Suicide and All-Cause Mortality Within 1 Year After a Suicide Attempt in the VigilanS Cohort.

Objective: Obtaining better knowledge on the outcomes of patients who attempt suicide is crucial for suicide prevention. The aim of our study was to determine the causes of death 1 year after a suicide attempt (SA) in the VigilanS program, mortality rates, and risk factors associated with any cause of death and suicide.Methods: A prospective cohort of 7,406 people who had attempted suicide between January 1, 2017, and December 31, 2018, was included in the study. The vital status of each participant was sought, and the cause of death was established through a phone call to their general practitioner or psychiatrist. Second, the relationship between sociodemographic and clinical factors and death by suicide within 1 year of an SA was assessed using a multivariable Cox model.Results: At 1 year, 125 (1.7%) participants had died, 77 of whom died by suicide. Half of the deaths occurred within the first 4 months after an SA. Hanging (20.3%; 24/125) and self-poisoning (19.5%; 23/125) were the methods the most often used for suicide. We demonstrated that male sex (HR = 1.79 [1.13-2.82], P = .01) and being 45 years of age or older (between 45 and 64 years old, HR = 2.08 [1.21-3.56], P < .01; 65 years or older, HR = 5.36 [2.72-10.54], P < .01) were associated with a higher risk of death by suicide 1 year after an SA and that being younger than 25 years was associated with a lower risk (HR = 0.22 [0.07-0.76], P = .02).Conclusions: One out of 100 people who attempted suicide died by suicide within 1 year after an SA. Greater vigilance is required in the first months following an SA, especially for males older than 45 years.Trial Registration: ClinicalTrials.gov identifier: NCT03134885.

Automated Monitoring Reports of the Activity of the French National Professional Suicide Prevention Helpline.

The French Professional Suicidal Helpline 3114 was launched on October 1st, 2021. The objective of this study was to implement automated reports of the activity of the suicidal helpline. We developed automated reports and presentations with Rmarkdown. Two formats were developed, national reports to present for a funding agency and regional reports for each calling center. These reports fulfill a critical need to adjust call distribution patterns, identify problems, adjust communication across the territory and ensure that 3114 is delivering the service it is supposed to provide.

The association between reattempted suicide and incoming calls to the brief contact intervention service, VigilanS: a study of the clinical profile of callers.

BACKGROUND: Suicide is a major health problem globally. As attempted suicide is a major risk factor for suicide, specific prevention strategies have been designed for use thereafter. An example is the brief contact intervention (BCI). In this regard, France employs a composite BCI, VigilanS, which utilizes three types of contact: phone calls, postcards and a 'who to contact in a crisis' card. Previous studies have found that this system is effective at preventing suicide. Nevertheless, VigilanS was not effective in the same way for all the patients included. This observation raises the question of specific adaptation during follow-up for populations that were less receptive to the service. In consideration of this issue, we identified one study which found that incoming calls to the service were linked with a higher risk of suicide reattempts. However, this study did not document the profiles of the patients who made these calls. Better understanding of why this population is more at risk is important in terms of identifying factors that could be targeted to improve follow-up. This research therefore aims to bring together such data. METHODS: We performed a retrospective analysis of 579 patients referred to VigilanS by Toulouse University Hospital (France). We examined the sociodemographics, clinical characteristics, and follow-ups in place and compared the patients who made incoming calls to the service versus those who did not. Subsequently, we conducted a regression analysis using the significantly associated element of patients calling VigilanS. Then, in order to better understand this association, we analyzed the factors, including such calls, that were linked to the risk of suicide reattempts. RESULTS: We found that 22% of the patients in our sample called the VigilanS service. These individuals: were older, at 41.4 years versus 37.9 years for the non-callers; were more likely to have a borderline personality disorder (BPD) diagnosis (28.9% versus 19.3%); and had a history of suicide attempts (71.9% versus 54.6%). Our analysis confirmed that incoming calls to VigilanS (OR = 2.9) were associated with reattempted suicide, as were BPD (OR = 1.8) and a history of suicide attempts (OR = 1.7). CONCLUSION: There was a high risk that the patients calling VigilanS would make another suicide attempt. However, this association was present regardless of the clinical profile. We postulate that this link between incoming calls and reattempted suicide may arise because this form of contact is, in fact, a way in which patients signal that a further attempt will be made.

Loss to follow-up in a population-wide brief contact intervention to prevent suicide attempts - The VigilanS program, France.

