Ethnic disparities in mental health problems in New Caledonia and French Polynesia.

OBJECTIVES: Indigenous people experience poorer mental health compared to the general population. Socioeconomic gaps partly explain these disparities. However, there is variability between populations and French overseas territories are understudied. This study examines the prevalence of mental health problems among Indigenous people in New Caledonia and French Polynesia, describing and comparing it with that of their counterparts while considering associated factors. METHODS: We used the data from the cross-sectional Mental Health in the General Population survey in the only 3 sites for which information on indigenous status was available: Noumea (2006) and the 'Bush' (2008) in New Caledonia, and French Polynesia (2015-2017). Current mental health issues were screened using the Mini-International Neuropsychiatric Interview. In multivariable analyses, we considered the following factors: gender, age, education level, marital status, occupational activity and monthly income. RESULTS: Overall, 2294 participants were analysed. Among the 1379 indigenous participants, 52.3% had at least one mental health issue. The prevalence of depressive disorder (18.0% vs 11.7%), alcohol use disorder (16.7% vs 11.7%) and suicide risk (22.3% vs 16.7%) were higher among indigenous participants compared to non-indigenous participants. After adjustment, the association between indigenous status and these mental health issues did not persist, except for alcohol use disorder. CONCLUSION: We found higher prevalence of depressive disorder, alcohol use disorder and suicide risk among indigenous people of French Polynesia and New Caledonia compared to their counterparts. These differences seemed largely explained by socioeconomic disparities. Future studies could explore the use of and access to healthcare by indigenous populations.

[Prevalence of mental disorders in French prisons: A systematic review]. / Prévalence des troubles psychiatriques en population carcérale française : une revue systématique de la littérature.

INTRODUCTION: The prevalence of psychiatric disorders among prisoners remains a major public health issue worldwide. In France, despite the increasing number of persons who are incarcerated (+30% between 1992 and 2002 with a 120% prison overcrowding), and a historical concern about the mental health of persons in detention and its management, no systematic review has been published on this subject. The aim of this article is to present the results of a systematic review of the literature on the prevalence of psychiatric disorders in French prisons. METHOD: The reporting of this systematic review conforms to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) checklist. We searched the PubMed and Web of Science databases. We used combinations of keywords relating to prison (prison*, jail*, inmate*), to psychiatry ("mental health", psychiatr*), and to France (France, French). This work was completed with a search through the digital libraries of the École des Hautes Études en Santé Publique (EHESP) and of the Système Universitaire de Documentation (Sudoc) to obtain data from academic works and the gray literature. References cited in studies included in this review were also examined. All references published up to September 2022, written in English or French, presenting the results of original quantitative studies on the prevalence of psychiatric disorders in correctional settings were included. Two researchers independently extracted data from included references according to a pre-established protocol. RESULTS: Among 501 records identified, a total of 35 papers based on 24 epidemiological studies met the eligibility criteria for inclusion in this review: 16 were cross-sectional, 7 retrospective and 1 both cross-sectional and retrospective. All papers were published between 1999 and 2022. We found one European study, 5 international studies, 18 regional or local studies. Of these, 21 studies had all-male or mixed gender samples (but when the sample was mixed gender, it was always at least 92% male). Almost half of the studies (n=11) involved a small sample of fewer than 500 persons. Half of the studies involved a sample of recently incarcerated persons: 6 involved a random sample of persons in detention, and 1 involved a sample of people incarcerated for more than 5 years. The last 5 studies focused on persons aged over 50 years and incarcerated for more than one year (n=1), incarcerated for sexual offences (n=2), placed in disciplinary cells (n=1) or in a special wing for radicalized or suspected radicalized individuals (n=1). Nine studies used standardized and validated diagnostic tools. According to the 4 studies involving representative samples and using standardized and validated diagnostic tools, the prevalence of the following psychiatric disorders was: 29.4-44.4% for anxiety disorders, 5-14.2% for PTSD, 28-31.2% for mood disorders, 6.9-17% for psychotic disorders, 32% for personality disorders and 11% for ADHD. CONCLUSION: This systematic review of the literature highlights the high prevalence of psychiatric disorders in French prisons. The data collected are in line with international studies. The great methodological heterogeneity of the papers included in this review calls for further rigorous research to better understand the rates of mental disorders in French prisons and to explore their determinants.

