Timetable and Budget
| Description | Deadline/Limit |
|---|---|
| Deadline for Stage 1 applications | 14 February 2023, 1pm |
| Notification of outcome of Stage 1 application | April 2023 |
| Deadline for Stage 2 application | 06 June 2023, 1pm |
| Notification of outcome of Stage 2 application | October - November 2023 |
| Project start | January 2024 |
| Project duration | 12 - 18 months |
| Budget | £200,000 per project |
Introduction
The National Institute for Health and Care Research (NIHR) Policy Research Programme (PRP) invites applications for a single research project to understand risk factors for the rise of suicide amongst children and young people (CYP) and the effectiveness of interventions.
This research aims to improve our understanding of the factors influencing the steady rise in CYP suicide rates, recognising the demographic diversity within CYP.
Background
Suicide is one of the leading causes of death in children and young people (CYP; defined as aged 10–24 years) and rates of suicide in this group, in England, have been steadily increasing over the last decade [1]. The increases in CYP suicide rates are greatest in females, amongst whom suicide rates have doubled since 2011, although rates remain half of those seen in males [1]. There is also evidence of a rise in the youngest group (aged 10–14 years) indicating that this issue is moving down the age range [1].
In some age/ sex groups amongst CYP, the suicide rates for 2021 are the highest for 20-40 years.
- For boys aged 15-19, the 2021 rate was the highest since 2001;
- For girls aged 15-19, the 2021 rate was the highest since before 1981 [1].
- 2019 saw one of the largest rises of the last decade in deaths by suicide amongst under-25s, with 565 suicides registered in this year [1]. Latest data shows this trend has continued, with 584 suicides registered in 2021 in this age group [1].
Evidence from surveys corroborate this concern, for example, the Millennium Cohort Study, which follows the lives of ~19,000 young people born at the start of the millennium in England, Scotland, Wales and Northern Ireland. The latest report, published in 2020, found that 7% of the sample reported self-harming with suicidal intent by age 17 [2].
Many risk factors, and combinations of risk factors, can increase the risk of dying by suicide. Previous studies and accounts from CYP affected by suicide have identified risk factors for this group [3]. These include greater academic pressures, increased social media use, rising rates of family instability, economic stresses, isolation, exposure to suicide, growing concerns about the environment, drug dependence, and lack of access to services and support. Self-harm has also been identified as a risk factor for suicide [4] and rates of self-harm in the community have risen since 2000, especially in young people [5].
As a consequence of the complex risk factors, suicide prevention is also complex. This research will help to improve understanding of these factors and where to target support. may also support identification of new targeted solutions. This research could also support us in understanding how risk factors might affect genders and age groups differently to support the development of appropriate interventions.
Understanding of the drivers of suicide risk factors and their respective importance across different demographic groups is limited. It is therefore a priority to strengthen the evidence base to better understand these factors and their potential role in the continued increase in suicide rates amongst CYP in England.
This research will also support ongoing work under the National Suicide Prevention Strategy [6] as well as informing plans for any future national policies or strategies.
Existing Literature
The 2022 National Confidential Inquiry [7] reports that, for suicides by patients aged under 18 (i.e., people who had been in contact with mental health services in the previous 12 months in the UK in 2009-2019):
- 19% (213 suicides over the 2009-19 period) were suicides by patients, an overall average of 19 per year. The number of suicides increased into the later teens.
- Gender: Half (98, 49%) of the patients aged under 18 were female, more than the proportion in other age groups (34%).
- Students: The majority (140, 74%) were full-time students.
- Ethnicity: 20 (11%) were from an ethnic minority group.
- Autism: 25 (13%) had a diagnosis of autism.
A 2017 report by the National Confidential Inquiry [3] (using information on suicides which occurred in 2014 and 2015) found that 6% of under 20s and 3% of 20–24-year-olds who died were reported to be lesbian, gay, bisexual, or transgender (LGBT) or uncertain of their sexuality, equivalent to 18 deaths per year. A quarter of LGBT under 20s had been bullied; most had previously self-harmed.
A report published by the National Child Mortality Database [8] noted that in the year ending 31 March 2020 for those below age 18:
- Age: 78% of suicides were for those between 15 and 17 years old, and 9% of suicides were in those aged 14 or below.
- Gender: 61% of suicides were of boys/young men, although 50% of suicides of those aged 13 or below were girls.
