The use of social media after bereavement by suicide: results from a French online survey.

BACKGROUND: According to recent research, the Internet and social media are shaping and changing how we die and mourn. However, the use of social media after bereavement by suicide remains poorly understood. Thus, emerging research is needed to better assess the role that social media can play after bereavement by suicide. The objective of our study was to evaluate the use of social media in French people bereaved by suicide and to assess their expectations toward social media. METHOD: We conducted a national cross-sectional online survey including French people bereaved by suicide assessing their use of social media after the death of their relative. All adults bereaved by suicide were eligible to participate in the study. An online 26-item questionnaire collected sociodemographic and loss-related characteristics and evaluated four dimensions: (1) the use of social media in daily life, (2) the perceived needs regarding suicide bereavement, (3) the use of social media associated with the suicide loss, and (4) the expectations regarding the development of an online resource for people bereaved by suicide and proposals regarding the development of such a resource. RESULTS: Among 401 participants, 61.6% reported using social media after the death of their relative by suicide, especially those recently bereaved, those receiving counseling and bereaved parents. The participants mainly used social media to reach peers bereaved by suicide and to memorialize, while they expected social media to help them finding information on suicide and accessing bereaved peers. Younger participants were more prone to use social media to memorialize, while bereaved partners and those bereaved by the suicide of a parent were less prone to use them with such aim. DISCUSSION: A large part of people bereaved by suicide use social media for their grief process, mainly to contact peers bereaved by suicide and to memorialize their loved one. According to or results, social media contributes to contemporary grief processes after suicide bereavement and can be seen as putative means to improve the well-being of people bereaved by suicide.

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.

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.

The Needs, Use and Expectations of People Bereaved by Suicide Regarding Online Resources: An Online Survey.

BACKGROUND: Online resources constitute a new and effective way to obtain support or information during bereavement processes. However, little is known about the needs, use and expectations of people bereaved by suicide regarding online resources. METHOD: The objective of our national cross-sectional online survey was to collect the use, needs and expectations of people bereaved by suicide regarding online resources. The data were collected from July to October 2021 through a 26-item online questionnaire hosted on the website LimeSurvey. RESULTS: A total of 401 respondents fully completed the questionnaire. Their mean age was 45.7. The majority of participants were women bereaved by the suicide of their child or partner. Half of the participants were bereaved for less than 3 years and benefited from counselling during their bereavement process. Three-quarters of the participants used the Internet for their bereavement process, mainly to obtain information on suicide bereavement and suicide prevention and to access testimonies of other people bereaved by suicide. Three-quarters of the participants found that available online resources for people bereaved by suicide are insufficient and expected a dedicated web platform to be developed. Finding information on suicide bereavement and on suicide prevention, discussing with a mental health professional and accessing testimonies of other people bereaved by suicide were expected by a majority of the participants regarding the future platform. Receiving counselling and being bereaved by the death of a child were the most important factors in explaining patterns of use and expectations regarding online resources. DISCUSSION: Our results offer precise insights into the needs, use and expectations of people bereaved by suicide regarding online resources. The development of web platforms offering access to reliable information on suicide bereavement and on suicide prevention to peers bereaved by suicide and help to seek counselling are urgently needed.

Intrusive experiences in posttraumatic stress disorder: Treatment response induces changes in the directed functional connectivity of the anterior insula.

BACKGROUND: One of the core features of posttraumatic stress disorder (PTSD) is re-experiencing trauma. The anterior insula (AI) has been proposed to play a crucial role in these intrusive experiences. However, the dynamic function of the AI in re-experiencing trauma and its putative modulation by effective therapy need to be specified. METHODS: Thirty PTSD patients were enrolled and exposed to traumatic memory reactivation therapy. Resting-state functional magnetic resonance imaging (fMRI) scans were acquired before and after treatment. To explore AI-directed influences over the rest of the brain, we referred to a mixed model using pre-/posttreatment Granger causality analysis seeded on the AI as a within-subject factor and treatment response as a between-subject factor. To further identify correlates of re-experiencing trauma, we investigated how intrusive severity affected (i) causality maps and (ii) the spatial stability of other intrinsic brain networks. RESULTS: We observed changes in AI-directed functional connectivity patterns in PTSD patients. Many within- and between-network causal paths were found to be less influenced by the AI after effective therapy. Insular influences were found to be positively correlated with re-experiencing symptoms, while they were linked with a stronger default mode network (DMN) and more unstable central executive network (CEN) connectivity. CONCLUSION: We showed that directed changes in AI signaling to the DMN and CEN at rest may underlie the degree of re-experiencing symptoms in PTSD. A positive response to treatment further induced changes in network-to-network anticorrelated patterns. Such findings may guide targeted neuromodulation strategies in PTSD patients not suitably improved by conventional treatment.

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.

Development of an Online Resource for People Bereaved by Suicide: A Mixed-Method User-Centered Study Protocol.