BACKGROUND: Brief Contact Interventions (BCIs) after a suicide attempt (SA) are an important element of prevention against SA and suicide. VigilanS generalizes to a whole French region a BCI combining resource cards, telephone calls and sending postcards, according to a predefined algorithm. However, a major obstacle to such real-life intervention is the loss of contact during follow-up. Here, we analyze the occurrence of loss of follow-up (LFU) and compare characteristics of patients LFU with follow-up completers. METHODS: The study concerned patients included in VigilanS over the period from 1st January 2015 to 31 December 2018, with an end of follow-up on 1st July 2019. We performed a series of descriptive analysis and logistic regressions. The outcome was the loss to follow-up, relative to the 6th month call marking the end of the follow-up; the predictive variables were the characteristics of the patient at entry and during follow-up. Age and sex were considered as adjustment variables. RESULTS: 11879 inclusions occurred during the study period, corresponding to 10666 different patients. The mean age was 40.6 ± 15 years. More than a third were non-first suicide attempters (46.6%) and the most frequent means of suicide was by voluntary drug intoxication (83.2%). 8335 patients were LFU. After simple and multiple regression, a significant relationship with loss to follow-up was identified among non-first suicide attempters, alcohol consumers, patients having no companion on arrival at the emergency room, patients who didn't make or receive any calls. An increased stay in hospital after a SA was a protective factor against loss of follow-up. CONCLUSION: A majority of patients were lost to follow-up by the expected surveillance time of 6 months. Characteristics of lost patients will help focusing efforts to improve retention in the VigilanS program and might give insights for BCI implemented elsewhere.

Suicide reattempt in a population-wide brief contact intervention to prevent suicide attempts: The VigilanS program, France.

OBJECTIVE: Among the postcrisis suicide prevention programmes, brief contact interventions (BCIs) have been proven to be efficient. VigilanS generalizes to a whole French region a BCI combining resource cards, telephone calls, and sending postcards, according to a predefined algorithm. However, a major problem in suicide prevention is the suicide reattempt, which can lead to final suicide. Here, we analyze the suicide reattempt in VigilanS. METHODS: The study concerned patients included in VigilanS over the period from January 1, 2015 to December 31, 2018, with an end of follow-up on July 1, 2019. We performed a series of descriptive analyses, survival curves, and regressions. The outcome was the suicide reattempt, and the predictive variables were the characteristics of the patient at entry and during follow-up in VigilanS. Age and sex were considered as adjustment variables. RESULTS: A total of 11,879 inclusions occurred during the study period, corresponding to 10,666 different patients, among which 905 reattempted suicide. More than half were primary suicide attempters (53.4%). A significant relationship with suicide reattempt was identified for the following characteristics: being a non-primary suicide attempter, having attempted suicide by voluntary drug intoxication and phlebotomy, alcohol consumption among primary suicide attempters, and having no companion at the emergency room visit among non-primary suicide attempters. Hanging (as suicide method), having made no call to VigilanS were protective factors. CONCLUSION: This study provides us with a valuable insight into the profiles of patients repeating a suicide attempts, which is important for suicide prevention in general.

[Preventing recidivism: as easy as a phone call?] / Prévenir la récidive : simple comme un coup de fil ?

Created in 2015 in the Nord-Pas-de-Calais region by Professor Guillaume Vaiva, the VigilanS system for maintaining a post-hospital link with suicidal patients is the result of a long process of maturation. Its effectiveness in reducing recidivism and suicidal mortality has led the Ministry of Health and Solidarity to request its extension to the entire country by 2022. Supported by a new type of caregiving, it can only be legitimate if it is integrated into the various measures of the global and multimodal suicide prevention policy.

Prevalence of and factors associated with post-traumatic stress disorder among French university students 1 month after the COVID-19 lockdown.

The COVID-19 pandemic and quarantine measures have sparked debate regarding their traumatic nature. This cross-sectional study reports the prevalence rate of probable post-traumatic stress syndrome (PTSD) and associated factors among French university students. A total of 22,883 students completed the online questionnaire. The prevalence rate of probable PTSD, assessed using the PTSD Checklist for DSM-5, was 19.5% [19.0-20.0]. Female (1.32 [1.21-1.45]) or non-binary gender (1.76 [1.35-2.31]), exposure to a non-COVID-19-related traumatic event (3.37 [3.08-3.67]), having lived through quarantine alone (1.22 [1.09-1.37]), poor quality of social ties (2.38 [2.15-2.62]), loss of income (1.20 [1.09-1.31]), poor quality housing (1.90 [1.59-2.26]), low-quality of the information received (1.50 [1.35-1.66]) and a high level of exposure to COVID-19 (from 1.38 [1.24-1.54] to 10.82 [2.33-76.57] depending on the score) were associated with PTSD. Quarantine was considered potentially traumatic by 78.8% of the students with probable PTSD. These findings suggest the pandemic context and lockdown measures could have post-traumatic consequences, stimulating debate on the nosography of PTSD.

[Management of suicidal crises and suicidal individuals]. / Prises en charge des crises suicidaires et des suicidants.