Attentional bias toward negative stimuli in PTSD: an eye-tracking study.

BACKGROUND: Research on biased processing of aversive stimuli in posttraumatic stress disorder (PTSD) has produced inconsistent results between response time (RT) and eye-tracking studies. Recent RT-based results of dot-probe studies showed no attentional bias (AB) for threat while eye-tracking research suggested heightened sustained attention for this information. Here, we used both RT-based and eye-tracking measures to explore the dynamics of AB to negative stimuli in PTSD. METHODS: Twenty-three individuals diagnosed with PTSD, 23 trauma-exposed healthy controls, and 23 healthy controls performed an emotional dot-probe task with pairs of negative and neutral scenes presented for either 1 or 2 s. Analyses included eye movements during the presentation of the scenes and RT associated with target localization. RESULTS: There was no evidence for an AB toward negative stimuli in PTSD from RT measures. However, the main eye-tracking results revealed that all three groups showed longer dwell times on negative pictures than neutral pictures at 1 s and that this AB was stronger for individuals with PTSD. Moreover, although AB disappeared for the two groups of healthy controls with prolonged exposure, it persisted for individuals with PTSD. CONCLUSION: PTSD is associated with an AB toward negative stimuli, characterized by heightened sustained attention toward negative scenes once detected. This study sheds light on the dynamics of AB to negative stimuli in PTSD and encourages us to consider optimized therapeutic interventions targeting abnormal AB patterns.

Admission to jail and psychotic symptoms: a study of the psychotic continuum in a sample of recently incarcerated men.

PURPOSE: We sought to measure the prevalence of psychotic symptoms (PSs) and psychotic disorders (PDs) in a sample of men entering jail and to compare these prevalences with those observed in the general population. We also aimed to explore the sociodemographic and clinical factors associated with PSs and PDs. METHODS: The Mental Health in the Prison Population (MHPP) survey interviewed 630 incarcerated men upon admission to jail, using the Mini International Neuropsychiatric Interview. We looked for associations between sociodemographic and clinical characteristics and the presence of lifetime PSs and PDs in the MHPP and Mental Health in the General Population (MHGP) surveys, which used the same methodology to collect data from the jail and general populations of the same geographical area. RESULTS: A higher proportion of PSs without PDs was found in the MHGP group (25.3% vs. 17.8%, p < 0.001), whereas a higher prevalence of PDs was found in the MHPP group (7.0% vs. 2.6%, p < 0.001). The multivariable model indicated that subjects who were single or separated/divorced/widowed and had a history of trauma exposure were at joint risk of PSs and PDs, whereas entering jail was not associated with either PSs or PDs after adjustment for all covariates. CONCLUSION: The present study shows that PDs, but not PSs, are more prevalent in men entering jail than in the general population. This overrepresentation could be further explained by the exposure to vulnerability factors found in this population rather than by any specificity related to entering jail.

Validation of a French questionnaire assessing knowledge of suicide.

OBJECTIVES: The objective of this study was to develop and validate the Knowledge of Suicide Scale (KSS), elaborated to assess adherence to myths about suicide. METHODS: The KSS is a self-questionnaire including 22 statements relating to myths about suicide for which the respondent is asked to rate his degree of adherence on a scale ranging from 0 ("strongly disagree") to 10 ("completely agree"). Using the script concordance test scoring method, the respondents' scores were compared with those of experts to obtain, for each item, a score between 0 (maximum deviation with the experts) and 1 (minimum deviation with the experts). One thousand and thirty-five individuals (222 psychiatric interns, 332 medical interns in the first semester excluding psychiatry and 481 journalism students) were included. RESULTS: According to the exploratory factor analysis, the KSS is a two-dimensional scale: the first subscale includes 15 items and the second seven items. The tool showed excellent face validity, correct convergent and divergent validities (multi-method multi-feature analyzes), and good internal consistency (Cronbach's alpha coefficient between 0.66 and 0.83 for scales and subscales). The KSS is moderately and negatively correlated with the Stigma of Suicide Scale (r=-0.3). It significantly discriminates groups with different expected levels of knowledge regarding suicide (P<0.001). CONCLUSIONS: The KSS demonstrated good psychometric properties to measure adherence to myths about suicide. This tool could be useful in assessing the effectiveness of suicide prevention literacy improvement programs.

