Catastrophizing and rumination mediate the link between functional disabilities and anxiety/depression in fibromyalgia. A double-mediation model.

Fibromyalgia can be considered to be a model of chronic pain resulting from dysregulation of pain processing. From a psychological point of view, it is possible to consider transdiagnostic processes that would participate in both the dysregulation of pain and associated emotions. OBJECTIVE: The aim of this study was to test the links that exist between the tendency to Repetitive Negative Thinking (RNT) and the anxious-depressive manifestations in fibromyalgia. More specifically, we wanted to test a double mediation model where RNT would mediate the link between pain and depression/anxiety via catastrophizing. METHOD: Eighty-two patients with fibromyalgia completed a series of questionnaires evaluating their level of depression, anxiety, disability related to pain, catastrophizing as well as various measures of Repetitive Thoughts. RESULTS: The results showed strong correlations between RNT levels, pain, and anxious-depressive manifestations in this population. Moreover, the links between pain and depression/anxiety were mediated by catastrophizing and RNT in serial. CONCLUSION: Results support the interest of studying RNT as a transdiagnostic process in fibromyalgia pain. Considering RNT in fibromyalgia allows a better understanding of tthe links that exist between pain and emotional disorders in this population and thus to better understand the psychopathological comorbidity of fibromyalgia.

Prevalence of Anxiety and Depression Symptomatology in Adolescents Faced With the Hospitalization of a Loved One in the ICU.

OBJECTIVE: ICU experience is linked to anxiety and depression symptomatology in family members of patients. Minors may be forbidden from visiting. To bring practices in line with evidence, we determined the prevalence of anxiety and depression symptomatology in adolescents visiting a relative in the ICU. DESIGN: One-year prospective observational monocenter study. SETTING: Medical-surgical ICU, University Hospital of Martinique. PATIENTS: Forty-one patients intubated for more than 2 days; 53 adolescents (12-17 yr) first- to third-degree relatives in regular contact (minimum once a month) with patient before hospitalization. INTERVENTIONS: Adolescents with unrestricted ICU access completed a satisfaction survey, anxiety history questionnaire, and psychometric evaluation (Hospital Anxiety and Depression Scale) before the patient's 15th day of hospitalization and extubation. MEASUREMENTS AND MAIN RESULTS: Forty adolescents (75.5%) visited their relative. Possible and probable anxiety and depression symptomatology prevalence was 35.9% and 18.9%, respectively, with no significant difference according to ICU visiting status. Most (80%) reported a lack of information, 40% insufficient consideration, and 27.5% misunderstood the reason for hospitalization. Two (5%) regretted visiting. Probable anxiety and depression symptomatology was associated with first-degree relationship (odds ratio, 9.1 [95% CI, 1.1-78.9]; p = 0.045), past exposure to a traumatic event (odds ratio, 8.7 [1.1-69.0]; p = 0.040) and past sense of threat (odds ratio, 10.4 [1.1-94.5]; p = 0.038). CONCLUSIONS: Anxiety and depression symptomatology is common in adolescent family members of ICU patients. An open visiting policy for adolescents is recommended, with visit planning, information meetings, and individual support from ICU staff.

High prevalence rates for multiple psychiatric conditions among inmates at French Guiana's correctional facility: diagnostic and demographic factors associated with violent offending and previous incarceration.

