Ann John

Ann John
Swansea University | SWAN · Institute of Life Science "ILS"

About

368
Publications
77,092
Reads
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18,908
Citations
Additional affiliations
September 2010 - present
Public Health Wales
Position
  • Hon. Consultant in Public health Medicine

Publications

Publications (368)
Article
Background The potential impact of the COVID-19 pandemic on population mental health is of increasing global concern. We examine changes in adult mental health in the UK population before and during the lockdown. Methods In this secondary analysis of a national, longitudinal cohort study, households that took part in Waves 8 or 9 of the UK Househo...
Article
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Background Poor attendance at school, whether due to absenteeism or exclusion, leads to multiple social, educational, and lifelong socioeconomic disadvantages. We aimed to measure the association between a broad range of diagnosed neurodevelopmental and mental disorders and recorded self-harm by the age of 24 years and school attendance and exclusi...
Article
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Validated methods of identifying childhood maltreatment (CM) in primary and secondary care data are needed. We aimed to create the first externally validated algorithm for identifying maltreatment using routinely collected healthcare data. Comprehensive code lists were created for use within GP and hospital admissions datasets in the SAIL Databank...
Article
Globally, too many people die prematurely from suicide and the physical comorbidities associated with mental illness and mental distress. The purpose of this Review is to mobilise the translation of evidence into prioritised actions that reduce this inequity. The mental health research charity, MQ Mental Health Research, convened an international p...
Article
Introduction Research has found differences in processes and outcomes of care between people in ethnic minorities and White British populations in some clinical conditions, although findings have been mixed. The Building an understanding of Ethnic minority people’s Service Use Relating to Emergency care for injuries study is investigating differenc...
Article
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Objective and ApproachThey are growing concerns that self-harm and mental health conditions are increasing in university students. This may reflect widening access to higher education, existing population trends or stressors associated with this setting. We linked real-world data from the Higher Education Statistics Agency between 2012-2018 with pr...
Article
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Objective and ApproachPupils ‘Educated in Other Than At School’ (EOTAS) are some of the most vulnerable learners, who, for reasons such as mental health or behavioural difficulties, do not attend a mainstream school. We linked population data from Education Wales (EDUW) between 2010-19 to primary and secondary healthcare records. Individuals includ...
Article
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Background Opioids kill more people than any other class of drug. Naloxone is an opioid antagonist which can be distributed in kits for peer administration. We assessed the feasibility of implementing a Take-home Naloxone (THN) intervention in emergency settings, as part of designing a definitive randomised controlled trial (RCT). Methods We under...
Article
Importance Associations have been found between COVID-19 and subsequent mental illness in both hospital- and population-based studies. However, evidence regarding which mental illnesses are associated with COVID-19 by vaccination status in these populations is limited. Objective To determine which mental illnesses are associated with diagnosed COV...
Article
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Background Concern that self-harm and mental health conditions are increasing in university students may reflect widening access to higher education, existing population trends and/or stressors associated with this setting. Aims To compare population-level data on self-harm, neurodevelopmental and mental health conditions between university student...
Preprint
Background Rates of self-harm and suicide appear to be increasing in young people and many attribute this to social media use. However, high quality studies examining young people’s experiences of self-harm and suicide-related content on social media, and the impact on wellbeing, are lacking. Methods An online national cross-sectional survey was co...
Article
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Objectives This study explored the views of young people from diverse backgrounds, with or without a history of self-harm, on the motivation and impacts of sharing self-harm imagery online and the use of their social media data for mental health research. Design Thematic analysis of 27 semi-structured one-to-one interviews. Setting Two workshops...
Article
Objective To enable reproducible research at scale by creating a platform that enables health data users to find, access, curate, and re-use electronic health record phenotyping algorithms. Materials and Methods We undertook a structured approach to identifying requirements for a phenotype algorithm platform by engaging with key stakeholders. User...
Conference Paper
Background Patients with depression are at increased risk of future cardiovascular disease (CVD) events compared to those without depression. The reasons for this are not fully understood. Appropriate management of CVD risk factors, including blood pressure (BP) are essential for primary prevention of CVD. Purpose To explore whether there are diff...
Article
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Background Population‐based studies have observed sex biases in the diagnosis and treatment of attention‐deficit hyperactivity disorder (ADHD). Females are less likely to be diagnosed or prescribed ADHD medication. This study uses national healthcare records, to investigate sex differences in diagnosis and clinical care in young people with ADHD, p...
Preprint
BACKGROUND The Integrated Motivational-Volitional (IMV) model is one of the leading theoretical models of suicidal thoughts and behaviour. There has been a recent proliferation in the assessment of suicidal and non-suicidal self-harm thoughts and behaviours (SHTBs) in daily life. OBJECTIVE This systematic review synthesises evidence from ecologica...
