Introduction: Irish Travellers are an indigenous ethnic minority (IEM) with poor health outcomes. Whilst they constitute less than 1% of the Irish population, they account for 10% of national young adult male suicide statistics. Methods: A rapid review of scientific publications related to mental health and suicide in Irish Travellers was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Searches of PubMed, PsycINFO and Google Scholar were performed. Eligibility criteria included: (i) Irish Travellers/Gypsy Travellers; (ii) information on mental health/suicide/self-harm; (iii) psychosocial anthropological perspectives of mental health; (iv) publications in english. Data on studies including design, methods, participants and key findings were extracted using a spreadsheet template. Results: From 5160 scientific references over the past 20 years, 19 papers made reference to Traveller mental health, and only 5 papers made specific data-based reference to suicide in Travellers. It was only when we qualified Travellers as being 'Irish Travellers' in our scientific review did we detect meaningful references to their existence as an IEM, and their health and well-being. Due to sample sizes and heterogeneity in design, results were synthesised narratively. Discussion: This paper draws together strands from the disciplines of psycho/socio/anthropological perspectives to gain deeper insights into mental health and suicide in Irish Travellers. In a knowledge vacuum, it behoves the scientific community to explain the value of scientific research and rigour to both policymakers as well as Travellers, shifting the existing discourse towards new knowledge and understanding around mental health and suicide in Travellers.

OBJECTIVES:Irish Travellers are an indigenous ethnic minority population in Ireland, with poor life expectancy. This study aims to identify factors associated with reported discrimination and how this affects their experiences of accessing and quality of health services, including mental health.METHODS:The All Ireland Traveller Health Study was a cross-sectional census study in 2010. All Traveller families completed a survey questionnaire (n = 6540), and at random an adult selected from the family completed either a health status (health status study = 1547) or health services utilisation survey (HSU = 1576). Experience of discrimination (EOD) from the census was analysed in relation to HSU data on services used in the previous 12 months and reported experiences of access and quality of that health service. Census variables were analysed in relation to EOD and perceived discrimination (PD).RESULTS:In the final models, EOD and PD were significantly associated with socio-demographic, socio-cultural and living conditions. The multivariate odds of reporting EOD ranged from OR 1.84 to 2.13 and were significant for those reporting worse opportunities in accessing health services, mental health (p = 0.001), hospitals (p < 0.001) and public health nurses (p < 0.001). The multivariate odds of reporting EOD ranged from OR 1.95 to 2.71 and remained significant for those who reported they had poorer experiences than others when using health services, quality of experience (OR 2.18, p =< 0.001), trust in providers (OR 1.95, p =< 0.001) and appropriate information (OR 2.71, p =< 0.001).CONCLUSIONS:Travellers experience high levels of discrimination which negatively affects their engagement with health services. Culturally competent services need to be developed.

The Lifeways study is novel in having information on three generations of the same families. It is well established that infant birth weight (IBW) predicts individuals’ risk of adult chronic disease and more recently studies report cross-generation transmission of risk patterns. The aims of this analysis were to examine whether adults’ birth weights were associated with measures of own health status or social position and to relate adults’ birth weights to that of the index child’s IBW. Finally, we assessed whether birth weight of either adults or children was associated with adult body mass index (BMI) of parents and grandparents. We included 1075 children whose IBW was recorded at recruitment from hospital records and 2546 adult cohort members followed from 2001 until 2014. At baseline, a sub-group of 920 adults had reported own birth weight (RBW). Results showed male adults’ RBW were significantly higher than females’ (P=0.001). Mothers’ RBW was significantly correlated with IBW (r=0.178, P<0.001). In mixed effects linear models with BMI as the outcome variable, of all adults, and in sub-groups of adults with RBW and of mothers only, the IBW was associated with adult BMI adjusting for other predictors. Adults’ BMI was positively associated with age (P=0.013), index child’s IBW (P=0.001), gender (P<0.001) but not own RBW, adjusting for family identification number. When mothers were removed from the adult models however, IBW ceased to be associated with BMI, a final model showed RBW being associated with adult BMI (P=0.04). There are cross-generational associations in the Lifeways cohort, the maternal association being stronger.

