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What is the significance of the ‘increase’ in student suicides?

There has been an increase in the suicide rate among Higher Education students, from 3.8 per 100, 000 in 2006/07 to 4.7 suicides per 100, 000 in 2016/17, according to new data released this week by the Office for National Statistics (ONS).

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Google headlines for ‘student suicide’ search, June 26th 2018

NB this isn’t only the latest data, it is also ‘new’ in the sense that this is the first time that the ONS has published data specifically focussing on ‘higher education student’ suicides, so in this sense I guess it is inherently news worthy, and the release of the data on the 25/06 certainly caused quite a stir in the mainstream news and talk shows following the release, with the main focus seeming to be on ‘what we should do about the problem of increasing student suicides’, and the fact that this is ‘new data’.

However, to my mind, while I appreciate the fact that there is an underlying increase in students reporting mental health issues that seems to correlate with the increase in suicide, I also believe there’s reason to be sceptical about the usefulness of the above data, especially since the ONS itself refers to these stats as ‘experimental statistics’.

Below, I summarise what the ONS data tells us about HE student suicides, and then contrast two sociological approaches to interpreting this data: the first being a broadly ‘structuralist’ perspective which accepts that the data is basically valid and asks ‘why are there more student suicides?’ (which was pretty much the narrative in the mainstream news); and a second, broadly Interpretivist approach which questions the validity of this data, and asks whether or not all of this might be something of a moral panic?

What does the data tell us?

Firstly, there has been an increase in the suicide rate among higher education students if we compare the data from 2006/07 to 206/17

student suicide rate 2017.png

However, although the data appears to have stabilized in the the last three years, the ONS reminds us that these rates are based on such low numbers (95 suicides in 2016/17) that it’s hard to draw any statistical significance from these figures.

Secondly, male students are approximately twice as likely to commit suicide than female students

male female student suicide rates england.png

Between the years of 2001 and 2017, a total 1,330 students died from suicide, of which 878 (66%) were male and 452 (34%) were female.

Thirdly, older students are more likely to kill themselves than younger students

student suicide rate age.png

This actually surprised me a little (note to self about ‘stereotypes’ of suicidal students): higher education students aged 30 or over are twice as likely to commit suicide compared to students aged 20 and under.

Some limitations of the above data

I recommend checking out the publication (link above and below at the end) by the ONS, they mention several limitations with this data: for example, the low overall numbers make it hard to draw any conclusions about the suicide rate with any degree of confidence (statistical significance); and the year on year on year data might not be accurate given delays in recording a death as a suicide, due to inquests taking a long time in some instances (e.g. a suicide which happened in 2016 might appear as a recorded suicide in 2017).

What are the underlying ’causes’ of the ‘increase’ in student suicides?

The mainstream media narrative pretty much took the increase in student suicides at face value, and offered up some of the following possible reasons to explain the increase:

  1. The suicide stats are the ‘extreme ‘tip’ of something of a ‘mental health crisis’ in universities – higher number of students are making use of mental health services, which are under-resourced: universities aren’t giving enough support to vulnerable students who are suicidal.
  2. The increase in mental health problems/ suicide could be due to the fact that university life has become more stressful: there’s more pressure to succeed and get at least a 2.1, and students no longer go to university to have ‘three years off’ (like I did ;)).
  3. Related to the above, mental health problems could be related to the ‘double adjustment’ (my invention that!) students have to go through: they have to adjust not only to the fact that university life isn’t as much fun as its been made out to be (at yer glossy open day), and they have to adjust to the fact that they are just not ‘that clever’ (the later probably applies more to hot-housed privately schooled students, and to those students who are more likely to have had their predicted grades inflated).

A broadly Interpretivist approach to understanding these stats… 

Interpretivists would be much more likely to question the validity of these stats, and thus the validity of the view that there is an increase in higher education student suicides, and the opinion that this is something which we should be concerned about.

There are certainly sufficient grounds to be sceptical about these stats:

  • If you were to compare the three year average for 2002/03 to 2004/05 with the three year average for 2014/15 to 20016/17 the ‘increase’ is much less significant.
  • The ONS itself says you cannot draw any significant conclusions from the small numbers used to derive these stats. And again, they even explicitly refer to them as ‘experimental stats’!
  • The overall number of student suicides is half that of the suicide rate in the general population: surely the headlines should be: ‘”great news, going to university helps lower suicide risk”?