BACKGROUND: French Guiana has the highest incarceration rate among French territories, it is higher than that of Brazil, Colombia or Venezuela. It is well known that mental health problems are over-represented in correctional facilities. Our objectives were to describe the prevalence of various psychiatric conditions and to study factors associated with violence and repeated offenses among arriving detainees at the sole correctional facility of French Guiana. METHODS: The study was cross-sectional. All consenting new adult prisoners incarcerated between 18/09/2013 and 31/12/2014 at the penitentiary centre of French Guiana were included. The Mini International Neuropsychiatric Interview (MINI) was used to screen for psychiatric diagnoses. In addition sociodemographic data was collected. RESULTS: Overall 647 men and 60 women were included. The participation rate was 90%.Overall 72% of patients had at least one psychiatric diagnosis (Fig. 2). Twenty percent had three or more diagnoses. Violent index offences were not more frequent among those with a psychiatric diagnosis (crude odds ratio 1.3 (95%CI = 0.9-2), P = 0.11. Multivariate analysis showed that after adjusting for sex and age, psychosis, suicidality and post-traumatic stress disorder were independently associated with violent offences. Generalized anxiety disorder was less likely to be associated with incarceration for violent offences. Having a history of a previous incarceration was significantly associated with a psychiatric condition in general (any diagnosis) OR = 3 (95%CI = 2-4.3), P < 0.0001. Calculations of the population attributable risks showed that in the sample 31.4% of repeat incarcerations were attributable to antisocial personality disorder, 28.3% to substance addiction, 17.3% to alcohol addiction, 8.7% to depression and 7% to psychosis. CONCLUSIONS: The very high prevalence of psychiatric disorders observed in our sample, and the relative lack of psychiatric facilities, suggest that part of the problem of very high incarceration rate may be explained by transinstitutionalization. Improving psychiatric care in prison and coordination with psychiatric care in the community after release is likely to be important.

[Acceptability of the systematic screening of suicidal adolescents in emergency departments]. / Acceptabilité du dépistage systématique des adolescents suicidants aux urgences.

Studies of adolescent suicide screening tools have increased with the development of questionnaires that can be used in paediatric emergency departments. This article proposes a literature review of the acceptability of such interventions. Although these tools are well accepted when they are systematized, their usefulness is determined by the availability of child psychiatric care with the right balance between the adolescent's confidentiality and parental involvement.

Suicide risk among prisoners in French Guiana: prevalence and predictive factors.

BACKGROUND: Suicide rates in prison are high and their risk factors are incompletely understood. The objective of the present study is to measure the risk of suicide and its predictors in the only prison of multicultural French Guiana. METHODS: All new prisoners arriving between September 2013 and December 2014 were included. The Mini International Neuropsychiatric Interview (MINI) was used and socio-demographic data was collected. In order to identify the predictors of suicide risk multivariate logistic regression was used. RESULTS: Of the 707 prisoners included 13.2% had a suicidal risk, 14.0% of whom had a high risk, 15.1% a moderate risk and 41.9% a low risk. Predictive factors were depression (OR 7.44, 95% CI: 3.50-15.87), dysthymia (OR 4.22, 95% CI: 1.34-13.36), panic disorder (OR 3.47, 95% CI: 1.33-8.99), general anxiety disorder (GAD) (OR 2.19, 95% CI: 1.13-4.22), men having been abused during childhood (OR 21.01, 95%, CI: 3.26-135.48), having been sentenced for sexual assault (OR 7.12, 95% CI: 1.98-25.99) and smoking (OR 2.93, 95%, CI 1.30-6.63). CONCLUSION: The suicide risk was lower than in mainland France, possibly reflecting the differences in the social stigma attached to incarceration because of migrant populations and the importance and trivialization of drug trafficking among detainees. However, there were no differences between nationalities. The results reemphasize the importance of promptly identifying and treating psychiatric disorders, which were the main suicide risk factors.

[Post-Traumatic Stress Disorder among Incomers in Remire-Montjoly Prison, French Guiana]. / Le trouble de stress post-traumatique parmi les détenus en centre pénitentiaire en Guyane française.