Objectives: Fibrinogen is an established biologically coherent predictor of CVD mortality. However, contention remains as to whether it is an independent risk factor and medications to lower fibrinogen are not in widespread use. We aimed to explore the independent relationship of fibrinogen to all-cause mortality at 12 year follow-up in the Lifeways Cross Generation Cohort Study.

Background: Infant birth-weight predicts risk of adult chronic disease and more recently studies have reported on cross-generation transmission of risk patterns. The Lifeways study is highly novel, with information on three generations of the same families.

Background There has been great interest in predictors of mortality in older cohorts in the international literature in recent years. The Lifeways Cross-Generation Cohort Study is a longitudinal birth cohort study including adult family members with detailed baseline objective and subjective health and socio-demographic measures, including a means-tested measure of General Medical Services (GMS) eligibility and comprehensive mortality follow-up to 2014. One of the chief study objectives was to establish the influence of healthcare availability on health outcomes.1 Methods 1223 Lifeways grandparents in 631 families participated in the baseline recruitment questionnaire and/or health examination. Mortality follow-up was achieved using national death records from the General Registry Office. A generalised linear mixed model estimated between couple and between family variance in odds of death to be 0, thus standard logistic regression was used. Predictors that were significant at univariable level (p < 0.10) and for which data were available on >75% of participants were entered into the multivariable models, with age, sex, smoking status retained a priori. Analysis was carried out using IBM SPSS Statistics v.20. Results Mean age at baseline was 59.7 (37.2–89.7); 124 deaths were confirmed within the 10-year follow-up period. In univariable analysis, the odds ratios and 95% confidence intervals (in parentheses) for the significant (p < 0.10) variables were as follows: Socio-demographic factors: male sex, 2.043 (1.405–2.970); age, 1.149 (1.120–1.178); GMS eligibility, 4.579, (2.616–8.014) and being married, 0.486 (0.290–0.817). Clinical factors: worse mean self-rated health, 1.564 (1.149–2.129); waist circumference, 1.029 (1.013–1.045); total cholesterol, 0.749 (0.597–0.941); average systolic blood pressure (SBP), 1.010 (0.999–1.021); reported hypertension, 1.784 (1.221–2.605); reported diabetes, 4.373 (2.460–7.773); reported activity-limiting health condition, 2.470 (1.369–4.459) and frequency of moderate exercise, 0.857 (0.739–0.993). The following are the odds ratios and 95% confidence intervals of all variables in the final multivariable model (Nagelkerke R Square value of 0.340, n = 817, 77 deaths). Age, 1.166 (1.125–1.209); male sex, 1.242, (0.705–2.186); smoker, 2.940 (1.525–5.668), waist circumference, 1.034 (1.012–1.056); average SBP, 0.989 (0.975–1.004); total cholesterol, 0.882 (0.677–1.147), reported hypertension, 2.180 (1.219–3.897); and reported diabetes, 1.947 (0.854–4.438). Conclusion The analysis confirms clearly that conventional clinical health status variables are significant predictors of mortality at 10-year follow-up in this longitudinal cohort of older Irish adults (explaining approximately 34% of the variance). GMS eligibility is also strongly associated with mortality, which may be because those with established health needs register themselves in order to avail of comprehensive means-tested healthcare. This has policy implications for healthcare provision and accessibility. Acknowledgement Additional authors from the Lifeways Cohort Study Steering Group. Reference O'Mahony D, Fallon UB, Hannon F, Kloeckner K, Avalos G, Murphy AW, Kelleher CC; Lifeways Cross Generation Cohort Study Steering Group. The lifeways cross-generation study: design, recruitment and data management considerations. Ir Med J. 2007;100(8 Suppl):3–6