There might also be an argument to made that this is something of a moral panic: it seems to me that the media perpetuate the idea that the typical suicidal student is a 19 year old female, when actually this is atypical – a 30+ year old male student is about 4 times more likely to kill himself.

I also think ‘class’ might come into this: Bristol University (A Russel Group, and thus a very middle class  university) has been in the news recently due to its high suicide rates:

bristol university suicides.png

So, might this uncritical news reporting just really be about stoking a moral panic not so much about the ‘increase’ in higher education student suicides (of which there appears to be no significant evidence), but really about the increase in suicide among our ‘precious’ middle class male students? 

Sources 

 

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How do we explain the 500% increase in prescriptions for Cow’s Milk Allergy between 2006 to 2016?

In a recent BBC documentary: ‘The Doctor Who Gave Up Drugs’ Dr Chris Van Tulleken (Dr CVT) set out to answer the above question. Here I summarise this documentary and throw in a few links and additional commentary

You can watch the documentary on BBC iplayer until Late June 2018, although TBH you may as well save yourself 50 mins and just skim read what’s below.

There has been a dramatic increase in prescriptions for children with Cow’s Milk Allergy (CMA) in recent years: A 500% increase in the 10 years to 2016 in fact!

A ‘prescription’ basically means that children with CMA get put on a specialist cow milk free ‘alternative milk’ formula, which costs twice as much as regular milk formula for children, and costs the NHS £64 million/ year.

In this section of the second episode of the series: ‘The Dr Who Gave Up Drugs, Dr CVT asks why there has been such a rapid increase in prescriptions for specialist formula to treat Cow’s Milk Allergy.

He says that as a new parent, he keeps hearing about it, which is odd because only 2% of children suffer from it, and so he’s wondering whether or not the above increase in prescriptions is due to increase in the underlying numbers of children who actually have cows milk allergy (or better detection) or whether there is something else fuelling the increasing public awareness of the condition.

The Normalisation of diagnosing and treating CMA

The documentary also visits one parent who thought her child had CMA when he developed XMA (one of the possible symptoms, but also something which 20% of babies suffer from), she visited her GP, who confirmed he didn’t have CMA. However, when she took her child to hospital for a bump, the pediatrician there noticed the XMA and prescribed specialist formula for CMA.

The child hated it, and so often went to be hungry. It too a visit to a Dr Robert Boyle (in the skeptical about CMA camp) who confirmed the child didn’t have CMA and so normal milk service was resumed.

The worrying thing about the above case is that alternative formula is being pushed on parents against their will, the normalisation of the diagnoses and treatment for a condition which in this case didn’t actually exist.

Health sociology.png

Industry lead education for NHS staff

One of the reasons Dr CVT is sceptical about the increase in awareness and prescription being linked to an actual underlying number of cases of children with CMA is that a lot of the education provided to Doctors about food allergies among children is sponsored by the companies who make alternative, specialist formulas to treat allergies.

To illustrate this point, the documentary visits a training day for NHS staff in Newcastle, aimed at educating staff about food allergies in babies – the event is sponsored by Danone, the company which makes one of the specialist CMA formulas, and what Dr CVT finds is advertising literature (various ‘glossy mags) and product samples alongside proper medical advice.

Another ‘test’ for the involvement of industry in educating about food allergies is to simply Google ‘cows milk allergy’ – which Dr CVT does and finds that most of the advice websites which help parents to self-diagnose their children are run by the companies who make specialist formula to treat the condition.

He also explores the web sites which parents and professionals use to diagnose for CMA, again run by the companies, and finds that the ‘symptoms’ which indicate Cow’s Milk Allergy are pretty much the kind of symptoms which every child has at some point, whether or not they have the allergy – things such as ‘colic’ and ‘vomiting’

Finally, he interviews Dr Adam Fox, who is a consultant  for the ‘Allergy Academy’, sponsored by Danone, and he doesn’t seem able to convince Dr CVT that there isn’t a conflict of interests between the companies who profit from increased diagnoses of Cow’s Milk Allergy providing education on how to diagnose for the condition.