Despite the recent interest in psychiatric illness in prison, the psychopathology of the Remire-Montjoly prison population remains largely unknown. Subject to significant population movements, French Guiana and its prison houses a very mixed population in which recent history has left a strong mark (earthquake in Haïti, civil war in Suriname, violence related to gold mining population and drug trafficking). These negative life events appear as potential vectors of psychological trauma. Additionally, strong links have been established in the literature between post-traumatic stress disorder (PTSD) and many other psychiatric disorders, including suicidal behavior and addictions. Under these conditions, we felt it essential to focus on the identification of PTSD in this sensitive population.Through adapted reception interviews, we tried to identify the PTSD, to describe by means of socio-demographic factors the studied population and to detect psychiatric comorbidities. The screening tool was the M.I.N.I. 5.0, which identifies 17 psychiatric disorders including the PTSD, based on the DSM IV definition. The target population was the prison incomers, agreeing to participate in the study, aged more than 18 years old and imprisoned between 18 January 2013 and 31 December 2013. To this date, 549 inmates were included in the study.The main result of this study was a prevalence of PTSD of 17% for incomers in detention. We found that the PTSD+ population is more likely to be female (15% against 7% p = 0.0246), which is consistent with the literature data. The M.I.N.I. 5.0 showed a higher prevalence of psychiatric disorders in the PTSD+ group. This association was confirmed in several types of pathology like mood disorders including: major depressive episode and manic or hypomanic episode, suicidal risk, some anxiety disorders including: panic disorder, obsessive-compulsive disorder and generalized anxiety disorder. Strong association was found for current major depressive episode, current manic or hypomanic episode and suicidal risk (p < 0.005).The prevalence of PTSD is very high in this study, about 24 times higher than in a general population survey using the same screening tool.A large number of comorbidities have been identified, which corresponds to those described in the literature. The specific issues of psychiatry in prison lead us to examine more specifically the significance of the results about suicide risk. A comprehensive suicide risk (sum of medium and high risk screened by the M.I.N.I.) was found in significantly more PTSD+ inmates (17% versus 7%, p = 0.005). This study supports the need for routine screening of PTSD among incomers in detention. This disease is both worrying and common in this population but the real issues are the comorbidities. Suicidal potential is among the most important issues in detention. Its evaluation should be completed by an early recognition of a PTSD.

[AI based Evaluation of Psychotrauma related to Lahars in the Commune of Prêcheur in the French Antilles]. / Évaluation assistée par IA des psychotraumatismes liés aux lahars dans la commune du Prêcheur aux Antilles françaises.

Objectives Natural disasters have a significant impact on mental health. Data collected from the population offer a unique opportunity for post-disaster monitoring to help identify psychological support needs. The aim of this study is: 1) to identify psychopathological aspects for the county of Prêcheur at risk from lahars (volcanic lava), and 2) to phenotype psychopathological aspects from data collected from the population. Method We applied an artificial intelligence (AI) assisted psycho-phenotyping method to data from 40 people over a 20-month period, to extract psychopathological and psychiatric aspects linked to traumatic natural hazards. These were then compared with the results of psychometric tests measuring overall mental health and post-traumatic stress. Results Rumination and negativation were among the most important psychopathological aspects identified. In addition, we noted the presence of re-experiencing and avoidance as core psychiatric dimensions over time. Among these, cognitive avoidance and emotional avoidance were found and seem to have emerged after the disaster. Conclusion We have proposed a new syndromic surveillance approach for mental health based on digital data that can support conventional approaches by providing additional useful information in the context of a disaster. Further studies are needed to better control bias, identify associations with valid instruments, and explore computational methods for continuous adjustment of the AI-analysis model.

Identifying suicidal risk factors in the French Overseas Territories with multimethod psychological autopsy (AUTOPSOM): a mixed-methods study protocol.