Knowing how to assess the suicidal risk of people in crisis, knowing how to orient them, welcome them, treat them and look after them are the keys to these multidisciplinary health care.

[Preventing suicidal crisis and suicide]. / Prévenir la crise suicidaire et le suicide.

Suicide is not the inevitable outcome of a suicidal crisis. The people concerned are most often sensitive to preventive actions, which can prevent them from committing self-destructive acts. Preventing the suicidal crisis and suicide requires the involvement of healthcare professionals. It is also everyone's business.

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.

[Suicide prevention after a suicide attempt: how to stay in touch?] / Comment prévenir la récidive après une tentative de suicide : garder le lien.

Suicide prevention after a suicide attempt: how to stay in touch? Attempted suicide is a major risk factor of further re-attempts and death. Self-harm behaviors are related to multiple causes, explaining why it is ineffective to have a single and simple strategy to offer after the clinical assessment in reducing morbidity and mortality. Furthermore, treatment adherence is known to be especially poor, in a context where social connection seems compromised and source of pain. Effective interventions can be divided into two categories: intensive intervention programs (care at home, supported by a series of brief psychotherapy interventions) and, case management programs that rely on a "stay in contact" dimension(letters, telephone, sms, mail, etc.). A prevention algorithm was further proposed to routine care in 2015, in the northern departments of France, Nord et Pas-de-Calais (4.3 million people), taking the name of VigilanS. The inclusion consists in sending a form for every patient assessed after a suicide attempt in the two departments to the medical staff of VigilanS, in order to provide information about the patient and the context of his suicide attempt. The algorithm consist in giving crisis card to all the patients; an information letter, explaining the aim of the monitoring is also given to the patient, and to his general practitioner. The calling staff is composed of4 nurses and 4 psychologists, all trained in suicidal crisis management. They use a phone platform located in the Emergency Medical Assistance Service (SAMU) of the Nord department, and manage the incoming calls from the patients, plus the outgoing calls towards the patients, their relatives and their medical contacts. A set of 4 postcards (1 per month) can be sent if needed incase of an inconclusive or a failed phone call. Built on a monitoring philosophy, VigilanS has further developd a real crisis case management dimension, requiring enough time to insure an effective medical supervision, and strong networking abilities. A specific time is also needed to take care of all the technical aspects of the organization. We measured the evolution of the number of suicide attempts before and after implantation of VigilanS: we found an acceleration of the reduction of stay for suicide attempt in Nord et Pas-de-Calais after 2014(-16% instead of -6%), instead of the two Picardy departments the most comparable show a degradation of the phenomenon (+13%). The system is currently being deployed across France.

Comment prévenir la récidive après une tentative de suicide : garder le lien. Les tentatives de suicide constituent un facteur de risque majeur de récidives et de décès. Les comportements suicidaires sont poly factoriels et rendent inefficace une stratégie unique de prévention. L'adhésion aux soins est mauvaise dans un contexte où les liens sociaux sont souvent en souffrance. Deux catégories de programme sont montré leur efficacité : les dispositifs d'intervention intensive et les dispositifs de veille. Ces derniers peuvent recouvrir différentes modalités (courriers, téléphone, textos, mails, etc.). Un dispositif régional innovant, baptisé Vigilan S, combine ces différentes stratégies dans l'algorithme suivant : délivrance d'une carte de crise à la sortie de la prise en charge hospitalière ; rappel téléphonique des non-primosuicidants 15 jours après leur sortie ; envoi de cartes postales personnalisées mensuellement pendant 6 mois en cas d'échec de l'appel ;information du médecin traitant. L'équipe de recontact, formée à la gestion de crise, gère tous les appels sortants et entrants vers les patients, leurs proches et leurs soignants. Un jeu de 4 cartes postales peut être envoyé encas d'appel téléphonique non concluant. S'appuyant sur une philosophie de veille, VigilanS a développé un véritable savoir-faire de gestion de crise, nécessitant une supervision médicale constante et de solides capacités de mise en réseau. Une étude « écologique ¼ en population générale a été lancée en 2015 dans les départements du Nord et du Pas-de-Calais. Quatre ans plus tard, il est constaté dans tout ce territoire une baisse moyenne de 13 % des passages aux urgences pour tentative de suicide, ainsi qu'une baisse de 12 % des levées de corps pour suicide par les médecins légistes. Le dispositif est en cours de déploiement en France métropolitaine et ultramarine.

Changes in the number of suicide re-attempts in a French region since the inception of VigilanS, a regionwide program combining brief contact interventions (BCI).