Application to Sociology

There are lots of applications – mainly centering around labelling theory and the power of corporations to shape agendas! Also risk society.

Image Source:

screen capture, BBC from documentary above.

 

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Why are we relying more on drugs to treat teenagers’ mental ill-health?

In a recent BBC documentary: ‘The Doctor Who Gave Up Drugs’ Dr Chris Van Tulleken (Dr CVT) set out to answer the above question. Here I summarise the section of part 2 of this documentary (which deals with teen mental ill health and antidepressants) and throw in a few links and additional commentary.

You can watch the documentary on BBC iPlayer here at least until Late June 2018, although TBH you may as well save yourself 50 mins and just skim read what’s below.

You will also find this post on ‘steemit.com‘ – a most excellent crypto-currency based blogging platform where users get paid in cryptocurrency (steem) for posting, commenting and even just upvoting other people’s work. I recommend you check it out!

Introduction: why are prescriptions for antidepressants in the UK increasing?

The general gist of the documentary is that we’re relying more on drugs to treat teenagers’ mental ill-health, but we could be giving out pills to thousands of teenagers which are not only ineffective but actually have severely dangerous side effects.

The number of British teenagers prescribed antidepressants has almost doubled in 10 years: in 2005, 30 000 teenagers were prescribed antidepressant drugs, increasing to 58, 000 in 2015.

The Increase in antidepressants: a visual representation

Each ping pong ball represents 4 teenagers prescribed antidepressants

2005

increase teenage depression UK.png

2015

teenage depression UK

This increase might be because more people are getting diagnosed and more effectively treated, however it might reflect the fact we are quicker to seek medicalised solutions to ‘depression’, and that these drugs are not effectively dealing with the underlying causes of depression, and maybe this doubling of prescriptions in 10 years is no a long term solution to depression.

A case study of teenage depression

To provide us with a ‘human face’ of depression, the documentary now visits Jess, 15 year old teenager who has been on antidepressants for 8 months and  whose suffered from anxiety since she was a young girl, finds school stressful because she feels trapped (30 odd kids in a class, with everyone close together). She hasn’t been in lessons for 10 months, and may not be doing her GSCEs.

Following counselling, she was put on Sertraline to combat her depression, 100 mg, double the normal dose of 50 mg. We now get the usual trawl through the possible side effects of the drug, and it’s not pretty: clinical trials have shown an increased risk of suicidal behaviour in adults aged less than 25 years, and Jess says she has felt more suicidal since starting the medication.

Interestingly, Jess states a desire to be free of the drugs, while her mother appears more relaxed, saying that there’s evidence that they work, and that her daughter shouldn’t be afraid of the stigma attached to taking antidepressants: the idea of just ‘pulling yourself together’ and coping is outdated.

Research evidence on the effectiveness of antidepressants

Dr CVT now looks at a recent study conducted by professor Andrea Cipriani of the University of Oxford. This study summarised all available evidence of how effective 14 antidepressants are in children and adolescents specifically, (rather than just evidence from adult trials). The basic research question was ‘do these drugs work’ (not ‘how do these drugs work), and they compared the drugs with each other and against the effectiveness of a placebo, a sugar pill.

depression drugs don't work.png

They found that only one drug: fluoxetine, or prozac, was more effective than a sugar pill in combatting depression among teenagers, which is worrying given that around 40% of teenage prescribed antidepressant drugs are on Sertraline. However, there is still a level of uncertainty around the research on the effectiveness on Fluoxetine – because people respond very differently to the drug.

Where Sertraline  there is good evidence that it works for adults, but the problem here is that teenagers brains are wired differently, and professor Cipriani’s research suggests what works for adults may not work for teenagers.

Wilderness Therapy as an alternative means of treating mental ill health

Dr CVT says there’s lots of evidence that being active out of doors is effective in treating mental ill health, especially depression.

To test this out, the documentary now returns to Jess, one month on, who has now had her prescription of Sertraline increased to 125 milligrams, and feels increasingly panicky and has upped her rate of self-harm, and expose her to a ‘therapeutic intervention’, in the form of the ‘Wilderness Foundation’ which uses activities in wild spaces and one on one counselling to help teenagers suffering from mental ill-health.