Opening the black box of hospitalizations in French high-secure psychiatric forensic units.

INTRODUCTION: Basic epidemiological data are rare concerning the activity of specialized forensic psychiatric facilities in France. Here, we investigated the activity of the ten (640 beds) French "units for difficult patients" (unités pour malades difficiles [UMDs]). METHOD: We used the Programme de médicalisation des systèmes d'information (PMSI) database to describe the characteristics and evolution of psychiatric hospitalisations in UMDs between 2012 and 2021, as well as the age, sex, and principal diagnoses of the patients hospitalized in these facilities. RESULTS: Between 2012 and 2021, 4857 patients were hospitalized in UMDs (6082 stays). Among them, 897 (18.5%) had more than one stay. The number of admissions ranged from a minimum of 434 to a maximum of 632 per year. The number of discharges ranged from a minimum of 473 to a maximum of 609 per year. The mean length of stay was 13.5 (SD: 22.64) months with a median of 7.3 months (IQR: 4.0-14.4). Among the 6082 stays, 5721 (94.1%) involved male patients. The median age was 33 (IQR: 26-41) years. The most frequent principal psychiatric diagnoses were psychotic disorders and personality disorders. CONCLUSION: The number of individuals hospitalized in specialized forensic psychiatric facilities has been stable for 10 years in France and remains lower than in most European countries.

Substance Use, Substance Use Disorders, and Co-Occurring Psychiatric Disorders in Recently Incarcerated Men: A Comparison with the General Population.

INTRODUCTION: The rates of alcohol and illegal drug use and the prevalence of alcohol and illegal drug use disorders (AUDs and DUDs) are high in prison populations, particularly in men entering jail. However, these rates have never been exhaustively assessed and compared to those of the general population in France. METHODS: We based our research on two surveys, conducted in the same French region, which included a total of 630 men entering jail and 5,793 men recruited from the general population. We used the Mini-International Neuropsychiatric Interview to assess alcohol and drug use, AUD, DUD, as well as co-occurring psychiatric disorders, and we examined differences in prevalence rates between the two populations. Logistic regression models were performed to (i) identify the factors associated with AUD and DUD and (ii) test whether the interaction between admission to jail and the presence of AUD, DUD, or both is linked to the presence of at least one co-occurring psychiatric disorder. RESULTS: Compared to the general population sample, the prevalence of AUD (33.8% vs. 8.7%, p < 0.001) and DUD (at least one type of drug: 28.7% vs. 5.0%, p < 0.001; cannabis: 24.0% vs. 4.7%, p < 0.001; opioids: 6.8% vs. 0.4%, p < 0.001; stimulants: 5.2% vs. 0.8%, p < 0.001) was significantly higher in the jail population sample, as well as the rates of past-year use of various substances (alcohol: 62.1% vs. 56.4%, p = 0.007; at least one type of illegal drug: 50.0% vs. 14.4%, p < 0.001; cannabis: 45.6% vs. 13.9%, opioids: 9.4% vs. 0.7%; stimulants: 8.6% vs. 1.9%). Admission to jail was associated with a higher risk of AUD (aOR = 3.80, 95% CI: 2.89-5.01, p < 0.001) or DUD (aOR = 4.25, 95% CI: 3.10-5.84, p < 0.001). History of trauma was also associated with both AUD (aOR = 1.81, 95% CI: 1.53-2.14, p < 0.001) and DUD (aOR = 2.15, 95% CI: 1.74-2.65, p < 0.001), whereas history of migration was only associated with DUD (aOR = 1.38, 95% CI: 1.12-1.71, p = 0.003). AUDs and DUDs were more strongly associated with co-occurring psychiatric disorders in incarcerated men than in the general population. Among individuals with AUD, DUD, or both, co-occurring anxiety and mood disorders were particularly more frequent in jail than in the general population. DISCUSSION/CONCLUSION: As in most countries, AUD and DUD are highly prevalent among men entering jail in France. Our results also suggest that incarceration constitutes an independent vulnerability factor for a dual disorder, which supports a systematic assessment and treatment of psychiatric disorders in men entering jail and diagnosed with an AUD or DUD.