- Ethnicity: 79% of suicides were from those of a white ethnic background, with 21% of deaths coming from those of black and minority ethnic backgrounds. This is comparable to general population projections for England in 2020 where 75% of 9- to 17-year-olds in England were estimated to be from a White ethnic background.
- Deprivation: For CYP under 20, there was not a significant different in suicide rates between the most and the least deprived areas. For those aged 22-24, men living in the most deprived areas have higher suicide rates than those living in the least deprived areas, but rates of suicide for women do not change significantly with deprivation [9; 10].
Suicide prevention interventions exist in a wide variety of different settings for example within education settings, community settings, NHS or digital interventions.
A 2018 systematic review [11] of suicide prevention interventions delivered in educational settings (mainly schools) concluded that school-based studies can have a positive impact on suicide-related behaviour and, overall, do not appear to cause unintended harmful consequences. In addition, The World Health Organisation’s (WHO’s) Live Life implementation guide [12] highlights ‘fostering socio-emotional life skills in adolescents’ within education settings as a key evidence-based strategy to preventing suicide deaths.
The cross-government suicide prevention plan [13] highlights work that Health Education England have conducted with local sports focussed organisations to support the development of suicide prevention interventions at a local level, an approach that was specifically targeted at young men.
Previous NIHR research has explored the use of the internet and social media in relation to suicidal behaviour, as a means of identifying priorities for prevention [14; 15], as well as the impact of a Distress Brief Intervention on suicidal Ideation, suicide attempts and self-harm in the immediate, short and longer term [16]; though these have not had a specific focus on CYP.
Research priorities
The policy team are particularly seeking research to understand risk factors for suicide by demographic group, with supporting research on the effectiveness of interventions. The broad research questions we are interested in are:
- What are the potential causes for the rise in suicide rates in CYP since 2009?
- Which specific risk factors are associated with the rise of suicide rates in CYP?
- What is the evidence on the effectiveness of existing interventions in reducing suicide and addressing associated risk factors for CYP?
The research will help to build the evidence base as to why suicide rates have increased amongst CYP over the last decade, particularly amongst young women and girls where the steepest increases have been observed. The research will also support understanding of the effectiveness of existing interventions to address such risk factors. This will inform decisions across government, the NHS and the broader sector on what actions are needed to reduce suicides and support CYP, a priority group. We do not expect an in-depth analysis of any specific intervention or setting.
Research should recognise the demographic diversity within the broad CYP group. Consideration should be given to how risk factors might differ in relation to gender, age group, and other demographic factors such as ethnicity and socioeconomic background. Consideration should also be given to whether the potential interventions may therefore also differ across these different CYP groups, and the intersectionality between these factors.
New Guidance on Health Inequalities data collection within NIHR PRP Research:
Health inequalities is a high priority area within the Department of Health and Social Care and the NIHR and is often present in a majority of funded projects. We are now assessing all NIHR research proposals in relation to health inequalities. We are asking applicants to identify in their application whether or not there is a health inequalities component or theme and how this research hopes to impact health inequalities. We are also asking researchers to collect relevant data, if appropriate for the research. Our goal is to collect information on health inequalities in research and data relating to the main outcome(s) of the proposed research.
Please clearly identify in the research plan section whether or not your application has a health inequalities component or relevance to health inequalities and detail the core set of health inequalities breakdowns that will be reported; if none please explain why.
We understand that research projects have different methodologies and focus on different populations, so please explain what data will be collected and reported for the methodology you plan to use. If a health inequalities component is not included, please explain why this does not fit within your proposed research. This should only be a few sentences.
For quantitative research we would ideally like researchers to provide one-way breakdowns of their main outcome(s) by the following equity-relevant variables: age, sex, gender, disability, region, 5 ONS Ethnic groups, and the 5 IMD quintile groups. If more detailed cross tabulations are appropriate, please include these. This table should be submitted to NIHR PRP at the end of the project. Due to data limitations, judgement calls may be necessary about which breakdowns to report and whether to merge categories to increase counts in particular cells; we ask you to make these judgement calls yourself, bearing in mind our data curation aim of enabling future evidence synthesis work in pooling results from different studies. More details and an example table can be found in Appendix A.
For qualitative research projects, this can be purely descriptive statistics giving the number of observations against the various variables.
Further details about this new request can be found in Appendix A.
A recording of the Health Inequalities in NIHR PRP Research Q&A Event which was held on 19 September 2022 is available to view on Youtube.
Areas out of scope for this programme of work
Self-harm as an outcome is out of scope of this programme, although may be of relevance as a risk factor for suicide.