INTRODUCTION: Understanding suicide in more isolated territories is a challenge because of the entanglement of cultural identity with historical, geographical and sociocultural specificities. This knowledge is a necessary precondition for the implementation of targeted prevention strategies in regions such as the French overseas territories (FOT), where data concerning suicidal risk factors is still incomplete. We aim to untangle sociocultural and clinical suicide risk factors by integrating a novel anthropological and psycholinguistic approach into the psychological autopsy method. This article describes the protocol of the clinical study 'Contribution of Psychological Autopsy to the Understanding of Suicidal Behaviours in Overseas France' (AUTOPSOM study), designed to identify common or new specific suicide risk factors in four FOT. METHODS AND ANALYSIS: A multicentre epidemiological study will be carried out in four FOTs (French Polynesia, Martinique, La Reunion and French Guiana) and at a comparison site in mainland France (La Somme). The methodology will be based on a mixed-methods (quantitative and qualitative) approach using a psychological autopsy to collect clinical data and life events in the deceased's life. We implemented an exploratory multimethod strategy that combines a succession of epidemiological, anthropological, psycholinguistic and psychological methods with a semiautomated analysis of the discourse of relatives bereaved by suicide. ETHICS AND DISSEMINATION: The study protocol (first version) was approved by the French Ethics Committee (CPP OUEST II, approval #22.04267.000122) and the Ethics Committee of French Polynesia (JOPF of 5 April 2022; CEPF opinion n°91 of 29 March 2022). The overall results and the perspectives established at the end of the study will be communicated to the bereaved relatives according to their will and serve for local suicide prevention purposes. TRIAL REGISTRATION NUMBER: NCT05773898.

The impact of rumination on fibromyalgia pain after physical activity: an experimental study.

Some fibromyalgia (FM) patients engage in rumination (i.e. a chain of repetitive, passive and relatively uncontrollable thoughts focused on negative content) to cope with the pain and discomfort of daily activities. The partial model of rumination in chronic pain suggests that rumination processes may play a causal role in maintaining pain. Rumination might also be one of the key factors interfering with the reestablishment of adapted physical activity. The objective of this study was to test how rumination vs. distraction induction influence FM patients' pain intensity, discomfort linked to pain, and affect after physical activity. Forty-seven participants with a diagnosis of FM were randomly assigned to undergo distraction induction vs. rumination induction after performing a physical activity in ecological setting. Their pain intensity, pain-related discomfort, and affect were measured at the baseline, after physical activity, and after rumination versus distraction induction. A series of mixed-design ANOVAs showed that rumination induction after physical activity impairs patients' recovery in terms of pain intensity and discomfort, but not affect, as compared to the distraction condition. In conclusion, participants with fibromyalgia who engage in rumination following a physical activity recover less from their pain experience as compared to distraction induction. These results are consistent with the partial model of rumination in chronic pain and support the idea that rumination may play a causal role in the development and maintenance of pain.

Suicide risk and mental health in the general population of French Polynesia.

OBJECTIVE: There are no reports on the burden of suicidal ideation and suicide attempts in the general population of French Polynesia (FP). We aimed to improve suicide prevention and mental health care by assessing the prevalence of suicide risk and major mental health disorders and care among adults in FP. METHODS: We conducted the Mental Health in General Population Survey in FP during 2015 to 2017. Participants were selected using the quota method to obtain a representative sample of the general population. Suicide risk and psychiatric diagnoses were assessed using the Mini International Neuropsychiatric Interview. RESULTS: We included 968 people aged 18 years or older. The prevalence of current suicidal ideation (13.1%) and current (2.6%) and lifetime suicide attempts (18.6%), as well as mental health disorders (42.8%), was high in FP. A notable proportion of participants with these conditions did not seek medical assistance. CONCLUSION: A high prevalence of suicide risk and mental health disorders was found in the general population of FP. Suicide prevention and mental health plans are needed in FP that include better access to primary care for the diagnosis and treatment of mental health disorders. Further research is needed to clarify cultural risk and protective factors.

Mental Health of Adolescent Relatives of Intensive Care Patients: Benefits of an Open Visitation Policy.