Association Between COVID-19 and Self-Harm: Nationwide Retrospective Ecological Spatiotemporal Study in Metropolitan France.

Background: The COVID-19 pandemic has not been associated with increases in suicidal behavior at the national, regional, or county level. However, previous studies were not conducted on a finer scale or adjusted for ecological factors. Objective: Our objective was to assess the fine-scale spatiotemporal association between self-harm and COVID-19 hospitalizations, while considering ecological factors. Methods: Using the French national hospital discharge database, we extracted data on hospitalizations for self-harm of patients older than 10 years (from 2019 to 2021) or for COVID-19 (from 2020 to 2021) in metropolitan France. We first calculated monthly standardized incidence ratios (SIRs) for COVID-19 between March 2020 and December 2021, using a Besag, York, and Mollié spatiotemporal model. Next, we entered the SIRs into an ecological regression in order to test the association between hospital admissions for self-harm and those for COVID-19. Lastly, we adjusted for ecological variables with time lags of 0 to 6 months. Results: Compared with a smoothed SIR of ≤1, smoothed SIRs from 1 to 3, from 3 to 4, and greater than 4 for COVID-19 hospital admissions were associated with a subsequent increase in hospital admissions for self-harm, with a time lag of 2 to 4 months, 4 months, and 6 months, respectively. Conclusions: A high SIR for hospital admissions for COVID-19 was a risk factor for hospital admission for self-harm some months after the epidemic peaks. This finding emphasizes the importance of monitoring and seeking to prevent suicide attempts outside the epidemic peak periods.

Conspiracy beliefs and perceptual inference in times of political uncertainty.

Sociopolitical crises causing uncertainty have accumulated in recent years, providing fertile ground for the emergence of conspiracy ideations. Computational models constitute valuable tools for understanding the mechanisms at play in the formation and rigidification of these unshakeable beliefs. Here, the Circular Inference model was used to capture associations between changes in perceptual inference and the dynamics of conspiracy ideations in times of uncertainty. A bistable perception task and conspiracy belief assessment focused on major sociopolitical events were administered to large populations from three polarized countries. We show that when uncertainty peaks, an overweighting of sensory information is associated with conspiracy ideations. Progressively, this exploration strategy gives way to an exploitation strategy in which increased adherence to conspiracy theories is associated with the amplification of prior information. Overall, the Circular Inference model sheds new light on the possible mechanisms underlying the progressive strengthening of conspiracy theories when individuals face highly uncertain situations.

A pilot study investigating affective forecasting biases with a novel virtual reality-based paradigm.

A body of research indicates that people are prone to overestimate the affective impact of future events. Here, we developed a novel experimental paradigm to study these affective forecasting biases under laboratory conditions using subjective (arousal and valence) and autonomic measures (skin conductance responses, SCRs, and heart rate). Thirty participants predicted their emotional responses to 15 unpleasant, 15 neutral, and 15 pleasant scenarios (affective forecasting phase) to which they were then exposed in virtual reality (emotional experience phase). Results showed that participants anticipated more extreme arousal and valence scores than they actually experienced for unpleasant and pleasant scenarios. The emotional experience phase was characterized by classic autonomic patterns, i.e., higher SCRs for emotionally arousing scenarios and greater peak cardiac acceleration for pleasant scenarios. During the affective forecasting phase, we found only a moderate association between arousal scores and SCRs and no valence-dependent modulation of cardiac activity. This paradigm opens up new perspectives for investigating affective forecasting abilities under lab-controlled conditions, notably in psychiatric disorders with anxious anticipations.