Introduction: Suicide bereavement is known to be highly distressing and is frequently associated with mental health problems. Despite high-level of need regarding mental and physical health, people bereaved by suicide display low level of help-seeking and perceived support in the aftermath of the loss. The lack of accessibility and reliability of face-to-face counseling resources is notably reported by suicide survivors. Online resources can enhance early access to help and support for people bereaved by suicide. The primary objective of the study is to design and implement an innovative and adaptive online resource for people bereaved by suicide according to their needs and expectation regarding online solutions dedicated to suicide bereavement. Methods: The ESPOIR2S study is a mixed-method user-centered study. ESPOIR2S seeks to build the resource from the perspectives and needs of both people bereaved by suicide and professionals or volunteers working in the field of postvention. The Information System Research (ISR) Framework is used to guide the design of the study through a 3-step research cycle. The structure of the ESPOIR2S study relies on a simultaneous collection of qualitative and quantitative data which will be collected and analyzed during (a) the Relevance cycle through an online questionnaire and focus groups; (b) the Design cycle through focus groups; and (c) and the Rigor cycle through an online questionnaire and semi-structured interviews. The user-centeredness will be ensured by the active participation of people bereaved by suicide, members of associations for bereaved people and professionals of postvention. Discussion: The mixed-method and user-centered design of the ESPOIR2S study will offer an in-depth collection of the needs and expectation of suicide survivors regarding online resources. Through the implementation of an adaptive online solution, we aim to enhance the access to help and support for suicide survivors which are highly correlated with well-being and recovery.

Factors Associated With Mental Health Disorders Among University Students in France Confined During the COVID-19 Pandemic.

Importance: The coronavirus disease 2019 (COVID-19) pandemic and quarantine measures have raised concerns regarding their psychological effects on populations. Among the general population, university students appear to be particularly susceptible to experiencing mental health problems. Objectives: To measure the prevalence of self-reported mental health symptoms, to identify associated factors, and to assess care seeking among university students who experienced the COVID-19 quarantine in France. Design, Setting, and Participants: This survey study collected data from April 17 to May 4, 2020, from 69 054 students living in France during the COVID-19 quarantine. All French universities were asked to send an email to their students asking them to complete an online questionnaire. The targeted population was approximately 1 600 000 students. Exposure: Living in France during the COVID-19 quarantine. Main Outcomes and Measures: The rates of self-reported suicidal thoughts, severe distress, stress, anxiety, and depression were assessed using the 22-item Impact of Events Scale-Revised, the 10-item Perceived Stress Scale, the 20-item State-Trait Anxiety Inventory (State subscale), and the 13-item Beck Depression Inventory, respectively. Covariates were sociodemographic characteristics, precariousness indicators (ie, loss of income or poor quality housing), health-related data, information on the social environment, and media consumption. Data pertaining to care seeking were also collected. Multivariable logistic regression analyses were performed to identify risk factors. Results: A total of 69 054 students completed the survey (response rate, 4.3%). The median (interquartile range) age was 20 (18-22) years. The sample was mainly composed of women (50 251 [72.8%]) and first-year students (32 424 [47.0%]). The prevalence of suicidal thoughts, severe distress, high level of perceived stress, severe depression, and high level of anxiety were 11.4% (7891 students), 22.4% (15 463 students), 24.7% (17 093 students), 16.1% (11 133 students), and 27.5% (18 970 students), respectively, with 29 564 students (42.8%) reporting at least 1 outcome, among whom 3675 (12.4%) reported seeing a health professional. Among risk factors identified, reporting at least 1 mental health outcome was associated with female gender (odds ratio [OR], 2.10; 95% CI, 2.02-2.19; P < .001) or nonbinary gender (OR, 3.57; 95% CI, 2.99-4.27; P < .001), precariousness (loss of income: OR, 1.28; 95% CI, 1.22-1.33; P < .001; low-quality housing: OR, 2.30; 95% CI, 2.06-2.57; P < .001), history of psychiatric follow-up (OR, 3.28; 95% CI, 3.09-3.48; P < .001), symptoms compatible with COVID-19 (OR, 1.55; 95% CI, 1.49-1.61; P < .001), social isolation (weak sense of integration: OR, 3.63; 95% CI, 3.35-3.92; P < .001; low quality of social relations: OR, 2.62; 95% CI, 2.49-2.75; P < .001), and low quality of the information received (OR, 1.56; 95% CI, 1.49-1.64; P < .001). Conclusions and Relevance: The results of this survey study suggest a high prevalence of mental health issues among students who experienced quarantine, underlining the need to reinforce prevention, surveillance, and access to care.

Attentional bias towards negative stimuli in healthy individuals and the effects of trait anxiety.