BACKGROUND: Symptoms of anxiety and depression are common in adolescents with a loved one in an intensive care unit (ICU) and are known precursors of posttraumatic stress disorder (PTSD). OBJECTIVES: To assess the prevalence of PTSD and associated factors in adolescent (age 12-17 years) relatives of patients in an ICU with an open visitation policy. METHODS: One year after the patient was discharged from the ICU, eligible adolescent relatives completed a satisfaction survey, anxiety history questionnaire, and psychometric evaluations (Hospital Anxiety and Depression Scale and 8-item Children's Revised Impact of Event Scale). RESULTS: Thirty-two patients intubated for >2 days and with a Simplified Acute Physiology Score II >30 were included. Forty-six adolescents with first- to third-degree relationships to the patient, and in regular contact (≥monthly) with the patient before hospitalization, were enrolled. The prevalence of PTSD among the adolescents was 33%. Adolescents who visited the ICU were less likely to report feelings of regret than those who did not visit the ICU (2% vs 9%, P = .01). A past sense of threat (odds ratio [95% CI], 19.4 [1.9-201.2]; P = .01) and anxiety and depression symptoms (odds ratio [95% CI], 9.6 [1.4-63.7]; P = .02) were independent factors associated with probable PTSD. CONCLUSIONS: A cautiously prepared open visiting policy should be maintained for adolescents with a relative in the ICU, because it could prevent feelings of regret and subsequent PTSD. Adolescents with risk factors should be screened and followed up.

Suicide in French Polynesia: a retrospective analysis based on medicolegal documents and interview with family.

OBJECTIVE: To analyse the epidemiological data on suicide in French Polynesia (FP). METHODS: Data on suicides were collected from the Public Health Direction, Judicial Police Investigations Court of Justice records, the Centre d'Opérations et de Renseignements de la Gendarmerie, patient records for those hospitalized in psychiatry and from psychological autopsies. RESULTS: The dataset consisted of 316 suicide cases in FP over 25 years (1992-2016). In FP, suicide was more frequent in men (sex ratio 3.2:1), young people (mean age, 34.4 years) and individuals with previously diagnosed psychiatric disorders (100 of 316; 31.6%) The most common method of suicide was hanging (276 of 316; 87.3%). A history of previous suicide attempts was found in 25 of 56 (44.6%) of suicide cases, when documented. The most common potential triggering factors for suicide were emotional problems. The suicide rates have remained stable during 1992-2016 (mean 10.6/100 000 inhabitants per year), with periods of economic crises increasing suicide rates. CONCLUSIONS: These results provide valuable information to enable the effective targeting of suicide prevention strategies toward those at high risk. Economic crises had larger impacts in the French overseas territories than mainland France. Given the unprecedented economic impact of the Covid-19 pandemic in FP, there is an urgent need to implement suicide epidemiological surveillance and prevention programmes.

TENTS guidelines: development of post-disaster psychosocial care guidelines through a Delphi process.

BACKGROUND: How best to plan and provide psychosocial care following disasters remains keenly debated. AIMS: To develop evidence-informed post-disaster psychosocial management guidelines. METHOD: A three-round web-based Delphi process was conducted. One hundred and six experts rated the importance of statements generated from existing evidence using a one to nine scale. Participants reassessed their original scores in the light of others' responses in the subsequent rounds. RESULTS: A total of 80 (72%) of 111 statements achieved consensus for inclusion. The statement 'all responses should provide access to pharmacological assessment and management' did not achieve consensus. The final guidelines recommend that every area has a multi-agency psychosocial care planning group, that responses provide general support, access to social, physical and psychological support and that specific mental health interventions are only provided if indicated by a comprehensive assessment. Trauma-focused cognitive-behavioural therapy (CBT) is recommended for acute stress disorder or acute post-traumatic stress disorder, with other treatments with an evidence base for chronic post-traumatic stress disorder being made available if trauma-focused CBT is not tolerated. CONCLUSIONS: The Delphi process allowed a consensus to be achieved in an area where there are limitations to the current evidence.

Course of posttraumatic stress symptoms over the 5 years following an industrial disaster: a structural equation modeling study.