Research conducted by the University of Essex suggests that 83% of the kids on the charity’s leading scheme have successfully gone on the further education or full time employment.

Jess gets taken along to the the Wilderness Foundation for a day to do ‘stuff’ outdoors, and we get treated to footage of Jess in an extremely pleasant wooded glade sparking a fire to life and putting up a hammock. Wilderness therapy is apparently well established in the USA, and it certainly seems to work for Jess, who spends 6 hours out of doors.

Do antidepressants ’cause’ an increase in teen suicides?

The documentary also visits one mother, Sarah, whose daughter Rachel killed herself within 11 days of an increase in her dose of Sertraline.

Rachel’s story seems similar to Jess’: she found secondary school difficult and hit a wall at GCSEs, finding it difficult to cope with the stress. After a visit to the Child and Adolescent Mental Health Services, she was prescribed fluoxetine and experienced the following side effects after 2 weeks:

  • Violent thoughts
  • Disturbing dreams
  • Bodily shaking
  • Nosebleeds

Rachel tried to hang herself at one point, and after several months of this, she was prescribed a different drug: Sertraline. She actually wanted this herself, she wanted something to work, but within 11 days of an increase in her dose of this second antidepressant Rachel killed herself.

Rachel’s mum Sarah doesn’t blame the Doctors as they were just following the approved ‘pathways’ to treating mental illness laid down in the formal guidelines, she blames the system which seems to based on inadequate knowledge of the harmful side effects of these drugs.

NB – we cannot actually prove a causal link

Could antidepressants actually be harming our children’s health?

Drug trials should not only tell us if the drugs are effective, they should also tell us if the drugs have any harmful side effects. The problem is that many of the drugs trials are run by drugs companies, with a vested interested in making their drugs look both effective and sage.

Dr David Healy is one of the few people to have done independent research into the effectiveness and safety of antidepressants with the raw data provided by the company. He argues that we need to see the raw data to uncover how the drugs affect individual patient – and this raw data can run into several reams of paper if there 100s of people in a trial.

It is extremely rare for drugs companies to release this original data, in fact, it’s only happened once when in 2004 legal challenges were made against claims made about the effectiveness of Seroxat, and antidepressant manufactured by the pharmaceutical company GlaxoSmithKline.

Dr David Healey analysed this original data and found that the claims made in the original 10 page article summarising the findings of the trials which claimed the drug was not only effective but also sage, were basically false, with Healey’s team finding that not only did the drug not work, but that the number of teenagers who developed suicidal thoughts following the use of the drug was three times greater than intimated in the original study, in which this side effect was described as ‘some teenagers becoming more emotionally labile’.

This research actually led to GlaxoSmithKlein being fined $3 billion in penalties and fines for health care fraud.

Dr David Healy says that in between the raw data and the sometimes misleading ‘main articles’ on the research findings published by the drugs companies, there are ‘company reports’, and even if we dig into these, there is cause to be concerned over the safety of many of antidepressants.

The rest of the documentary

The documentary returns to Jess, who has kept up her therapy for 6 months (I think it’s 6 months, it’s not that clear) and after some ups and downs (including one suicide attempt at school) the therapy seems to be working – she gets taken through a process of gradually having things she finds difficult added into the programme, and eventually manages to cope with going shopping and buying something (progress for her, in dealing with crowds).

After 6 months, Jess even manages to return to school and sit her mock GCSE exams, and at the very end of the documentary, we even see her at her 16th birthday party on stage singing, in front of friends and family.

The documentary also pays the standard visit to the Clinical Lead for Child Mental Health Care Services who reiterates that all Doctors are doing in prescribing antidepressants is following NICE guidelines, which are based on the best available evidence, however, Dr CVT’s point is the best available evidence is shaky at best.

NICE refuse to be interviewed, but do say they are reviewing their guidelines

Conclusions

The whole point of the documentary seems to be to inform us of the uncertainties surrounding the effectiveness and safety of many of the antidepressants we are increasingly prescribing to our teenagers.