Persistent physical symptoms after COVID-19 infection and the risk of Somatic Symptom Disorder.

OBJECTIVE: Evidence shows that many patients with COVID-19 present persistent symptoms after the acute infection. Some patients may be at a high risk of developing Somatic Symptom Disorder (SSD), in which persistent symptoms are accompanied by excessive and disproportionate health-related thoughts, feelings and behaviors regarding these symptoms. This study assessed the frequency of persistent physical symptoms and SSD and their associated factors in patients with confirmed COVID-19. METHODS: We conducted a longitudinal retrospective study after the first two French lockdowns at the Lille University Hospital (France), including all patients with confirmed COVID-19. Persistent physical symptoms and excessive preoccupations for these symptoms were measured 8 to 10 months after the onset of COVID-19. The combination of the Patient Health Questionnaire-15 and the Somatic Symptom Disorder-B Criteria Scale was used to identify the individuals likely to present with SSD. Two linear regression models were performed to identify sociodemographic and medical risk factors of SSD. RESULTS: Among the 377 patients with a laboratory-confirmed diagnosis, 220 (58.4%) completed the questionnaires. Sixty-five percent of the 220 included patients required hospitalization, 53.6% presented at least one persistent physical symptom and 10.4% were considered to present SSD. Female sex, older age, infection during the second wave and having probable PTSD were significantly associated with the severity of SSD and SSD was associated with a significantly higher healthcare use. CONCLUSIONS: The identification of SSD should encourage clinicians to move beyond the artificial somatic/psychiatric dualism and contribute to a better alliance based on multi-disciplinary care.

Mental Health Symptoms of University Students 15 Months After the Onset of the COVID-19 Pandemic in France.

Importance: The Conséquences de la pandémie de COVID-19 sur la santé mentale des étudiants (COSAMe) survey was conducted among university students in France during the COVID-19 pandemic and found that although there was a slight decrease in anxiety, depression, and stress between the first lockdown (T1) and 1 month after it ended (T2), the prevalence of suicidal ideation had increased between these periods and 1 in 5 students had probable posttraumatic stress disorder (PTSD) at T2. These results emphasize the need to explore the long-term consequences of the COVID-19 pandemic. Objectives: To measure the prevalence of mental health symptoms among university students in France 15 months after the first lockdown (T3) and to identify factors associated with outcomes. Design, Setting, and Participants: This cross-sectional study reports data from the third measurement time of the repeated COSAMe survey, which took place from July 21 to August 31, 2021, through an online questionnaire sent to all French university students. Main Outcomes and Measures: The prevalence of suicidal thoughts, PTSD (PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition] [PCL-5]), stress (Perceived Stress Scale), anxiety (State-Trait Anxiety Inventory), and depression (Beck Depression Inventory) at T3 were gender- and degree-standardized and compared with prevalence rates at T1 and T2. Multivariable logistic regression analyses identified risk factors. Results: A total of 44 898 students completed the questionnaires. They were mainly women (31 728 [70.7%]), and the median (IQR) age was 19 (18-21) years. Standardized prevalence rates of stress, anxiety, depression, suicidal thoughts, and PTSD were 20.6% (95% CI, 20.2%-21.0%), 23.7% (95% CI, 23.3%-24.1%), 15.4% (95% CI, 15.1%-15.8%), 13.8% (95% CI, 13.5%-14.2%), and 29.8% (95% CI, 29.4%-30.2%), respectively. Compared with the decreased prevalence rates at T2, there was an increase at T3 for stress (2.5% increase), anxiety (13.9% increase), and depression (22.2% increase). The prevalence of suicidal ideation continued to increase from T1 (10.6%) to T3 (13.8%), and the prevalence of probable PTSD increased from 1 in 5 students to 1 in 3 students between T2 and T3. Female and nonbinary participants; participants without children and living in an urban area; and those with financial difficulties, a chronic condition, psychiatric history, COVID-19 history, social isolation, and low perceived quality of information received were at risk of all poor outcomes at T3 (eg, stress among women: adjusted OR, 2.18; 95% CI, 2.05-2.31; suicidal thoughts among nonbinary respondents: adjusted OR, 5.09; 95% CI, 4.32-5.99; anxiety among students with children: adjusted OR, 0.68; 95% CI, 0.56-0.81; depression among students living in a rural area: adjusted OR, 0.80; 95% CI, 0.75-0.85). Conclusions and Relevance: These results suggest severe long-lasting consequences associated with the pandemic on the mental health of students. Prevention and care access should be a priority.

