[Suicidality in the perinatal period: Descriptive study on factors associated with suicidal ideation among women hospitalized in the perinatal period at the specialized hospital center]. / Suicidalité en période périnatale : quels sont les facteurs associés ?

OBJECTIVES: Suicide is the leading cause of maternal mortality in high-resource countries. The onset of suicidal ideation is a major risk factor for suicide attempts. Suicidality has a major impact on the mother-baby relationship and on child development. The main objective of the study was to identify factors associated with the occurrence of perinatal suicidal ideation in women requiring hospitalization. The secondary objectives of the study were to describe the socio-demographic and clinical characteristics of this specific population, to specify the follow-up procedures at hospital discharge and to develop a semi-directed interview framework for psychiatric evaluation of perinatal patients admitted to a psychiatric hospital in order to better identify those at risk of suicide and improve overall management, particularly in terms of referral to existing perinatal care services. METHODS: Descriptive and retrospective study carried out at the Specialized Hospital Center of women hospitalized in the perinatal period between 2014 and 2019. The inclusion criteria were: inpatient pregnant or postpartum within one year of delivery, 16 to 43 years. A keyword search was performed to retrieve the computerized records. All records matching the inclusion criteria were included. We studied the occurrence of suicidal ideation according to the main known clinical and socio-demographic risk factors. RESULTS: The sample included 25 pregnant patients and 57 post-partum patients. The presence of a psychiatric history increased the risk of suicidal ideation by 4.38 (P<0.03). The association between the occurrence of a stressful life event and the risk of suicidal ideation onset was close to significant (P<0.10). One third of the patients had been admitted for a reason related to suicidality. Less than one-third of the patients had been referred to existing perinatal services. CONCLUSIONS: Suicidality in the perinatal period has a major impact on the dyad as well as on the whole family. The search for suicidal ideas must be systematic during psychiatric interviews, a fortiori when a psychiatric history has been authenticated. Every patient hospitalized in adult psychiatry should be referred to specialized outpatient perinatal psychiatry services. Prevention involves raising awareness and training of all health professionals, networking, but also informing the general public.

[The psychiatric hospital discharge database (RIM-P): An essential tool for the surveillance of hospitalization after a suicide attempt]. / Le Recueil d'information médicalisé en psychiatrie (RIM-P) : un outil nécessaire pour la surveillance des hospitalisations suite à une tentative de suicide.

BACKGROUND: Epidemiological surveillance of suicide attempts is essential for monitoring indicator trends in the evaluation of prevention actions. As part of this surveillance, analysis of data from hospitalization for suicide attempts is particularly useful. METHODS: For the first time, data from two national hospital discharge databases, the "Programme de médicalisation des systèmes d'information en médecine, chirurgie, obstétrique" (PMSI-MCO) and the " Recueil d'information médicalisé en psychiatrie" (RIM-P) have been analyzed jointly. All patients aged 10 or more hospitalized in 2012 in medicine, surgery or psychiatry departments in metropolitan France have were included. RESULTS: Through 2012, 89,072 patients (62% females and 38% males) totalized 134,051 hospital stays following a suicide attempt, with 93.4% (n=83,196) in medicine or surgery wards and 32.1% (n=28,594) in psychiatry wards (solely or transferred after a stay in medicine or surgery). However, among the patients transferred to psychiatry after hospitalization in medicine or surgery for suicide attempt, 82.4% had no suicide attempt code noted at their discharge from psychiatry. One or more psychiatric diagnoses were observed in 75% of the patients hospitalized for suicide attempt. The most common diagnoses in men and in women were mood disorders (46%), particularly depression (42%; 44% in women and 38% in men). Mental disorders related to alcohol use were noted in more than a quarter of the patients, more frequently in men (37%) than in women (21%). Some diagnoses were rarely noted in medicine or surgery, such as anxiety disorders and disorders of adult personality and behavior. CONCLUSION: Improvement of the epidemiological surveillance of suicide attempts requires a systematic coding of hospitalizations in psychiatry as well as in medicine and surgery. Data from hospitalization in psychiatry yield a more precise identification of psychiatric co-morbidities associated with suicide attempts. The frequent presence of mental problems associated with suicide attempts should encourage clinicians to search for these symptoms systematically as soon as possible after admission of the patient.

[Factors associated with suicide attempts by sexual minorities: Results from the 2011 gay and lesbian survey]. / Facteurs associés aux tentatives de suicide chez les minorités sexuelles : résultats de l'enquête presse gays et lesbiennes 2011.