Dr CVT suggest we are far too trusting of the research done by drugs companies, and we shouldn’t allow them to control the information we have about these drugs… we should be much more sceptical, and in the meantime, we should pursue alternative treatments such as wilderness therapy and mindfulness which are unlikely to cause harm.

K.T.’s Commentary

One thing I want to pick up on his the ‘social causes’ of Jess’ anxiety. Basically, it seems she just hates the crowded environment of the school, along with all the stress of testing that goes along with it….

Personally, I get this, it has exactly the same effect on me as a teacher.

I also get the ‘wilderness therapy’ as a solution  – I love being outdoors, walking: it’s just that I don’t need anyone to structure it for me, I also don’t really regard it as ‘therapy’ – rather it’s just ‘doing something enjoyable’.

It appears to me that Jess’ depression is pretty much 100% socially induced – by the school system. Get her back to nature, and doing something ‘naturally’ empowering, and she’s O.K, as she is singing in front her friends and family – surely it’s the social context that’s the problem?

It’s not rocket science is it! What needs to change here is society, although that’s easier said than done.

I also have to admit being a bit taken aback by the size of that GSK fine – $3 billion for health care fraud, that’s something I’m going to have to come back to later!

Sources/ find out more!

Disclaimers/ health advice provided in the documentary

Doctor Chris Van Tulleken reminds us that it might be dangerous to stop taking antidepressants suddenly and that any change of dose should only be made with medical supervision.

 

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Indicators of Health in International Development

Health is a crucial indicator of development – The International Aid community believe that health is the most important thing to spend money on – with more than 90% of the aid budget being spent in this area.

There are four basic measurements of health in development

  • Life Expectancy – The average number of years people are expected to live in a country (which if you remember makes up one of the three indicators of the Human Development Index).
  • Child Mortality – The number of children which die before their first birthday (measured per thousand).
  • Maternal Health – The number of women who die as a result of pregnancy or childbirth.
  • Disease indicators – The proportion of the population that has AIDS, Malaria, diarrheal and other infectious diseases.

On all of the above four ‘indicators of health’, things are considerably worse in lower income countries than higher income ones.

  1. Life Expectancy – in the UK average life-expectancy is 81.5 years (some commentators would expect this to go down as the effect of Tory policies leads to increasing inequality and worse health care with the NHS privatisation.), while in At the other end of the scale, life expectancy is still less than 55 years in nine sub-Saharan African countries – including The Democratic Republic of the Congo, Nigeria and Sierra Leone.
  2. Child Mortality – In Low income countries – 40% of those dying in any one year are children aged 0-15. In high income countries, only 1% of deaths are among people between 0-15 years of age. (Source – World Health Organization)

Reducing Child Mortality is Millennium Development Goal  4and the latest MDG report says –

The highest levels of under-five mortality continue  to be found in sub-Saharan Africa, where one in  eight children die before the age of five (129 deaths  per 1,000 live births), nearly twice the average in  developing regions overall and around 18 times the  average in developed regions. With rapid progress in other regions, the disparities between them and sub-Saharan Africa have widened. Southern Asia has the second highest rate—69 deaths per 1,000 live births or about one child in 14.

countries highest infant mortality 2016
Countries with the highest infant mortality rate, 2016
  1. Maternal Health – Improving Maternal Health is Millennium Development Goal 5

As with child mortality, maternal deaths are concentrated in sub-Saharan Africa and Southern Asia, which together account for around 85% of such deaths globally. A crucial factor in explaining maternal deaths (and improving this is part of MDG5 is that less than half of women giving birth are attended by a health care professional – in sub Saharan Africa – 64% of women, compared to 28% in Asian and less than 2% in the developed world.

  1. Disease indicators

Millennium Development Goal 6 is to Combat AIDS, HIV, Malaria and other diseases

In 2013, 35 million people were living with the AIDS virus— nearly a 30 per cent increase over 1999. Sub-Saharan Africa remains the most heavily affected region, accounting for around 70 per cent of new HIV infections, people living with HIV and AIDS deaths.

According to a 2015 World Health Organisation report, Malaria death rates have plunged by 60% since 2000, translating into 6.2 million lives saved.

“Global malaria control is one of the great public health success stories of the past 15 years,” said Dr. Margaret Chan, Director-General of WHO. “It’s a sign that our strategies are on target, and that we can beat this ancient killer, which still claims hundreds of thousands of lives, mostly children, each year.”