Evolution in French University Students' Mental Health One Month After the First COVID-19 Related Quarantine: Results From the COSAMe Survey.

Introduction: The COVID-19 related quarantine had negative psychological effects among University students. Evidence from previous epidemics suggests that negative psychological effects of quarantine measures can last or even worsen after the quarantine lift. The objective of this study was to assess the evolution of students' mental health and to identify factors associated with mental health outcomes 1 month after the lift of the lockdown. Materials and Methods: This repeated cross-sectional study collected data during the first quarantine in France (T1, N = 68,891) and 1 month after its lift (T2, N = 22,540), through an online questionnaire sent to all French University students. Using cross-sectional data, we estimated prevalence rates of suicidal thoughts, severe anxiety (State-Trait Anxiety Inventory, State subscale), depression (Beck Depression Inventory), and stress (Perceived Stress Scale) at T1 and T2. Using longitudinal data (N = 6,346), we identified risk factors of poor mental health outcomes among sociodemographic characteristics, precariousness indicators, health-related data, information on the social environment, and media consumption, adjusting for baseline mental health status. Results: We found lower prevalence rates of severe stress (21.7%), anxiety (22.1%), and depression (13·9%) one month after the quarantine compared to the quarantine period (24.8%, 27.5%, and 16.1%, respectively). The prevalence rate of suicidal thoughts increased from 11.4 to 13.2%. Regardless of the existence of symptoms during quarantine, four factors were systematically associated with poor mental health outcomes 1 month after the quarantine was lifted: female gender, a low feeling of integration before the quarantine period, a low quality of social ties during the quarantine, and a history of psychiatric follow-up. Conclusions: The prevalence rates of severe stress, anxiety, and depression, although being lower than during the first lockdown, remained high after its lift. The prevalence rate of suicidal ideation increased. This stresses the need to consider the enduring psychological impact of the pandemic on students as a critical public health issue.

Psychiatric hospitalisations for people who are incarcerated, 2009-2019: An 11-year retrospective longitudinal study in France.

Background: Despite the poor mental health status of people who are incarcerated, few studies have examined the number of psychiatric hospitalisations in this population. Since 2010, France has progressively opened nine full-time inpatient psychiatric wards exclusively for people who are incarcerated, called "specially adapted hospital units" (unités hospitalières spécialement aménagées, UHSAs, 440 beds). This study aimed to present the annual rates of psychiatric hospitalisations and primary psychiatric diagnoses among people who are incarcerated in France from 2009 to 2019. Methods: We used discharge reports from the French national hospital database to describe longitudinal retrospective administrative data of psychiatric hospitalisations for people in jail and prison between 2009 and 2019, the age, sex, and principal diagnoses of these patients, the proportion of voluntary versus involuntary care, and the interactions between UHSAs and other facilities. Findings: Between Jan 1, 2009, and Dec 31, 2019, 32,228 (92.2% men, n = 29,721; 7.8% women, n = 2 507) incarcerated people were hospitalised for psychiatric care (64,481 stays). The main diagnoses were psychotic disorders (27.4%), personality disorders (23.2%), and stress-related disorders (20.2%). The annual number of incarcerated people hospitalised in psychiatric care increased from 3263 in 2009 to 4914 in 2019. The gradual increase in the activity of UHSAs (300 hospitalisations in 2010 versus 3252 in 2019) was not associated with a reduction in the rate of hospitalisation of incarcerated people in local psychiatric hospitals. Interpretation: The creation of psychiatric hospitals specifically dedicated to the prison population has not stopped the hospitalisation of people who are incarcerated at psychiatric hospitals. These findings suggest that access to psychiatric hospitalisation remains problematic for people who are incarcerated in France. Funding: There was no funding source for this study.