BACKGROUND: Since the 1990s, several studies have found higher rates of suicide attempts in homosexuals and bisexuals than in heterosexuals. The current challenge is to identify risk factors for targeting prevention. The aim of this paper was to determine, for the first time in France, the prevalence of suicide attempts over a 12-month period and associated factors in a population of men and women who self-identified as homosexuals or bisexuals. METHODS: A convenience sample cross-sectional survey was conducted in 2011 using an anonymous self-administered questionnaire made available in the gay press, and Internet sites targeting the gay or lesbian community. Among the persons completing the questionnaire, 10,100 men and 2963 women residing in France answered the questions on suicide attempts. The factors associated with suicide attempts during the previous 12 months were identified by logistic regression. RESULTS: Lifetime prevalence for suicide attempts was 16% in men and 18% in women; 12-month prevalence was 1.6% in men and 1.9% in women. Factors independently associated with suicide attempts in the past 12 months in men and women were lack of occupational activity, victim of sexual abuse, termination of a long-term relationship, excessive alcohol consumption in the past 12 months, depression, and in addition, in men, living in a small locality, victim of verbal or physical aggression and use of anxiolytics. CONCLUSION: According to our results, the fight against homophobia is an important element for the prevention of suicide attempts among homosexual and bisexual men. Indeed, in addition to traditional risk factors for suicide attempt, a significant association was also found with homophobic aggression in the past year.

Body-weight perception and related preoccupations in a large national sample of adolescents.

OBJECTIVES: This study aimed to investigate the association between body-weight (BW) perception, weight preoccupation and behaviour, including weight control practices and compulsive over-eating episodes, across gender and actual BW classes. DESIGN: This study used a cross-sectional observational study. PARTICIPANTS: A large, nationally representative sample of 6404 ninth-grade French adolescents was randomly selected from schools throughout France. METHODS: Weight and height were measured, and BW preoccupation, BW control practices and compulsive over-eating were self-reported using standardized questionnaires. RESULTS: Nearly one-third of adolescents misperceived their BW. Misperception was more frequent among girls than boys (42.2% vs. 27.3%, P < 0.01). Underestimation of BW among overweight adolescents, like BW overestimation among underweight adolescents, was associated with less preoccupation with weight and fewer weight control practices than accurate perception of BW. Normal weight adolescents who overestimated their BW were more likely to declare weight preoccupations (ORa = 8.66 [6.67-11.25]), dieting (ORa = 4.81 [3.68-6.27]) and recurrent compulsive over-eating episodes (ORa = 2.36 [1.72-3.23]) compared with their counterparts who correctly estimated their BW. CONCLUSION: Our study underlines the role of these associations in each category of actual BW (underweight, normal weight and overweight) in a large national sample.

[Sources of information on suicide attempts in the Nord - Pas-de-Calais (France). Contributions and limitations]. / Les sources d'information sur les tentatives de suicide dans le Nord - Pas-de-Calais. Apports et limites.

BACKGROUND: There are very few permanent indicators of mental health in France; suicidal behavior is often only understood on the basis of deaths by suicide. METHOD: The epidemiological interest and methodological limits of four medico-administrative databases from which data on suicide attempts can be extracted have been the subject of a study in the Nord - Pas-de-Calais Region of France: telephone calls for emergency medical assistance after suicide attempt (2009 to 2011), admissions in emergency services with a diagnosis of suicide attempt (2012), medical-surgical hospital admissions as a result of suicide attempt (2009 to 2011), and psychiatric admissions with a diagnosis of suicide attempt (2011). RESULTS: Usable data were provided by one of two emergency medical assistance units, five of thirty emergency departments and all medical-surgical and psychiatric units; in data from the latter two sources, a unique anonymous identifier gave individual statistics, while the first two covered only suicide attempts. In 2011, the number of suicide attempt calls per 100,000 inhabitants was 304, whereas the number of hospitalisations with this diagnosis was 275; rates are highest in men between 20 and 49 years of age, and in women below 20 years of age and between 40 and 49. Sources are seen to be very homogeneous with regards to the average age at which suicide took place (between 37.8 and 38.5 years, depending on the source), and to the sex (55.0% to 57.6% of women). In 2011, the number of patients with a diagnosis of suicide attempt treated in psychiatry is 2.6 times lower than the number hospitalised for suicide attempt in medical-surgical units (3563 vs 9327). CONCLUSION: Permanent gathering of data, and the large volume of data recorded, should encourage the use of these databases in the definition and assessment of mental health policy: an increased contribution from emergency call centers and emergency services, and the coding of the suicidal nature of intoxications by a few clearly under-declaring units, must however be achieved in order to improve this source of information.

[Estimation of prevalence of depressive episodes in French adolescents]. / Estimation de la prévalence de l'épisode dépressif chez l'adolescent en France.

BACKGROUND: Although the diagnosis and treatment of depressive disorders are important public health issues in adolescents, epidemiological data in this population are scarce. OBJECTIVE: The aims of this study were to estimate the 12-month prevalence rates of depressive disorders among ninth grade pupils in French schools, and to identify the sociodemographic correlates. METHODS: The data were collected through a national cross-sectional study conducted among ninth grade pupils in France in 2003-2004. Depressive disorders were assessed using a self-administered questionnaire derived from the standardised Composite International Diagnosis Interview-Short Form (CIDI-SF). RESULTS: A total of 7110 teenagers (mean age 15.1 years) were included. Of these, 9.6% (95% CI 8.6-10.6) reported symptoms corresponding to at least one major depressive episode (MDE) over the past 12 months. Three correlates were independently associated with a higher prevalence of 12-month MDE: being a female (adjusted odds ratio 3.0; 95% CI 2.4-3.8), being greater or equal to 16 years old (aOR=2.2; 95% CI 1.0-5.0) and living alone with one's mother (aOR=1.7; 95% CI 1.3-2.4) or with one's mother and her spouse (aORa=1.4; 95% CI 1.0-2.1). CONCLUSION: The high prevalence of depressive disorders in French adolescents is thoroughly discussed. The needs for developing mental health surveillance, comprehensive prevention and care programs for this population are crucial.

