical Interview Schedule (CIS-R) (e.g. depression, anxiety, sleeplessness).

KCL will be addressing following key questions:

i. What is the relationship between non-employment and common mental disorders?

ii. Does it vary according to the reason for non-employment?

iii. Does it vary by age group?

iv. Has it varied over time (1993, 2000, 2007)?

v. Is it related to particular common mental health disorders (CMD) symptoms?

The Adult Psychiatric Morbidity Survey (APMS) series provides data on the prevalence of both treated and untreated psychiatric disorder in the English adult population (aged 16 and over). This survey is the fourth in a series and was conducted by NatCen Social Research, in collaboration with the University of Leicester, for NHS Digital.

The previous surveys were conducted in 1993 (16-64 year olds) and 2000 (16-74 year olds) by the Office for National Statistics, which covered England, Scotland and Wales. The 2007 Survey included people aged over 16 and covered England only.

The work aims to develop understanding and evidence base for association between non-employment and common Mental Disorders in the UK and trends of such strengths of this association between 1993 and 2014.

The UK has witnessed significant increases in the percentage of older workers in the labour market, and the employment rate for those aged 50 and over is currently 57% (ONS Labour Force Survey, 2016) compared with 31% around a decade ago (Whiting, 2005), reflecting policies to encourage older workers to remain active in the labour market and delay retirement (Bartley, 1994; Vickerstaff, 2010). Investigations of employment status and mental health have primarily focused on unemployment as an exposure and its negative impact on psychological well-being. Studies of retirement and mental health have yielded mixed results. On the one hand, reduced prevalence of depressive episodes and mental fatigue has been reported following retirement (Westerlund et al. 2010; Calvo et al. 2013; Choi et al. 2013). However, this appears to coincide with the statutory retirement age and not the timing of individual exit from work (Villamil et al. 2006). British data indicate worse mental health associated with early retirement (Buxton et al. 2005), an association, which diminishes closer to statutory retirement ages (Melzer et al. 2004; Butterworth et al. 2006). Older workers may leave the workforce due to disability, unemployment, or early retirement, although these distinctions are often blurred (Calvo, 2006): for example, influenced by availability of disability and/or retirement benefits (Laaksonen et al. 2016; ONS Labour Force Survey, 2016) as well as perceived poor health or the presence of a chronic disorder (Mein et al. 2000; Monden, 2005; Vickerstaff, 2010), and more heterogeneous factors such as lower education, being single, physical inactivity and a high body mass index (Alavinia & Burdorf, 2008).

Few studies have investigated paid employment and mental health closer to retirement age: instead focusing on younger age groups (Butterworth et al. 2013), all working age groups (Weich & Lewis, 1998; Martikainen et al. 2000; Ford et al. 2010), or on early retirement (Buxton et al. 2005). A study of Korean men aged 55 years and older found that those in paid employment had a lower prevalence of depressive symptoms than the non-employed group (Park et al. 2016), similar to findings from two US studies (Calvo, 2006; Glass et al. 2006), and to those from various multinational European surveys based on respondents aged 60 years and older (Choi et al. 2013; Di Gessa & Grundy, 2014); however, all relied on brief screening instruments as mental health measures or single questions as outcomes.

APMS 2014 data is therefore required from NHS Digital in order to carry out the above outlined study in order to investigate these key research questions further through analysis of a nationally representative survey into CMD.

The data has already been disseminated under the pervious v0.7 of the agreement, no further data will be disseminated under this version of the agreement . This agreement is only an extension to continue to retain the data already provided.

The 2014 APMS data set is held on behalf of NHS Digital by the UK Data Service (UKDS) (www.ukdataservice.ac.uk) and the UKDS is responsible for dissemination under direction by NHS Digital. King's College London will receive the pseudonymised APMS data set. There is no facility to select individual variables. KCL will be able to download the data set from UKDS for the period specified within the Data Sharing Agreement and must securely destroy all local copies of the data set when the Agreement expires and notify NHS Digital in line with standard procedures. This 2014 version of the data set available has been redacted on Disclosure Control Procedure advice to minimise the likelihood of individuals being able to identify anyone taking part in the survey.

UKDS will transfer the pseudonymised APMS data to KCL. No other organisations will be involved in the flow of data.

The APMS 2014 dataset will be used by KCL to conduct research in non-employment and common mental disorders in the UK, building on the gaps identified in literature. Nationally representative data is required to reach generalisable conclusions which are relevant for public health policy and programme development in this sector of health.

Once the APMS data has been received by KCL, it will be saved in Kings College London secure folders which only approved employees of KCL will have access to. KCL store data on a server on site which can be remotely accessed via secure, password protected computers supplied by the institutions.

The data will be analysed using STATA. KCL will analyse trends over time, and investigate any associations between mental health and non-employment. The APMS data will allow KCL to look at sub-components of common mental health disorders.

Individual level APMS data will not be linked to any other datasets.

There will be no requirement nor attempt to re-identify individuals from the data.

Data will only be accessed by individuals within KCL who have authorisation to access the data for the purpose(s) described, all of whom are substantive employees of KCL.

All organisations party to this Agreement must comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract - i.e. employees, agents and contractors of the Data Recipient who may have access to that data).

