An investigation of the multimorbidity of mental disorders and alcohol attributable conditions
Lead Research Organisation:
University of Liverpool
Department Name: Psychological Sciences
Abstract
Alcohol is the main cause of death in young people. In England in 2017 there were almost 6000 deaths across all age groups caused by alcohol, with around a fifth of the population drinking more alcohol than is recommended by government guidelines. We know that individuals who drink too much are also more likely to have a mental health problem, but we know less about the future health of people who have both of these problems and specifically whether physical diseases caused by alcohol are more common in this group. We do know that individuals with both alcohol and mental health problems may not always be able to access the treatments they need and that GPs currently do not routinely ask people with depression and anxiety about their drinking. This work will help us to understand what diseases are more common in this group of people and how best to treat them.
Multimorbidity refers to people having at least two health conditions at the same time and it is important we understand how these multiple conditions interact to affect someone's overall health. This work will investigate the most common patterns of multimorbidity, including mental health problems, depending on whether someone does or does not drink excessively. We know that people may use alcohol to help cope with mental health problems and conversely that drinking too much can make mental health worse. We will therefore look at whether the ordering of the alcohol and mental health problem, in addition in addition to other information regarding employment, housing, smoking, and physical health affects whether people die earlier than they should.
Our research will use national surveys, cohort studies (which follow people throughout their lives) and electronic healthcare records (which include data from when you visit your GP or are admitted to hospital). We will use statistical methods to understand more about multimorbidity in relation to alcohol and mental health and to identify different groups of individuals who have experienced similar types of health conditions. We will also conduct workshops with healthcare staff to ask them whether our findings reflect what they see in their practice. We will then determine whether individuals who have experienced many disadvantages in their lives and those with other behavioural risk factors (e.g. smoking and poor diet) are more likely to experience multimorbidity and whether they develop these conditions at a younger age.
We will follow individuals who have been admitted to hospital who already have a disease caused by alcohol to look at whether they are more likely to experience particular patterns of multimorbidity, and which of these people use the most health services and treatments and so may require support at an earlier stage. We will then use what we have discovered about the patterns and pathways of multimorbidity to think about what effect that changes in the way we treat people who drink excessively or have mental health problems might have on outcomes for those patients and the impact this might have on the NHS.
Our work may show that we need to do more to ensure that alcohol and mental health services are better joined up than they currently are. Further impacts of our work will be in developing web-tools that can be used by GPs to understand which patients are likely to have the poorest outcomes and in selecting the best treatment options for their patients. We can also help inform the development of government policies and in selecting which treatments and services to provide, to avoid individuals with mental health problems experiencing more harms as a result of their drinking.
Multimorbidity refers to people having at least two health conditions at the same time and it is important we understand how these multiple conditions interact to affect someone's overall health. This work will investigate the most common patterns of multimorbidity, including mental health problems, depending on whether someone does or does not drink excessively. We know that people may use alcohol to help cope with mental health problems and conversely that drinking too much can make mental health worse. We will therefore look at whether the ordering of the alcohol and mental health problem, in addition in addition to other information regarding employment, housing, smoking, and physical health affects whether people die earlier than they should.
Our research will use national surveys, cohort studies (which follow people throughout their lives) and electronic healthcare records (which include data from when you visit your GP or are admitted to hospital). We will use statistical methods to understand more about multimorbidity in relation to alcohol and mental health and to identify different groups of individuals who have experienced similar types of health conditions. We will also conduct workshops with healthcare staff to ask them whether our findings reflect what they see in their practice. We will then determine whether individuals who have experienced many disadvantages in their lives and those with other behavioural risk factors (e.g. smoking and poor diet) are more likely to experience multimorbidity and whether they develop these conditions at a younger age.
We will follow individuals who have been admitted to hospital who already have a disease caused by alcohol to look at whether they are more likely to experience particular patterns of multimorbidity, and which of these people use the most health services and treatments and so may require support at an earlier stage. We will then use what we have discovered about the patterns and pathways of multimorbidity to think about what effect that changes in the way we treat people who drink excessively or have mental health problems might have on outcomes for those patients and the impact this might have on the NHS.
Our work may show that we need to do more to ensure that alcohol and mental health services are better joined up than they currently are. Further impacts of our work will be in developing web-tools that can be used by GPs to understand which patients are likely to have the poorest outcomes and in selecting the best treatment options for their patients. We can also help inform the development of government policies and in selecting which treatments and services to provide, to avoid individuals with mental health problems experiencing more harms as a result of their drinking.
Technical Summary
The compounded health risks for patients with comorbid alcohol and mental health problems are not established. We will use several secondary data sources to identify multimorbidity clusters of physical non-communicable diseases with common and severe mental disorders, focusing on clusters of Wholly or Partially Alcohol Attributable Conditions. This research is paramount given significant reductions in life expectancy for individuals with alcohol problems and with mental disorder. The timing is salient given cuts to primary care alcohol screening and to alcohol treatment services.