This study aimed to investigate the time course of attentional bias for negative information in healthy individuals and to assess the associated influence of trait anxiety. Thirty-eight healthy volunteers performed an emotional dot-probe task with pairs of negative and neutral scenes, presented for either 1 or 2 s and followed by a target placed at the previous location of either negative or neutral stimulus. Analyses included eye movements during the presentation of the scenes and response times associated with target localization. In a second step, analyses focused on the influence of trait anxiety. While there was no significant difference at the behavioral level, the eye-tracking data revealed that negative information held longer attention than neutral stimuli once fixated. This initial maintenance bias towards negative pictures then increased with increasing trait anxiety. However, at later processing stages, only individuals with the highest trait anxiety appeared to fixate longer on negative pictures than neutral pictures, individuals with low trait anxiety showing the opposite pattern. This study provides novel evidence that healthy individuals display an attentional maintenance bias towards negative stimuli, which is associated with trait anxiety.

Leveraging the Web and Social Media to Promote Access to Care Among Suicidal Individuals.

After two decades of exponential development, the Internet has become an inseparable component of suicide prevention matters. More specifically, social media has turned out to be a privileged space for suicidal individuals to express their distress and seek support. Although this tendency carries with it specific risks and challenges, it creates unprecedented opportunities to face the challenges of help seeking and access to care. In this paper, we present the empirical, technological, and theoretical evidence supporting the implementation of a digitally augmented prevention policy that would increase its reach. Congruent to the clinical observations and theories on the help-seeking process, we argue that social media can help undertake three main functions of increasing proactivity to bring suffering Web users to care. The gateway function relates to the properties of social media interactions to leverage help-seeking barriers and enable ambivalent individuals to access the mental healthcare system. The communication outreach function aims to broadcast pro-help-seeking messages, while drawing on the functional structure of the social media network to increase its audience. The intervention outreach function consists in using machine learning algorithms to detect social media users with the highest risk of suicidal behaviors and give them a chance to overcome their dysfunctional reluctance to access help. We propose to combine these three functions into a single coherent operational model. This would involve the joint actions of a communication and intervention team on social networks, working in close collaboration with conventional mental health professionals, emergency service, and community resources.

Dissociation of explicit and implicit responses during a change blindness task in schizophrenia.

BACKGROUND: Patients with schizophrenia are abnormally disturbed by information onsets, which may result in a disadvantage in filtering relevant information. The paradigm of change blindness offers the interesting possibility of studying sensitivity to the sudden irruption of visual information with ecological stimuli in schizophrenia. An increased attentional capture by the irruption of visual information would suggest better performance in patients than in healthy controls. This approach has the advantage of circumventing a non-specific general attentional deficit in schizophrenia. METHODS: Sixteen patients with schizophrenia and 16 healthy controls were asked to detect changes in 99 scenes with 0, 1 or 3 changes. We measured the participants' speed and accuracy in explicitly reporting the changes via motor responses and their capacity to implicitly detect changes via eye movements. RESULTS: Although the controls were faster and more efficient in explicitly reporting changes, the patients' eyes shifted more quickly toward the changes. Regardless of the group, increasing the magnitude of change improved the performance. CONCLUSIONS: The better capacity of the patients to shift their eyes toward changes confirmed the capture by the sudden irruption of visual information in schizophrenia while avoiding the effects of general attentional deficits. However, the striking dissociation between this implicit response and the capacity to explicitly report changes could be interpreted as a deficit in access to conscious perception.

[Hypersexuality in Parkinson's disease. Advantage of the presence of the entourage for medical assessment]. / Prise en charge de l'hypersexualité dans la maladie de Parkinson. Intérêt de la présence de l'entourage lors de l'évaluation médicale.

OBJECTIVE: To improve the management of hypersexuality caused by antiparkinsonian treatment and its psychopathological implications in patients with Parkinson's disease (PD). If hypersexuality is a classic form of impulse control disorder (ICD) observed in PD, its rate is certainly underestimated. METHODS: We have proposed to meet patients with Parkinson's disease, referred by the neurology department of Lille University Hospital, for detection or suspicion of hypersexuality, in the presence of their spouse. The session consisted of an interview conducted by our psychiatry team. This evaluation was conducted between January 1 and August 31, 2011. Nine patients were referred to our service, 7 agreed to meet us, 6 of them with their spouse. RESULTS: An interview in the presence of the spouse has improved hypersexuality screening and information given to the patient and his close contacts regarding the side effects of treatment, and particularly the occurrence of hypersexuality. It also highlighted the various expressions of these behavioral changes, often minimized by patients, as spouses had great difficulty dealing with this. It helped them to improve verbal communication and, therefore, to be more informative concerning sexual behavior changes in connection with the treatment and its management. Finally, it has enabled improved support for secondary consequences of this impulse control disorder, such as guilt, jealousy or shame. Our interest has also focused on the impact of this hypersexuality on patients' families. Among the six sets partners, four had symptoms requiring specific psychiatric care: depression, suicidal intention or post-traumatic stress disorder. PERSPECTIVE: Hypersexuality seems underestimated in patients receiving antiparkinsonian treatment. This underestimation is probably linked to some defense mechanisms such as denial or minimization, but also to the feelings generated by these behavioral problems, such as shame or guilt. On the other hand, some patients do not experience stress related behavioral changes (even though the family may complain). Systematic partner interview could be a solution to improving this screening.