A Short Media Training Session Is Effective in Reinforcing Psychiatrists' Communication Skills About Suicide.

Because it has been associated with significant increases [through the Werther Effect (WE)] or decreases [through the Papageno Effect (PE)] of suicide rates, media coverage of suicide-related events is recognized as a prevention leverage. Unfortunately, the recommendations that the World Health Organization (WHO) has published to help journalists reporting on suicide remain poorly applied. The Mini Media Training (MMT) is a short media training session designed to increase psychiatrists' ability to communicate about suicide during interviews. We aimed at assessing the effect of the MMT on psychiatrists' ability to help journalists complying with the WHO recommendations. From June 2017 to December 2019, 173 physicians and residents in psychiatry were recruited during French national congresses. At baseline (T0) and 1 and 3 months later (T1), participants received the MMT, which consisted in a simulated interview where they we asked to answer a journalist about a mock suicide. Communication skills were measured with a score summing the number of delivered pieces of advice in relation to the WHO recommendations, with a maximum score of 33. A weighted score was also derived based on the degree of directivity needed for the participant to provide these items, again with a possible maximum of 33. A total of 132 psychiatrists participated in the study at T0 and T1. Both the weighted and unweighted score significantly increased from T0 to T1 (d = +2.08, p < 0.001, and d = +1.24, p < 0.001, respectively). Having a history of contacts with journalists, a short professional experience (<3 years) and prior knowledge of the WE, PE, and WHO recommendations were significantly associated with greater unweighted and weighted scores at baseline. The latter two variables also predicted greater T0-T1 improvement of the weighted score. These results suggest that the MMT could be effective for improving the ability of psychiatrists to guide journalists toward more responsible media coverage of suicide. As a short, easy to implement educational activity, the MMT could therefore be considered in association with other measures to help media professionals mitigating the WE and promoting the PE.

Mental health among medical, healthcare, and other university students during the first COVID-19 lockdown in France.

Background The COVID-19 pandemic has raised concerns regarding its psychological effect on university students, especially healthcare students. We aimed at assessing the risk of mental health problems according to the type of university studies, by adjusting for potential confounders. Methods We used data from the COSAMe study, a national cross-sectional survey including 69,054 French university students during the first quarantine. The mental health outcomes evaluated were suicidal thoughts, severe self-reported distress (as assessed by the Impact of Events Scale-Revised), stress (Perceived Stress Scale), anxiety (State-Trait Anxiety Inventory, State subscale), and depression (Beck Depression Inventory). Multivariable logistic regression analyzes were performed to test the association between the type of university studies (healthcare studies: medical and non-medical, and non-healthcare studies) and poor mental health outcomes, adjusted for sociodemographic characteristics, precariousness indicators, health-related data, quality of social relationships, and data about media consumption. Results Compared to non-healthcare students (N = 59,404), non-medical healthcare (N = 5,431) and medical students (N = 4,193) showed a lower risk of presenting at least one poor mental health outcome (adjusted OR [95%CI] = 0.86[0.81-0.92] and 0.87[0.81-0.93], respectively). Compared to non-healthcare students, medical students were at lower risk of suicidal thoughts (0.83[0.74-0.93]), severe self-reported distress (0.75[0.69-0.82]) and depression (0.83[0.75-0.92]). Non-medical healthcare students were at lower risk of severe selfreported distress (0.79[0.73-0.85]), stress (0.92[0.85-0.98]), depression (0.83[0.76-0.91]), and anxiety (0.86[0.80-0.92]). Limitations This is a large but not representative cross-sectional study, limited to the first confinement. Conclusions Being a healthcare student is a protective factor for mental health problems among confined students. Mediating factors still need to be explored.