We will use population surveys, cohort data and electronic healthcare records to investigate how alcohol attributable conditions cluster with mental disorders and the most common transitions to these multimorbidities. We will determine the socioeconomic, social (e.g. employment, social networks) and behavioural (e.g diet) risk factors for these transitions. Hospital records will then be analysed to determine patterns of multimorbidity, frequency of healthcare use and risk of mortality in individuals originally admitted for an alcohol attributable condition.
Our focus will move to treatment provision to investigate how primary care treatment for excessive drinking differs based on an individual's mental health and experience of multimorbiidty. All work will feed into economic models evaluating how accounting for multimorbidity affects existing policy appraisals (e.g. taxation or specialist alcohol treatment access) and the impact of new policies linked to mental health.
This work will i) inform GPs what conditions they should screen for based on an individual's previous mental health and alcohol use, ii) provide evidence on the utility of alcohol screening across different mental disorders and whether financial incentives should be expanded to common mental disorders and iii) determine the best interventions to avoid alcohol-related harms in individuals with a mental disorder.
We will use population surveys, cohort data and electronic healthcare records to investigate how alcohol attributable conditions cluster with mental disorders and the most common transitions to these multimorbidities. We will determine the socioeconomic, social (e.g. employment, social networks) and behavioural (e.g diet) risk factors for these transitions. Hospital records will then be analysed to determine patterns of multimorbidity, frequency of healthcare use and risk of mortality in individuals originally admitted for an alcohol attributable condition.
Our focus will move to treatment provision to investigate how primary care treatment for excessive drinking differs based on an individual's mental health and experience of multimorbiidty. All work will feed into economic models evaluating how accounting for multimorbidity affects existing policy appraisals (e.g. taxation or specialist alcohol treatment access) and the impact of new policies linked to mental health.
This work will i) inform GPs what conditions they should screen for based on an individual's previous mental health and alcohol use, ii) provide evidence on the utility of alcohol screening across different mental disorders and whether financial incentives should be expanded to common mental disorders and iii) determine the best interventions to avoid alcohol-related harms in individuals with a mental disorder.
Publications
Ujhelyi Gomez K
(2021)
Are psychosocial interventions effective in reducing alcohol consumption during pregnancy and motherhood? A systematic review and meta-analysis.
in Addiction (Abingdon, England)
Description | Organisation of roundtable event in Liverpool to develop recommendations on how to better integrate mental health and alcohol services |
Geographic Reach | Local/Municipal/Regional |
Policy Influence Type | Contribution to new or Improved professional practice |
Impact | This work will lead into recommendations for local services about how they can make their services more accessible for services users experiencing multimorbidity and to think about the current challenges people may currently face and how they can be overcome. The attendees at the roundtable event discussed further ideas that they wanted to implement as a result of this event. |
Description | Improving treatment pathways and outcomes for people with co-occurring mental health problems and alcohol use disorders |
Amount | £141,784 (GBP) |
Funding ID | NIHR204587 |
Organisation | National Institute for Health Research |
Sector | Public |
Country | United Kingdom |
Start | 02/2023 |
End | 07/2024 |
Description | Understanding the association between mental health and alcohol use in Black, Asian and Minority ethnic groups |
Amount | £63,840 (GBP) |
Organisation | Alcohol Research UK |
Sector | Charity/Non Profit |
Country | United Kingdom |
Start | 08/2021 |
End | 03/2023 |
Description | Understanding treatment pathways and integration of services for people with co-occurring mental health and alcohol problems |
Amount | £60,327 (GBP) |
Organisation | NorthWest ESRC Doctoral Training Centre |
Sector | Academic/University |
Country | United Kingdom |
Start | 08/2022 |
End | 09/2025 |
Description | Understanding treatment pathways and outcomes for people with co-occurring mental health problems and alcohol use disorders |
Amount | £7,120 (GBP) |
Organisation | National Institute for Health Research |
Department | School for Primary Care Research |
Sector | Academic/University |
Country | United Kingdom |
Start | 03/2022 |
End | 10/2022 |
Description | Development of partnership with Alcohol Change UK |
Organisation | Alcohol Research UK |
Country | United Kingdom |
Sector | Charity/Non Profit |
PI Contribution | We provided recorded and written documentation to Alcohol Change in advance of the research workshop to explain the proposed aims and methodological approaches for the study in order to gain their feedback. |
Collaborator Contribution | Alcohol Change provided feedback on this project and have joined the Project Advisory Group for the proposed work so that they can engage with us in developing this work going forwards and help us to ensure that this work has the required impact. |
Impact | This partnership has informed the focus of our proposed research project and we have developed a good working relationship with the Research Manager at Alcohol Change who will work with us going forwards. |
Start Year | 2020 |
Description | Development of partnership with Institute of Alcohol Studies |
Organisation | Institute of Alcohol Studies (IAS) |
Country | United Kingdom |
Sector | Charity/Non Profit |
PI Contribution | We provided recorded and written documentation to IAS in advance of the research workshop to explain the proposed aims and methodological approaches for the study in order to gain their feedback. |
Collaborator Contribution | IAS provided feedback on this project and have joined the Project Advisory Group for the proposed work so that they can engage with us in developing this work going forwards and help us to ensure that this work has the required impact. |
Impact | This partnership has informed the focus of our proposed research project and we have developed a good working relationship with the Research Manager at IAS who will work with us going forwards. |
Start Year | 2020 |
Description | Working with Public Health England to understand the impact of this research on current policies |
Organisation | Public Health England |
Country | United Kingdom |
