[Patient satisfaction regarding further telephone contact following attempted suicide]. / Vécu subjectif du recontact téléphonique après tentative de suicide.

At a time when increasing importance is given to providing satisfaction to the users of health services, it is surprising that this concept has hardly ever been examined in the field of suicide. Although suicide (prevention and management) is an important part of public health, there seems to be little interest in finding out patients' opinions about the healthcare services which are offered to them. Back in 1976, some authors found a link between the risk of suicide and a low level of satisfaction of healthcare. To date, only two studies looking at management of suicidal patients have included an assessment of patient satisfaction (a strong link between dissatisfaction and suicidal risk was found). During the SYSCALL study, which measured the impact of systematic recontacting by telephone on recurrence of suicide, in the weeks following a suicide attempt, we aimed to find out if this procedure and its methods were well-accepted by the patients. When the patients were first recontacted, 13 months after the suicide attempt, and included in our study, we assessed by means of a questionnaire, their experience of being faced with this intervention, and its impact on their future. Of the 605 patients included, 312 were put into the control group, 147 were recontacted at the end of the first month, and 146 at the end of the third month. The rate of repeat suicide attempts in the year following the initial attempt, was significantly lower in the group that was recontacted after one month, than in the control group [12% against 22%; P=0.03]. It would therefore seem that systematic recontacting by telephone one month after attempted suicide may have contributed in reducing the risk of an early repeat suicide attempt. Of the 482 patients whom we managed to contact by 13 months, 254 had filled out the questionnaire about their subjective experience, in writing or by telephone, this making a response rate of 52.7%. Amongst the patients who replied, female patients are over-represented with more of them being recontacted than males, but no difference was found in the psychiatric symptomatology observed when they were assessed and included in the study. On the other hand, we found a higher incidence of mood disorders and suicidal risk in those who were examined at the final assessment at 13 months. A large majority (78.9%) of the patients who were recontacted, considered recontacting as beneficial, 40.4% considered that it had influenced their lives, and 29.4% thought that recontacting had contributed to avoiding them making a further suicide attempt. Out of the patients recontacted, 94.5% had appreciated the person that had recontacted them, and only 8.3% had been disturbed at being recontacted by a different doctor than the one whom they had met in the Emergency department. A majority of them (54.1%) considered that telephoning was the most appropriate method for recontacting, but of those who were not convinced of being recontacted by telephone, 89.5% of them thought that consultation was the best alternative. Finally, around a third of patients would have preferred being recontacted earlier. On closer examination of the 10 recontacted patients who were dissatisfied by being recontacted, we did not find any elements to characterize them, except for a previous history of more suicide attempts in their family. Finally, a majority of the dissatisfied patients would have preferred being notified in advance of the time of recontacting, and half of them thought that recontacting was too late, but they were not disturbed by being contacted by a different doctor. Telephone recontacting and its methods were surprisingly well-accepted by the patients, even though it is intrusive in nature and unusual in France. We think that despite the inevitable bias that is linked to it, the opinion of patients should be sought and developed in the management of patients who have attempted suicide and in the treatment of the suicidal crisis in general. Even though patients' satisfaction rates may improve the quality of treatment, we should bear in mind that listening to, noting down and examining patients' opinions and words, is in itself a useful factor for patients in their quest for improving their health.

Directed forgetting in depression.

Subjects with depression exhibit deficits in prefrontal function. We posited that as a result, in a supraspan memory test, they would be impaired in their ability to inhibit recall of irrelevant words, and because of consequent overload of working and episodic memory capacity, would be impaired in their ability to recall relevant words. We tested this hypothesis in 30 inpatients and outpatients with a diagnosis of major depressive disorder and 30 controls subjects using a form of the Directed Forgetting Paradigm using exclusively neutral words. The depressed subjects did exhibit deficits in prefrontal function. All subjects were given four lists of 24 items each, in which half the words were followed by the instruction and half by the instruction Our hypothesis found support in a significant group by item type interaction effect exhibited when subjects were instructed to recall only those items followed by the instruction: depressed subjects recalled relatively more words to be forgotten and relatively fewer words to be remembered. A control experiment suggested that these results could not be accounted for by a differential effect of depression on memory encoding.