Expertise required
Subject expertise of suicide prevention is essential, including an in-depth knowledge of the complex, multi-faceted nature of suicide and in relation to children and young people specifically.
Outputs
Applicants are asked to consider the timing and nature of deliverables in their proposals. Policymakers will need research evidence to meet key policy decisions and timescales, so resource needs to be flexible to meet these needs. A meeting to discuss policy needs with DHSC officials will be convened as a matter of priority following contracting, including to discuss the draft project plan.
Ongoing dissemination of findings throughout the life cycle of the project will be required to support ongoing policy development. This includes timely reports for the advisory group as well as a final report and/or slide deck at the end of the project outlining key findings and recommended policy actions. A strategic dissemination plan following the final report would also be desirable.
Budget and duration
Applications will be assessed on value for money, we would not expect them to cost more than £200K.
The duration of the project should be as short as is consistent with delivering a high-quality study.
Costings can include up to 100% full economic costing (FEC) but should exclude output VAT. Applicants are advised that value for money is one of the key criteria that peer reviewers and commissioning panel members will assess applications against.
Management arrangements
A research advisory group including, but not limited to, representatives of DHSC, NHS England, and the successful applicants for the research should be established. The advisory group will provide guidance, meeting regularly over the lifetime of the research. The successful applicants should be prepared to review research objectives with the advisory group, and to share emerging findings on an ongoing basis. They will be expected to:
- Provide regular feedback on progress
- Produce timely reports to the advisory group
- Produce a final report for sign off
Research contractors will be expected to work with nominated officials in DHSC, its partners and the NIHR. Key documents including, for example, research protocols, research instruments, reports and publications must be provided to DHSC in draft form allowing sufficient time for review.
References and key documents
- Office for National Statistics. Suicides in England and Wales [online]. 2022. Available from: Suicides in England and Wales - Office for National Statistics
- Patalay P, Fitzsimons E. Psychological distress, self-harm and attempted suicide in UK 17-year olds: prevalence and sociodemographic inequalities. Br J Psychiatry [online]. 2021;219(2):437-439. Available from: Psychological distress, self-harm and attempted suicide in UK 17-year olds: prevalence and sociodemographic inequalities
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH). Suicide by children and young people [online]. Manchester, University of Manchester: 2017. Available from:Suicide by Children and Young People
- Gairin I, House A, Owens D. Attendance at the accident and emergency department in the year before suicide: retrospective study. Br J Psychiatry [online]. 2003;183:28-33. Available from: Attendance at the accident and emergency department in the year before suicide: Retrospective study
- McManus S, Gunnell D, Cooper C, Bebbington PE, Howard L, Brugha T, et al. Prevalence of non-suicidal self-harm and service contact in England, 2000–14: repeated cross-sectional surveys of the general population. The Lancet Psychiatry [online]. 2019;6(7):573-81. Available from: Prevalence of non-suicidal self-harm and service contact in England, 2000–14: repeated cross-sectional surveys of the general population
- Department of Health. Preventing suicide in England - a cross-government outcomes strategy to save lives [online]. London: 2012. Available from: Preventing suicide in England - A cross-government outcomes strategy to save lives
- The National Confidential Inquiry into Suicide and Safety in Mental Health. Annual report: UK patient and general population data, 2009-2019, and real time surveillance data [online]. Manchester, University of Manchester: 2022. Available from: NCISH | Annual report 2022: UK patient and general population data 2009-2019, and real-time surveillance data
- National Child Mortality Database. Suicide in children and young people [online]. Bristol, University of Bristol: 2021. Available at: Suicide in Children & Young People | National Child Mortality Database
- Office for National Statistics. How does living in a more deprived area influence rates of suicide? [online]. 2020. Available from: How does living in a more deprived area influence rates of suicide? | National Statistical
- Office for National Statistics. Suicides by age and IMD quintile, England, 2010-2019 registrations combined [online]. 2022. Available from: Suicides by age and IMD quintile, England, 2010 to 2019 registrations combined - Office for National Statistics
- Robinson J, Calear AL, Bailey E. Suicide prevention in educational settings: a review. Australasian Psychiatry [online]. 2018;26(2):132–40. Available from: Suicide prevention in educational settings
- World Health Organisation. Live Life: An implementation guide for suicide prevention in countries [online]. 2021. Available at: LIVE LIFE: An implementation guide for suicide prevention in countries
- HM Government. Cross-government suicide prevention workplan [online]. London: 2019. Available from: Cross-government suicide prevention workplan
Links to previous NIHR research
15. Understanding the role of social media in the aftermath of youth suicides - NIHR Funding and Awards
Appendix A: Further Detail on the New Guidance on Health Inequalities data collection within NIHR PRP Research
Health Inequalities is a high priority area within the Department of Health and Social Care and the NIHR and is often present in a majority of funded projects. We are now assessing all NIHR research proposals in relation to health inequalities. We are asking applicants to identify in their application whether or not there is a health inequalities component or theme and how this research hopes to impact health inequalities. We are also asking researchers to collect relevant data related to health inequalities, if appropriate for the research. Collecting specific information about health inequalities in research submitted to the programme will allow for categorisation of health inequalities research, curation of data to aid future health inequalities research and enable policymakers to better understand the implications of health inequalities within their policy areas. This is a new request from the NIHR PRP and we will be continuing to monitor queries and adapt the process as needed. If you have any feedback on this new request, please contact us at prp@nihr.ac.uk.