[Epidemiology of insomnia in France]. / Épidémiologie de l'insomnie en France : état des lieux.

BACKGROUND: Sleep is usually considered as a factor for good health and personal equilibrium. However, the epidemiology of insomnia, which is the most frequent of sleep disorders, is still unknown in France. METHODS: All epidemiological studies concerning the prevalence of insomnia and its associated factors carried out in France and published between 1980 and 2009 have been extracted from Medline. Subsequently, a research of reports not indexed in Medline has been carried out in the national Public health Database. We also sought the presence of questions concerning sleep disorders in questionnaires and reports from health surveys in the general population. RESULTS: In the general population, six specific studies had been undertaken between 1987 and 2003 while there had been eight occupational studies between 1980 and 2000. Surveys in schoolchildren and in students focused on the daytime tiredness due to lack of sleep but few studies investigated insomnia in children and teenagers. Methodological differences as well as the heterogeneity in the definition of the disorders yielded very diverse prevalences. Between 30 and 50% of adults in France declared the presence of at least one sleep disorder while the prevalence of insomnia using the DSM-IV criteria concerned between 15 and 20% of the population. Women reported sleep disorders more frequently than men. Sleep disorders were associated with work absenteeism. Comorbidity with anxiety and depressive disorders has also been highlighted in several studies. CONCLUSION: Surveillance of sleep disorders appears as an important public health issue requiring prior standardization of questionnaires and survey methods.

[Factors associated with cervical cancer screening in women covered by national health insurance]. / Les facteurs associés au dépistage des cancers du col utérin dans une population mutualiste.

BACKGROUND: The aims of our study were to examine the factors associated with cervical screening in women whose tests are supported by a national health insurance scheme, the Mutuelle Générale de l'Education Nationale. METHODS: A self-administered postal questionnaire was sent to a random sample of 10,000 adults aged 20 to 60 years old living in France and insured with the Mutuelle Générale de l'Education Nationale. Response rate was 66.5% (N=6,518). RESULTS: Of the 3,741 women aged 20 to 60 years old, 88.5% have had at least one cervical smear. Mean age for the first cervical smear was 29.3 years (95% CI: 29.0-29.6). Preventive practices (mammogram, cervical smear and fecal occult-blood testing) were strongly related. The predictive factors for cervical smear during the past three years included: age between 30 and 49 years, marital status (married, separated or divorced), the socioeconomic status (unskilled workers reported cervical smears less often than women from other socioeconomic status). Consulting a gynaecologist in the past twelve months increased 9-fold the probability of having a cervical smear and 2-fold when consulting a general practitioner compared to women who consulted neither a gynecologist nor a general practitioner. CONCLUSIONS: In a population whose tests were supported by a national health scheme, the socioeconomic status was one of the determinants of Pap smear.

A French study of the Dominic Interactive.

INTRODUCTION: The Dominic Interactive was developed in North America to assess a child's perception of her/his own symptoms, which is critical to balance parents' and school professionals' perception. It is a computerized, DSM-IV-based pictorial questionnaire akin to a video game, for children aged 6-11. A strengths and competencies scale displays positive situations. Most children complete the Dominic Interactive 90 situations within 10-15 min. OBJECTIVE: Because of the cultural differences between North American and French children, a study of the appropriateness of the instrument to assess French children was required. METHODS: The CD-ROM-based Dominic Interactive was completed by 253 community children, and by 150 children from outpatient clinics in four French cities. The latter also received clinical diagnoses. Prevalence estimates yielded by the Dominic Interactive in the general population and referred children, relationships between prevalence estimates based on the Dominic Interactive and clinical judgments, and differences between Dominic Interactive scores in sub-samples of children with and without a clinical diagnosis were studied. RESULTS: Significant differences between clinically referred and non-referred children were found for every diagnosis, and between Dominic Interactive scores of referred children with and without a clinical diagnosis with the exception of oppositional disorder. Parental acceptability of the instrument was never a problem, children like it, and clinicians' comments were positive. DISCUSSION: Reference and clinical judgment both indicate that the Dominic Interactive is appropriate to assess child mental health in France. Clinical judgment discrepancies between sites and small numbers are the limitations of this study. CONCLUSION: The instrument performed well in the French context. The potential advantages of using the Dominic Interactive (children enjoy the activity, parents approve of it, it is relatively cost-effective, etc.) suggest its applicability in other settings.