The present study examined individual latent changes in posttraumatic stress disorder (PTSD) symptoms over a 60-month period after an industrial disaster. Participants were recruited from survivors of a factory explosion. Participants were assessed retrospectively for peritraumatic reactions and acute stress symptoms. Posttraumatic stress disorder symptoms were then assessed at 6, 15, and 60 months. Using structural equation modeling, the authors tested 3 hypotheses of individual latent change: stability of PTSD symptoms between 6, 15, and 60 months; change between 6 and 15 months; and change between 15 and 60 months. Only one model provided a good fit suggesting that PTSD symptoms evolved between 6 and 15 months after trauma exposure and remained stable at the individual level thereafter.

A positive association between a polymorphism in the HTR2B gene and cocaine-crack in a French Afro-Caribbean population.

OBJECTIVES: Cocaine dependence has a strong heritability component. The aim of this study was to investigate the putative association between the serotonin 2B receptor gene (HTR2B), crack use disorders and impulsivity. METHODS: A French Afro-Caribbean male population of patients with crack use disorders (n = 80) was compared to healthy Afro-Caribbean male controls (n = 60). Comorbid ADHD and impulsivity were assessed. Five single nucleotide polymorphisms (SNPs) in the HTR2B gene were selected: rs643700, rs6736017, rs1549339, rs17586428 and rs3806545. These SNPs were chosen to include most of the linkage disequilibrium blocks in the HTR2B gene. The French translation of the Barratt Impulsivity Scale BIS-11 was used to evaluate impulsivity. Comorbid ADHD was diagnosed using the Wender Utah Rating Scale-25 item for Attention Deficit-Hyperactivity Disorder. RESULTS: We have observed a positive association between the rs6736017 polymorphism and crack use disorders in a French Afro-Caribbean male population. CONCLUSIONS: In our population, the risk effect of HTR2B rs6736017 appeared to be specific to individuals with crack use disorders rather than being driven by impulsivity or ADHD alone.

Explanatory factors of post-traumatic distress and burnout among hospital staff 6 months after Hurricane Irma in Saint-Martin and Saint-Barthelemy.

BACKGROUND: In September 2017, the Hurricane Irma devastated the islands of Saint-Martin and Saint-Barthelemy (French West Indies). This was a particularly distressing time for the local healthcare staff in charge of rescuing the population. The aim of this study was to identify the explanatory factors of post-traumatic distress and burnout in hospital staff. METHODS: An anonymous questionnaire was sent to all 509 hospital workers of Saint-Martin and Saint-Barthelemy. Post-traumatic distress and burnout was assessed using the Post-Traumatic Stress Disorder Checklist (PCL-S) and Copenhagen Burnout Inventory (CBI) scales. Bivariate and multivariate analyses were used to determine the explanatory variables for these two psychological disorders. RESULTS: Two hundred and sixty-two questionnaires were completed (response rate of 51.7%). The explanatory factors of post-traumatic distress were female gender (OR = 12.93, 95% CI: 2.70-232.10), electricity shortages (OR = 2.92, 95% CI: 1.13-8.19) and home damage (OR = 1.16, 95% CI [1.02-1.33]). In parallel, the explanatory factors of burnout were post-traumatic distress (OR: 10.42, 95% CI: 4.72-25.58), female gender (OR = 2,41, 95% CI: 1.24-5.02) and paramedical staff (OR = 2,53, 95% CI: 1.15-6.21). In the multivariate analysis, only burnout was significantly associated with post-traumatic distress (OR = 9.26, 95% CI: 4.11-23.14). CONCLUSIONS: Six months after Irma, post-traumatic distress among hospital staff was strongly linked to burnout. This study revealed the lack of electricity as a new factor related to post-traumatic distress. It also suggested that psychological intervention should be strengthened.

Supportive effect of body contact care with ylang ylang aromatherapy and mobile intervention team for suicide prevention: A pilot study.