Our goal is to facilitate more widespread and consistent reporting of health inequality breakdown data relating to the primary outcomes of NIHR funded research. We would ideally like researchers to focus on the following equity-relevant variables: age, sex, gender, disability, region*, 5 ONS Ethnic groups**, and the 5 IMD quintile groups. These variables are considered an ideal, but we understand that these are subject to change depending on the sample population and specific research question.
For qualitative research projects, this can be purely baseline characteristics of the participants, for example, the number of participants in each ethnic group.
For quantitative research projects, if there are multiple outcomes/effects with your stakeholders, select a small number of main outcomes as appropriate to report equity breakdowns. We will not be prescriptive about the number of the outcomes, as it will depend on the number of study design types and the nature of the project aims. We are asking for one way cross tabulations of each primary outcome by these equity-relevant variables, if appropriate for your research, together with the number of observations in each cell. If more detailed cross tabulations are appropriate for your proposed research, please include these as well. This request applies to both primary data collection studies and secondary analysis of routine data, and to causal inference studies as well as descriptive studies; however, if this is not possible due to data limitations then please explain. Due to sample size and other data limitations there may be difficult scientific and/or data security*** judgement calls to make about which breakdowns to report and whether to merge categories to increase counts in particular cells; we ask you to make these judgments yourself, bearing in mind our data curation aim of enabling future evidence synthesis work in pooling results from different studies. We also ask that researchers report breakdowns for the unadjusted as well as adjusted outcomes/effects, as appropriate.
We understand that research projects may employ different methodologies, and focus on different populations. Please explain how the variables and data collection methods chosen are appropriate to the methodologies used.
We ask that you please clearly identify in the research plan section of the application whether your application has a health inequalities component or not and detail the core set of health inequality breakdown data that will be collected, if applicable. Submission of the data collection will be a condition of the final report for all research with relevant methodologies regardless of whether the research has a health inequalities component that will need to be submitted to NIHR PRP when the grant has finished. This should only take a few sentences within the research plan section.
* Table below uses the nine regions in England, further regions can be used if using the UK as the study population. Please report region breakdown for large samples in nationally representative descriptive studies. There is no need to report this for small sample studies, for sub-national studies, or for quasi-experimental studies where it would require time-consuming re-estimation.
** White, Mixed/ Multiple ethnic groups, Asian/ Asian British, Black/ African/ Caribbean/ Black British, Other ethnic group. If the sample size is small then it is fine to report only some of the requested equity breakdowns and to merge some of the sub-groups as appropriate.
*** For guidance on how to handle data security concerns in reporting of sensitive data please see ONS guidance.
Example data table for submission at the end of the funded research project
(N.B. If there is more than one main outcome then you will require more tables and if you adjust your outcome then you will need two tables for the adjusted outcome and unadjusted outcome. For other methodologies, variable vs number of observations may be more appropriate to record participant data). This table is for an example only. It does not contain sub variables and does not illustrate any preference for certain variables, as these will be dependent on the proposed research.
| Variable | Outcome (an appropriate average for this subgroup, usually the mean) | Number of observations | Additional information about variation if appropriate, e.g. range, standard deviation |
|---|---|---|---|
| Age | - | - | - |
| Sex | - | - | - |
| Gender | - | - | - |
| Disability | - | - | - |
| Ethnic Group | - | - | - |
| IMD Group | - | - | - |
| Region | - | - | - |