BACKGROUND: Brief Contact Interventions (BCIs) after a suicide attempt (SA) are an important element of prevention against SA and suicide. They are easier to generalize to an entire population than other forms of intervention. VigilanS generalizes to a whole French region a BCI combining resource cards, telephone calls and mailings, according to a predefined algorithm. It was implemented gradually in the Nord-Pas-de-Calais (NPC), France, between 2015 and 2018. Here, we evaluate the effectiveness of VigilanS, in terms of SA reduction, using annual data collected by participating centers. Hypothesis tested: the higher the VigilanS implementation in a center (measured by penetrance), the greater the decrease in the number of SA observed in this center. METHODS: The study period was from 2014 to 2018, across all of NPC centers. We performed a series of linear regressions, each center representing a statistical unit. The outcome was the change in the number of SA, relative to the initial number, and the predictive variable was VigilanS' penetrance: number of patients included in VigilanS over the total number of SA. Search for influential points (points beyond threshold values of 3 influence criteria) and weighted least squares estimations were performed. RESULTS: Twenty-one centers were running VigilanS in 2018, with an average penetrance of 32%. A significant relationship was identified, showing a sharp decrease in SA as a function of penetrance (slope = - 1.13; p = 3*10- 5). The model suggested that a 25% of penetrance would yield a SA decrease of 41%. CONCLUSION: VigilanS has the potential to reduce SA. Subgroup analyzes are needed to further evaluate its effectiveness. Subgroup analyses remain to be done, in order to evaluate the specific variations of SA by group.

[Sleep disorders and their treatment in post-traumatic stress disorder]. / Les troubles du sommeil et leur traitement dans le trouble stress post-traumatique.

Subjects suffering from post-traumatic stress disorder present sleeping disorders like a chronic insomnia, traumatic nightmares, but also less expected, sleep breathing disorders. Sleep problems are a factor of development and maintenance of PTSD, but also a factor of resistance to treatment. After a therapy focused on PTSD, they represent frequent residual symptoms. It is necessary to couple, with the usual management of PTSD, targeted approaches for sleep problems. These targeted approaches allow an improvement of the nocturnal properties but also diurnal specific symptoms of PTSD. Stakes around primary, secondary and tertiary prevention of PTSD emerge around these sleep disorders.

[Suicide in prison: Epidemiology and prevention]. / Le suicide en prison : épidémiologie et dispositifs de prévention.

Suicide is one of the most important causes of death in prison around the world. In France, suicide rate for prisoners is 18.5 suicides per 10,000 inmates: seven times more common than in the general population. Among the risk factors identified in the literature, those most strongly associated with suicide in prison are physical isolation in custody, psychiatric history and history of suicide attempts. The prevention of suicide in prison involves several measures including treatment of psychiatric disorders, improvement of living conditions in custody, social support of prisoners and use of specific tools and programs by prison supervisors. No program for prevention of suicidal recurrence has ever been implemented. We propose to adapt « VigilanS ¼, a program already applied in the general population, to the prison population.

Combining brief contact interventions (BCI) into a decision-making algorithm to reduce suicide reattempt: the VigilanS study protocol.

INTRODUCTION: The early postattempt period is considered to be one of the most at-risk time windows for suicide reattempt or completion. Among the postcrisis prevention programmes developed to compensate for this risk, brief contact interventions (BCIs) have been proven to be efficient but not equally for each subpopulation of attempters. VigilanS is a region-wide programme that relies on an algorithmic system to tailor surveillance and BCI provisions to individuals discharged from the hospital after a suicide attempt. AIM: VigilanS' main objective is to reduce suicide and suicide reattempt rates both at the individual level (patients included in VigilanS) and at the populational level (inhabitants of the Nord-Pas-de-Calais region). METHODS AND ANALYSIS: At discharge, every attempter coming from a participating centre is given a crisis card with an emergency number to contact in case of distress. Patients are then systematically recontacted 6 months later. An additional 10-day call is also given if the index suicide attempt is not the first one. Depending on the clinical evaluation during the phone call, the call team may carry out proportionated crisis interventions. Personalised postcards are sent whenever patients are unreachable by phone or in distress. On the populational level, mean suicide and suicide attempt rates in Nord-Pas-de-Calais will be compared before and after the implementation of the programme. Here/there cross-sectional comparisons with a control region will test the spatial specificity of the observed fluctuations, while time-series analyses will be performed to corroborate the temporal plausibility of imputing these fluctuations to the implementation of the programme. On the individual level, patients entered in VigilanS will be prospectively compared with a matched control cohort by means of survival analyses (survival curve comparisons and Cox models). DISCUSSION: VigilanS interventional components fall under the ordinary law care regime, and the individuals' general rights as patients apply with no addendums or restrictions for their participation in the programme. The research section received authorisation from the Ethical Committee of Lille Nord-Ouest under the caption 'Study aimed at evaluating routine care' and is registered in 'Clinical Trials'. The French Ministry of Health plans to extend the experimentation to other regions and probe the relevance of this type of 'bottom-up' territorial prevention policy at the national level. TRIAL REGISTRATION NUMBER: NCT03134885.