Article
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Background Childhood adversity is associated with increased later mental health problems and suicidal behaviour. Opportunities for earlier healthcare identification and intervention are needed. Aim To determine associations between hospital admissions for childhood adversity and mental health in children who later die by suicide. Method Populatio...
Article
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Background People under the care of mental health services are at increased risk of suicide. Existing studies are small in scale and lack comparisons. Aims To identify opportunities for suicide prevention and underpinning data enhancement in people with recent contact with mental health services. Method This population-based study includes people...
Preprint
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Background Rates of childhood mental health problems are increasing in the United Kingdom. Early identification of childhood mental health problems is challenging but critical to future psycho-social development of children, particularly those with social care contact. Clinical prediction tools could improve these early identification efforts. Aim...
Article
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Background Healthcare and support workers play a pivotal role in delivering quality services and support to people seeking sanctuary who have experienced poor physical and mental health linked to previous trauma, relocation and loss of freedoms. However, they often encounter various challenges in their daily work, ranging from communication barrier...
Article
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Introduction COVID-19 has caused severe disruption to clinical services in Bangladesh but the extent of this, and the impact on healthcare professionals is unclear. We aimed to assess the perceived levels of anxiety, depression and burnout among doctors and nurses during COVID-19 pandemic. Methods We undertook an online survey using RedCap, direct...
Preprint
Full-text available
Background Opioids kill more people than any other class of drug. Naloxone is an opioid antagonist which can be distributed in kits for peer administration. We aimed to determine feasibility of undertaking a definitive randomised controlled trial (RCT) of Take-home Naloxone (THN) in emergency settings. Methods Using individual-level-routine health...
Article
Full-text available
Background Parental difficulties, including mental ill health, substance misuse, domestic violence and learning disability have been associated with children entering out-of-home care. There is also evidence that these issues may co-occur within families. Understanding how the co-occurrence of these difficulties is associated with care entry is co...
Preprint
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Background: COVID-19 is associated with subsequent mental illness in both hospital- and population-based studies. Evidence regarding effects of COVID-19 vaccination on mental health consequences of COVID-19 is limited. Methods: With the approval of NHS England, we used linked electronic health records (OpenSAFELY-TPP) to conduct analyses in a 'pre-...
Article
Background Self-harm and suicide remain prevalent in later life. For younger adults, higher early-life cognitive ability appears to predict lower self-harm and suicide risk. Comparatively little is known about these associations among middle-aged and older adults. Methods This study examined the association between childhood (age 11) cognitive abi...
Article
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Background The EVITE Immunity study investigated the effects of shielding Clinically Extremely Vulnerable (CEV) people during the COVID-19 pandemic on health outcomes and healthcare costs in Wales, United Kingdom, to help prepare for future pandemics. Shielding was intended to protect those at highest risk of serious harm from COVID-19. We report t...
Article
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Background Estimates suggest that 1 in 100 people in the UK live with facial scarring. Despite this incidence, psychological support is limited. Aims The aim of this study was to strengthen the case for improving such support by determining the incidence and risk factors for anxiety and depression disorders in patients with facial scarring. Metho...
Article
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Background: There is little information about characteristics and long-term outcomes of individuals who self-harm during a suicide cluster. Aims: To compare characteristics of individuals who self-harmed during a suicide cluster in South Wales (∼10 deaths between December 2007 and March 2008) with others who self-harmed prior to the cluster and to...
Preprint
Full-text available
Background Population-based studies have observed sex biases in the diagnosis and treatment of attention deficit hyperactivity disorder (ADHD). Females are less likely to be diagnosed or prescribed ADHD medication. This study uses national healthcare records, to investigate sex differences in diagnosis and clinical care in young people with ADHD, p...
Article
Full-text available
Background The World Health Organisation declared the novel Coronavirus disease (COVID‑19) a global pandemic on 11th March 2020. Since then, the world has been firmly in its grip. At the time of writing, there were more than 767,972,961 million confirmed cases and over 6,950,655 million deaths. While the main policy focus has been on controlling th...
Preprint
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Bereavement by suicide is different from other forms of bereavement and needs specialised support. Children and young people who lost loved ones to suicide are more likely to suffer a complicated bereavement process and have poorer mental health. This review aims to assess the evidence for the effectiveness of interventions to support children and...
Preprint
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Background Looked after children (Lac) continue to attain suboptimal health and social outcomes and have a high prevalence of mental, developmental and behavioural disorders. Limited in research is the exploration of neurodevelopmental disorders (NDDs) in this vulnerable population. This review aims to compare prevalence rates of NDDs in children w...
Article
Objective: In 2008, the UK entered a period of economic recession followed by sustained austerity measures. We investigate changes in inequalities by area deprivation and urbanicity in incidence of severe mental illness (SMI, including schizophrenia-related disorders and bipolar disorder) between 2000 and 2017. Methods: We analysed 4.4 million i...