The data will not be made available to any third parties other than those specified except in the form of aggregated outputs with small numbers suppressed in line with the HES Analysis Guide.

King's College London has prepared 4 papers for peer-reviewed publications and hoping to submit them in the next six months by March 2023. Although the specific journals are not yet confirmed, the list of possibilities is expected to include:

> Epidemiology and Psychiatric Sciences

> Age and Ageing

> European Journal of Ageing

> Psychological Medicine

Further data analysis will be carried out using the 1993, 2000, 2007 and 2014 APMS (Adult Psychiatric Morbidity Survey) in the next three years. The findings will be submitted for publication to open-access, peer-reviewed journals, with estimated publication dates between January 2023 and December 2025

Further research conference posters and/or oral presentations will be submitted to various national and international conferences All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide/compliant with the MHSDS disclosure control rules including suppression and rounding. For each paper published on the research, short presentations will be developed to summarise the findings for different stakeholders, such as pensioners, KCL will use institutional websites / social media accounts to promote findings through summaries or links to published work - for example, host blog posts on King’s Health Partners and through institutional Twitter accounts to promote engagement efforts so that research benefits reach communities to support improved health outcomes.

Outputs were discussed and presented in engagement through Department for Work and Pensions (DWP), led by the project supervisor based at Institute of Psychiatry, Psychology and Neuroscience at Kings College London.

Furthermore, following papers and presentations were disseminated so far:

Mental health needs of “baby boomers” (50- 70 year olds) covered in report from England’s Chief Medical Officer’s annual report. This article is posted in: Health, Mental Health, Older Workers, Retirement. December 15 2016. Co-authors:Dr Gayan Perera

Dr. Gayan Perera from King’s College London was a guest speaker at the ICAP Sri Lanka conference in August 2016

Perera, G. et al., (2019). Paid employment and common mental disorders in 50–64-year olds: analysis of three cross-sectional nationally representative survey samples in 1993, 2000 and 2007. Epidemiology and psychiatric sciences, 28(1), 88-99.

WHERL conference at Prudential Governor’s House Laurence Pountney Hill London EC4R 0HH: Findings presented at this conference on the 13th April 2016

King's College London will be presenting key findings of this data at the European Psychiatry Association, Section of the Epidemiology and Social Psychiatry in Cambridge on 9th September 2022. King's College London will acknowledge NHS Digital for data provision. Abstract can be found in here: https://www.psychepi.org/congress/wp-content/uploads/sites/2/2022/09/EPA-Online-Abstract-Book-v1.2.pdf.

The aim of these papers is to investigate the effect of mental health among the non-employed and employed communities. The findings will be published with the assistance of various government and non-governmental organisations in order to disseminate those findings. In addition to the publications, KCL will present their findings to stakeholder organisations, including the Department for Work and Pensions, and the Pension Policy Institute.

These research outputs seek to directly increase the evidence base for the association between common Mental disorders and non-employment in England for various age and gender groups, for whom there are longstanding concerns about non-employment. By increasing the evidence base, an indirect objective is to contribute further to improved public health policy and programming. The eventual aim would be to achieve benefits to health through support of employment for those with common mental disorders and predict those who are about to become patients with common mental disorders and therefore to improve the quality of life among the population in England.

At this point, actual expected benefits and magnitude are as yet not quantified given data analysis has not been conducted. However, through the course of the project, a more detailed dissemination plan focusing on policy recommendations that emerge from the research will be formulated to formalise these steps, and progress will be shared with NHS Digital. Outputs will be primarily discussed and presented in engagement through Department for Work and Pensions (DWP), led by the project co-supervisor. Furthermore, KCL will present these findings at the European Psychiatric Association (EPA) section of Social epidemiology. EPA conferences, seminars and talks are hosted by a range of mental health practitioners. It is reasonable to expect these benefits will be realised primarily because the research results will have policy implications for old age and disadvantaged groups.

King's College London have prepared the following four papers and will be submitting them in the next 6 months.

1: Paid employment and mental health in 65-74 year olds: analysis of national data from 2000, 2007 and 2014

2: Trends in association between non-employment and common mental disorders among 25-64 year olds: analysis of four cross-sectional nationally representative survey samples in 1993, 2000, 2007 and 2014

3: Associations of non-employment with common mental disorder subcomponents among working age population: analysis of national data from 1993, 2000, 2007 and 2014

4: Trends in association between physical illnesses and common mental disorders: Analysis of four nationally representative surveys in England

Findings from above papers are useful to improve health and social care in the UK. Particularly, this demonstrates that occupational mental health support is needed particularly middles-aged employees. Furthermore, employment improves mental health among older aged population and therefore, working after age 65- 74 is better for employee mental health.

The researcher at King's College London analysed the findings and found that three large national surveys of people aged 50–64 years showed there is an excess prevalence of CMD in those who were not in paid employment in above papers and presentations. However, these associations were only present for people who characterised their non-employment as due to ill-health, and no associations were observed with non-employment for other reasons. The association between employment status and seen a doctor for physical health mental health in mid-life is important, given increasing employment within these age groups and rises in the statutory pension age.