[Prevention of suicide of the elderly in France. To a multimodal strategy against depression and isolation: CQFDi]. / Prévention du suicide des personnes âgées en France. Vers une stratégie multimodale de lutte contre la dépression et l'isolement : CQFDi.

ISSUE: Suicide is a major problem of public health around the world, and if suicidal mortality rates have declined in recent years, the elderly remain a category of the world's population at major risk of suicide. Seventeen percent of deaths by suicide across the world are individuals over the age of 65. The existence of suicidal ideas for an individual in this age group increases the risk of suicide attempt in the year by 34. In France, about a little less than a quarter of suicides belong to persons over 60-years-old. More risk factors found in the international literature are in the foreground of mental disorders and in particular the major depression episode, then secondarily addictions, neuro-degenerative disorders as well as pain and other diseases. Depression is found in 60% to 90% of suicides. We notice also that older people privileged the general practitioner as interlocutor to discuss their problems and worries much more than psychiatrists or psychologists. In fact, two-thirds of the elderly who committed suicide had consulted their general practioner in the month prior to suicide and half in the 10 last days. That raises the question of the identification of depression and the evaluation of suicidal risk. On the other side, there is an abundant literature about psychosocial risk factors especially on the influence of isolation and lack of social support as well as on conflicts and family losses. In France, more than 4 million of the elderly live alone. So, while the world population is increasing and life expectancy lengthens, it is important to already act for elderly suicide prevention. PERSPECTIVES: Suicide prevention actions whose efficacity have been demonstrated around the world are designed as part of multimodal strategies combining several levers of action. The consensual recommendations for prevention of elderly suicide recommend the association of actions on the reduction of depression and combating social isolation in connection with the training of front-line actors such as general practitioners. As a result of these experiments and recommendations, the first francophone multimodal strategy was developed to act both on depression and social isolation: the Coopération Québec France sur la dépression et l'isolement (CQFDi) program which will be implemented in France and Quebec in 2019. CONCLUSION: It has been proven that multimodal suicide prevention strategies allow a reduction in the number of suicides. The CQFDi program focuses on at risk of suicide population and aims to reduce the suicide rate of elderly people in France.

[French translation and validation of a short version of the Suicide Intervention Response Inventory-2 (SIRI-2-VF)]. / Traduction française et validation d'une version courte du Suicide Intervention Response Inventory-2 (SIRI-2-VF).

OBJECTIVES: Training health professionals about suicidal crisis is one major line of suicide prevention worldwide. France has one of the highest suicide rates in Europe, and although crisis intervention training has been set up since 2001, there presently is no training assessment tool in the French language for health professionals trained in suicide prevention. In the four levels of Kirpatrick's education pyramid, training that takes place in France today solely assesses level one status, that is to say relative to the level of satisfaction of participants (self-report). This study proposes a validated short French version of the Suicide Intervention Response Inventory-2 (SIRI-2) of Neimeyer & Mc Innes. The SIRI-2 questionnaire assesses the ability of first line intervention in dealing with suicidal individuals. METHODS: The translation methodology was inspired from Vallerand's model of cross-cultural back translation. This method is regularly used for translating from the English language to a French version. In order to translate the English version, we used an extensive 7-step methodology implicating several bilingual translators, expert reviewers (psychologists and psychiatrists) and a scientific committee. Participants were 107 students from different French universities and study programs: psychology, medicine and nursing (17 were men; average age was 26.6). Fifteen of these participants answered the SIRI-2-VF on two occasions (separated by a 15-day interval) in order to estimate the temporal stability of the instrument. The scores of the students were compared to six French experts in suicide prevention and with the original expert group who worked on the development of SIRI-2 (n=7). We used Student t Test for construct validity, Cronbach's Alpha for internal consistency and Pearson's correlation coefficient for temporal stability. RESULTS: Following a fidelity comparison of the results of the French experts with those of the American experts, ten items presenting the least good fidelity were suppressed in order to obtain a short version of the SIRI-2 containing 15 questions (SIRI-2-VF). Statistical analyses of the short version (15 questions, SIRI-2-VF) showed good validity (difference between experts and subjects is significant: t=31.5, P<0.001) and reliability (good internal consistency: α=0.850 for positive statements and α=0.830 for negative statements, and a temporal stability: r=0.827, bilateral test, P<0.001). CONCLUSIONS: This tool should improve the range of specific instruments in French suicidology adapted for French culture of suicide intervention. It is the first tool in France that reaches level 2a of Kirkpatrick's pyramid to assess clinical skills after training in suicidology.