Article
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Objectives We investigated the feasibility and validity of establishing a nationwide e-cohort of individuals with a diagnosis of attention deficit hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) for future longitudinal research. Design Individuals with a childhood diagnosis of ADHD/ASD as recorded on routinely available healthc...
Preprint
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The adoption of digital health technologies accelerated during Covid-19, with concerns over the equity of access due to digital exclusion. Using data from a text-based online mental health service for children and young people we explore the impact of the pandemic on service access and presenting concerns and whether differences were observed by so...
Article
Background: Restricting access to suicide methods is one of the most effective suicide prevention approaches. Methods: Trends in method specific suicide rates (2014-2021) in India were calculated using National Crime Records Bureau data (NCRB) by sex and geographical region. Joinpoint regression analysis was used to empirically identify any chan...
Article
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Introduction Shielding aimed to protect those predicted to be at highest risk from COVID-19 and was uniquely implemented in the UK during the first year of the pandemic from March 2020. As the first stage in the EVITE Immunity evaluation (Effects of shielding for vulnerable people during COVID-19 pandemic on health outcomes, costs and immunity, inc...
Article
Living reviews are an increasingly popular research paradigm. The purpose of a 'living' approach is to allow rapid collation, appraisal and synthesis of evolving evidence on an important research topic, enabling timely influence on patient care and public health policy. However, living reviews are time- and resource-intensive. The accumulation of n...
Article
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Introduction The COVID-19 pandemic increased public use of digital mental health technologies. However, little is known about changes in user engagement with these platforms during the pandemic. This study aims to assess engagement changes with a digital mental healthcare service during COVID-19. Methods A cohort study based on routinely collected...
Article
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Background Understanding and quantifying the differences in disease development in different socioeconomic groups of people across the lifespan is important for planning healthcare and preventive services. The study aimed to measure chronic disease accrual, and examine the differences in time to individual morbidities, multimorbidity, and mortality...
Article
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Background: Understanding and quantifying the differences in disease development in different socioeconomic groups of people across the lifespan is important for planning healthcare and preventive services. The study aimed to measure chronic disease accrual, and examine the differences in time to individual morbidities, multimorbidity, and mortali...
Article
There was continuing public and political concern about the loss of life at sea during the second half of the nineteenth century in Britain. New regulatory requirements, introduced to examine the competence of officers, prevent overloading and reduce the risks from hazardous cargoes such as coal, were in place by 1890. However, the effectiveness of...
Article
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Background Suicide is a serious public health problems worldwide. Although suicide rates in the eastern Medetranian region are lower than western countries, increasing incidences is reported. This study aims to explore the demographic, clinical characteristics, and associated variables of people died by suicide in Iraq through a limited retrospecti...
Article
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Objectives To determine whether clinically extremely vulnerable (CEV) children or children living with a CEV person in Wales were at greater risk of presenting with anxiety or depression in primary or secondary care during the COVID-19 pandemic compared with children in the general population and to compare patterns of anxiety and depression during...
Article
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Objectives To quantify population health risks for domiciliary care workers (DCWs) in Wales, UK, working during the COVID-19 pandemic. Design A population-level retrospective study linking occupational registration data to anonymised electronic health records maintained by the Secure Anonymised Information Linkage Databank in a privacy-protecting...
Article
Air pollution (AP) is a significant environmental risk to human health. Historically, the impact of AP exposure has focused upon the physical health effects, yet the implications of AP on mental health have received limited attention. Despite this, recent research has highlighted emerging evidence supporting a possible aetiological link. The purpos...
Article
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Introduction Injuries are a major public health problem which can lead to disability or death. However, little is known about the incidence, presentation, management and outcomes of emergency care for patients with injuries among people from ethnic minorities in the UK. The aim of this study is to investigate what may differ for people from ethnic...
Article
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Background: ACTivate your wellbeing is a digital health and well-being program designed to support and encourage positive lifestyle behavior change. The website includes 5 lifestyle behavior change modules and a 12-week well-being intervention based on acceptance and commitment therapy. It was timely to adapt the resource for a new audience in the...
Article
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Introduction The main objective was to compare suicide rates and their trends across the three UK Armed forces (Royal Navy, Army and Royal Air Force) from 1900 to 2020. Further objectives were to compare suicide rates with those in the corresponding general population and in UK merchant shipping and to discuss preventative measures. Methods Examin...
Article
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Introduction The COVID-19 pandemic has posed a serious health risk, especially in vulnerable populations. Even before the pandemic, people with mental disorders had worse physical health outcomes compared to the general population. This umbrella review investigated whether having a pre-pandemic mental disorder was associated with worse physical hea...