OBJECTIVES: To assess understudied, alternative suicide prevention modalities in a mental health care setting. METHODS: This was a prospective study of patients (n = 140, 68 cases and 72 controls) who were admitted to hospital or who contacted an SOS suicide crisis line for suicidal ideation or attempts. Psychiatric diagnoses (Mini-International Neuropsychiatric Interview) and intensity of anxiety/depression/suicidality (Hamilton Anxiety Rating Scale, Montgomery-Åsberg Depression Rating Scale, and Beck Scale for Suicidal Ideation) were assessed. All intervention group subjects received a crisis card with a crisis line number, interviews with psychologists or volunteers and a telephone call on days 10 to 21, then 6 months later. These subjects also had a choice between two further 4-month interventions: body contact care or mobile intervention team visits. RESULTS: The interventions significantly reduced the number of suicide attempts and suicide (3%) at 6 months compared with the control condition (12%). There were fewer losses to follow-up in the intervention group (7.35%) than in the control group (9.72%). CONCLUSIONS: The results favour the implementation of integrated care and maintaining contact in suicide prevention.

Specificity of the links between workplace harassment and PTSD: primary results using court decisions, a pilot study in France.

OBJECTIVES: France is one of the first countries to have passed specific legislation concerning "mental harassment" (In French the term used in the legislation is "harcèlement moral" referring to harassment or bullying leading to mental or psychological distress.) in the workplace. However, the definition of mental harassment at work remains fairly vague. It is, indeed, a complex issue, since no objective and precise consensual definition has been given so far. The objective of this study is to clarify the criteria that French judges consider as characteristic of mental harassment, and to check whether the specific links between mental harassment at work and PTSD pointed to in recent international studies have been taken into account. This study proposes the main lines for debate in countries that have not yet adopted legal clauses on mental harassment at work. METHODS: Our study is based on a sample of 22 people who were legally recognised as having been mentally harassed at work; this sample is taken as representative of all court decisions passed on harassment and published as such on the French Ministry of Justice website. RESULTS: To establish whether they were considering a case of harassment, the judges based their decisions on the nature of the accusations. In all cases (22/22), the charges brought against the defendant had to do with offences against the employee's dignity. Five cases out of 22 dealt with an offence infringing their rights, 10 cases out of 22 related to the employee's future within the company being compromised, while half of the cases (11/22) concerned a deterioration in the person's health. In more than half of the cases, the judges also looked for other factors, such as repetition and duration of the period of harassment. Whenever the judges noted a deterioration in the victim's mental health, they also referred to medical certificates reporting anxio-depressive syndromes or psychological disorders without providing further detail. No PTSD-like symptomatology was mentioned among these cases, although several studies have shown that many victims of mental harassment at work have specific symptoms of PTSD. CONCLUSIONS: This study is the first study to be carried out on mental harassment at work and to refer to court decisions since the law was promulgated in France (2002). It appears that, in order to be recognised as a victim of mental harassment at work, numerous proofs of harassment or bullying need to be produced. It must have been repeated and have led to consequences in several domains. Several attestations and documents are required demonstrating clearly that harassment or bullying did indeed occur. Further to this, although to date judges have not considered PTSD to be an element contributing to the presumption of harassment, connections between bullying or harassment and clinical signs of PTSD have been attested by several studies that confirm that bullied victims can suffer from PTSD-like symptoms, although they do not necessarily match the strict DSM-IV criteria (absence of A1 criterion). It would seem advisable to request psychiatric examination in cases of harassment.

Improving the mental health system for trauma victims in France.

France has a rich history of exposure to large-scale traumas such as wars, disasters and terrorist attacks, and psychiatric teams specialized in emergency interventions for mass trauma have been created across the territory. However, no public resources are dedicated for long-term interventions or for individual trauma cases. This letter describes how a government supported model of care has been created and implemented in 2019. A national centre for resources and resilience (CN2R) and 10 regional ambulatory services specializing in psychotraumatology were created with the aim of improving public mental health-care delivery while providing a comprehensive suite of services for trauma victims from the most immediate to longer-term considerations.

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.