Despite tremendous progress, malaria remains an acute public health problem in many regions. In 2015 alone, there were an estimated 214 million new cases of malaria, and approximately 438 000 people died of this preventable and treatable disease. About 3.2 billion people – almost half of the world’s population – are at risk of malaria.

Some countries continue to carry a disproportionately high share of the global malaria burden. Fifteen countries, mainly in sub-Saharan Africa, accounted for 80% of malaria cases and 78% of deaths globally in 2015.

In developing countries, the main causes of death are

  1. Lower respiratory infections11.3%
  2. Diarrheal diseases8.2%
  3. HIV/AIDS7.8%
  4. Heart disease 6.1%
  5. Malaria 5.2%
  6. Tuberculosis 4.3%
  7. Prematurity and low birth weight 3.2%
  8. Birth asphyxia and birth trauma 2.9%
  9. Neonatal infections 2.6%

Many of the above diseases are ‘infectious diseases’ (aka ‘communicable’ diseases) – they are typically spread through either sharing bodily fluids or by parasites – often picked up from coming into contact with dirty water or raw sewage.

Relating back to the previous ‘health indicator’, the last three on the list are ‘maternal health issues’ and relate to either very young children or mothers dying in childbirth – if you add up the three figures then you get a figure of 9% of deaths due to poor maternal health).

 

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The Increase in Smoking in Poorer Countries

Smoking is on the increase in several low income and middle income countries according to this World Health Organisation data, published in the World Bank’s recent review of 2016

smoking

According to the World Health Organisation up to 80% of the world’s tobacco users now live in low and middle income countries, with younger people especially taking up smoking in increasing numbers.

Why is Smoking Increasing in Poorer Countries?

In Short, it seems that since governments in developed countries have made it more difficult for tobacco companies to kill people in rich countries, they’ve now moved on to trying to kill people in poor countries instead.

tobacco-advertising-poor-countries

A recent Guardian article summarising this World Health Organisation report, notes that:

The latest evidence shows that tobacco industry marketing remains a significant global problem, particularly for people in the poorest countries who are the most exposed to it. Our study examined tobacco marketing in 16 countries.

  • In communities in low-income countries, 81 times more tobacco adverts were observed than in high-income countries.
  • People in lower-income countries were 46 times more likely to hear radio adverts, 11 times more likely to see poster adverts and nine times more likely to see television adverts than those living in high-income countries.
  • Access to tobacco was also higher in poorer countries. In low-income countries, we observed two and a half times more stores selling tobacco in the communities in the low-income and lower-middle-income countries than in the high-income countries. Worryingly, 64% of stores visited sold single cigarettes compared with just 2.8% in high-income countries.

This high level of marketing in poorer countries is consistent with the tobacco industry’s targeting of these countries. They are key to the industry’s future. In the west, the tobacco industry’s profits continue to increase despite the decline in smoking rates , but it is unclear how long this pricing power will hold out in the face of growing regulations.

How to Reduce Smoking in the Developing World?

The World Health Organisation notes that there are several things that effectively reduce the use of tobacco consumption:

  • Banning positive advertising for cigarettes, although there are only total bans in 29 countries worldwide.
  • Promoting negative advertising – those horrible picture adds about how smoking causes disease apparently work
  • Taxation – a 10% increase in the price reduces smoking by 5% in low income countries.
  • NB – A further challenge here is tackling Organised Crime – and their role in smuggling tax-free cigarettes, which can subvert national taxation policies.

This is a useful little data-case-study for lots of reasons

  • It’s a good example of the negative role TNCs play in development
  • It’s a good example of a critique of neoliberalism – it seems that regulation by the government – of advertising and through taxes for example – can really help reduce smoking.
  • This kind of reminds me of ‘Runaway World’ – we know what works to reduce smoking, but what with both TNCs and Organised crime having so much to gain financially from cigarettes, it seems unlikely that governments are going to get a handle on this problem any time soon!
  • Finally this is also a slap in the face to ethnocentrism – You (I did until today!) were probably under the impression that smoking’s on the decline – well it may be in the UK – but looked at globally it’s not.