Preprint
Full-text available
Background: The EVITE Immunity study investigates the effects of shielding Clinically Extremely Vulnerable (CEV) people during the COVID-19 pandemic on health outcomes and healthcare costs in Wales, UK, to help prepare for future pandemics. Shielding was intended to protect those at highest risk of serious harm from COVID-19. We report the cost of...
Article
Full-text available
Introduction Gypsies and Travellers have poorer physical and mental health than the general population, but little is known about mental health service use by Gypsy and Traveller children and young people. Finding this group in routine electronic health data is challenging, due to limited recording of ethnicity. We assessed the feasibility of using...
Article
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Introduction: The UK shielding policy intended to protect people at the highest risk of harm from COVID-19 infection. We aimed to describe intervention effects in Wales at 1 year. Methods: Retrospective comparison of linked demographic and clinical data for cohorts comprising people identified for shielding from 23 March to 21 May 2020; and the...
Preprint
Full-text available
Self-harm and suicide remain prevalent in later life. For younger adults, work has highlighted an association between higher early-life cognitive ability and lower self-harm and suicide risk. Comparatively little is known about its association with self-harm and suicide among older adults. Furthermore, most work has measured cognitive ability in ea...
Technical Report
Full-text available
The purpose of this study is to advance the development of early identification tools for young people’s mental health (MH) problems in social care settings. Almost all young people with social care contact are likely to experience some kind of mental health problem, yet a small proportion of these are thought to have formal diagnoses, and even f...
Preprint
Abstract Background Childhood adversity (CA) is associated with increased later mental health (MH) problems and suicidal behaviour. Opportunities for earlier healthcare identification and intervention are needed. Aim To determine associations between hospital admissions for CA and MH in children who later die by suicide. Method Population-based...
Preprint
Full-text available
Objectives: We investigated the feasibility and validity of establishing a nationwide e-cohort of individuals with a diagnosis of ADHD and/or ASD for future longitudinal research. Design: Individuals with a childhood diagnosis of ADHD/ASD as recorded on routinely available healthcare datasets were compared with matched controls and a sample of dire...
Article
Full-text available
Domiciliary care workers (DCWs) continued to provide care to adults in their own homes throughout the COVID-19 pandemic. The evidence of the impact of COVID-19 on health outcomes of DCWs is currently mixed. The OSCAR study will quantify the impact of COVID-19 upon health outcomes of DCWs in Wales, explore causes of variation and extrapolate to the...
Article
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Mitigating the COVID-19 related disruptions in mental health care services is crucial in a time of increased mental health disorders. Numerous reviews have been conducted on the process of implementing technology-based mental health care during the pandemic. The research question of this umbrella review was to examine what the impact of COVID-19 wa...
Article
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Although the COVID-19 pandemic has been shown to be detrimental to mental health, it may hold a parallel potential for positive change. Little is known about posttraumatic growth (PTG) as a potential outcome for individuals with lived experience of psychiatric disorders following trauma exposure, especially in the context of the COVID-19 pandemic....
Article
Background Public use of digital mental health technologies has informed several studies focusing on patterns of engagement within user-led digital support systems. General engagement with these services has increased since the start of the COVID-19 pandemic. However, to the best of our knowledge, this is the first study to explore how user engagem...
Article
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Introduction There was and still is much speculation about the COVID-19 pandemic impact on suicide rates. We aimed to assess the effect of the COVID-19 pandemic on suicide rates around the world. Methods We sourced real-time suicide data from countries or countries areas through a systematic internet search (official websites of Ministries of heal...
Article
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Background: Studies on COVID-19 pandemic-associated changes in mortality following self-harm remain scarce and inconclusive. Aims: To compare mortality risks in individuals who had self-harmed to those for individuals who had not, before and during the COVID-19 pandemic (Waves 1 and 2) in Wales, the United Kingdom, using population-based routinely...
Article
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The COVID-19 pandemic has harmed many people's mental health globally. Whilst the evidence generated thus far from high-income countries regarding the pandemic's impact on suicide rates is generally reassuring, we know little about its influence on this outcome in lower- and middle-income countries or among marginalised and disadvantaged people. Th...
Article
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Introduction Although the evidence base on bullying victimization and self‐harm in young people has been growing, most studies were cross‐sectional, relied on self‐reported non‐validated measures of self‐harm, and did not separate effects of in‐person and cyberbullying. This study aimed to assess associations of self‐harm following in‐person bullyi...
Article
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Background Worldwide, the Coronavirus pandemic has had a major impact on people's health, lives, and livelihoods. However, this impact has not been felt equally across various population groups. People from ethnic minority backgrounds in the UK have been more adversely affected by the pandemic, especially in terms of their physical health. Their me...
Article
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Background Co-occurring psychiatric disorders are common in autism, with previous studies suggesting 54–94% of autistic individuals develop a mental health condition in their lifetime. Most studies have looked at clinically-recruited cohorts, or paediatric cohorts followed into adulthood, with less known about the autistic community at a population...