Sector | Public |
PI Contribution | We have provided information to Public Health England on the research we are undertaking on the multimorbidity of mental health problems and alcohol attributable conditions and we have worked specifically with Clive Henn (Senior Alcohol Advisor). We produced videos and written materials which explained our research and the potential impact so that we could receive feedback at our research workshop and at other meetings. |
Collaborator Contribution | Clive Henn represented Public Health England at our research workshop and provided valuable feedback on our research questions in relation to national guidelines and policies. |
Impact | This collaboration influenced the development of our research collaborative application and the questions for our proposed research. |
Start Year | 2020 |
Description | Blog written for Alcohol Change UK website on "Alcohol and mental health: how can we better support those with co-occurring problems?" |
Form Of Engagement Activity | Engagement focused website, blog or social media channel |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Public/other audiences |
Results and Impact | Blog written for Alcohol Change around how we can provide better support for individuals with co-occurring alcohol and mental health problems and the changes that may be required to prevent the development of alcohol attributable physical health problems in this group. This blog provided an overview of this project on multimorbidity and we received some enquiries relating to the commentary. |
Year(s) Of Engagement Activity | 2020 |
URL | https://alcoholchange.org.uk/blog/2020/alcohol-and-mental-health-how-can-we-better-support-those-wit... |
Description | Internal presentation at University of Liverpool on the project |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Postgraduate students |
Results and Impact | Presentation at an internal seminar on the project which resulted in engagement in this research from postgraduate students in the department who have become involved in the research project. |
Year(s) Of Engagement Activity | 2020 |
Description | Presentation at the Early Career Alcohol Research Symposium by postdoctoral researcher working on the project |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | Presentation resulted in questions from the audience about the methodology used and interest in how we identified the clusters of multimorbidity. |
Year(s) Of Engagement Activity | 2021 |
URL | https://ecars2021.org/ |
Description | Presentation at the Liverpool Mental Health Network meeting |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Professional Practitioners |
Results and Impact | Presentation at the Mental Health Network which promoted the study at a regional level and which resulted in interest from clinicians and academics in the region. This resulted in us developing research questions around end of life care for individuals with an alcohol attributable condition, which was a new element for this research. |
Year(s) Of Engagement Activity | 2020 |
Description | Presentation at the Society for the Study of Addiction 2021 conference |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Presentation on this research including the identified clusters of multimorbidity and the associations with mental health and alcohol use. The presentation was followed with questions around the implications of this research and the audience commented that it provides further evidence for the need to improve care for people with co-occurring mental health and alcohol use disorders. |
Year(s) Of Engagement Activity | 2021 |
URL | https://www.addiction-ssa.org/annual-conference/ssa-annual-conference-2021/ |
Description | Presentation on the project findings at a roundtable event we organised for clinicians, policy makers and commissioners in Liverpool |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Professional Practitioners |
Results and Impact | Project findings presented at a roundtable event we organised in Liverpool around how to better integrate mental health and alcohol services, leading to the development of recommendations aiming to reduce the identified harms for people with co-occurring mental health and alcohol use disorders. |
Year(s) Of Engagement Activity | 2021 |
Description | Public workshops exploring the different treatment pathways for people with co-occurring mental health and alcohol use disorders |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Patients, carers and/or patient groups |
Results and Impact | Two online workshops were held with 25 public representatives with lived experience of co-occurring mental health and AUDs and professionals who work with them (e.g. health professionals). The aims of the workshops were to identify the most common treatment pathways and models experienced by people with co-occurring mental health and alcohol use disorders, including whether the treatment model was i) serial, ii) parallel or iii) integrated and to understand stakeholder views on the positives and negatives of each of these treatment pathways. |
Year(s) Of Engagement Activity | 2022 |
URL | https://www.spcr.nihr.ac.uk/research/3-schools-seminar-series/manchester |
Description | Research workshop organised involving academics, patient and policy representatives and clinicians |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | We organised a research workshop which took place online and which involved pre-workshop activities, a 2 hour event and follow up activities. The workshop included more than 30 people, such as academics, policy representatives, clinicians and patient representatives. The workshop involved a presentation, group activities in breakout groups to discuss the overall aims for the project and specific breakout groups which focused on the different work packages and the research questions, methods and data to be used. This workshop helped us to shape the development of the research methods and provided clear feedback on the relevance of these questions to both clinical practice and current policies. |
Year(s) Of Engagement Activity | 2020 |
Description | Workshop with the Dual Diagnosis service in North Manchester |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Professional Practitioners |
Results and Impact | We presented on the project to the Dual Diagnosis service in North Manchester which included both mental health and drug and alcohol practitioners. The session included a presentation on the project and a focus group with the staff about their experiences of providing treatment to individuals with co-occurring alcohol and mental health problems. This event was valuable in both developing relevant networks, but also in advising the focus of the research and in understanding the timing of the different treatments in determining outcomes. |
Year(s) Of Engagement Activity | 2020 |