[Use of psychotherapy among adults with a history of suicide attempt: Results form a large population-based study]

Is mindfulness practice "at risk" of increasing spirituality? Systematic review and critical analysis of a claimed effect

INTRODUCTION

Mindfulness meditation has gained prominence in somatic and psychiatric care in several countries including France. Studies have shown its effectiveness in various conditions, in particular the prevention of depressive relapses. However, there are criticisms and concerns about its potential links to Buddhism and spirituality, raising issues of secularism and sectarianism. This issue is particularly conflicting in France with regard its historical and political relationship with secularism.

OBJECTIVES

This study aims to assess quantitative data regarding the impact of mindfulness meditation on spirituality and religiosity using quantitative validated scales.

METHODS

A systematic review was conducted. PubMed was searched for relevant studies using keywords related to mindfulness and spirituality/religiosity scales. Four scales assessing spirituality were identified: FACIT-sp, INSPIRIT, DSES, and DUREL. Qualitative analysis determined if scale items pertained to spirituality or other topics considered by opponents to mindfulness as "at risk" for deviances or sectarian aberrations. Quantitative analysis assessed the effect size of changes in scale scores before and after mindfulness meditation interventions.

RESULTS

Eighteen studies were analyzed, with varying scales and program durations including 1272 participants. Qualitative analysis showed that most scales contained items related to spirituality as well as "at risk" elements like religion and mysticism. Quantitative analysis revealed that a few studies reported significant increases in spirituality scores following mindfulness meditation, but the clinical relevance of these changes was questioned. In general, control groups had smaller score changes.

INTERPRETATION

While some studies suggest a potential increase in spirituality due to mindfulness meditation, the clinical significance of these findings remains uncertain. Moreover, mindfulness meditation's ties to Buddhism are disputed, and its roots are intertwined with various psychotherapy traditions that incorporate spirituality. The role of secularism in psychotherapy is also debated in France, emphasizing the need for proper use and regulation policy rather than prohibition of mindfulness-based approaches. This study highlights the complexity of assessing the impact of mindfulness meditation on spirituality and religiosity. It suggests that a pragmatic approach focusing on risk and harm reduction may be more suitable than labeling the practice as "at risk". Further research is needed to clarify these issues in the specific cultural context of France.

Factors associated with past-year medication use and psychotherapy in adults with suicidal ideation in France

BACKGROUND

The objective of the study is to assess the sociodemographic and clinical factors associated with past-year medication use and/or psychotherapy among adults with suicidal ideation in the past 12 months.

METHODS

Data were drawn from the 2017 Health Barometer survey, a large computer-assisted telephone survey on a representative sample of the general population aged 18 to 75 years living in metropolitan France (n = 25,319). Logistic and multinomial regression analyses were used to study past-year medication use and/or psychotherapy as a function of sociodemographic and clinical factors. Analyses were restricted to individuals reporting suicidal ideation in the past year (n = 1,148).

RESULTS

Overall, 43.6% of adults with suicidal ideation reported no treatment for a mental health reason in the past year; 36.6% reported using medication only, 4.8% psychotherapy only, and 15.0% both. Sociodemographic and clinical factors associated with increased probability of treatment varied as a function of the type of treatment received. Adjusting for key factors including clinical factors, older adults with suicidal ideation were more likely than younger adults to receive medication only.

CONCLUSIONS

The findings point to differential inequalities in access to medication and psychotherapy among adults with suicidal ideation in the general population of France.

Predisposing, enabling and need factors associated with past-year health service use for mental health reasons in adults with suicidal ideation in France

BACKGROUND

We aimed to determine the prevalence of past-year health service use for mental health reasons in a French representative sample of adults overall and in those reporting suicidal ideation in the past year and assess the factors associated with health service use according Andersen's model of healthcare seeking behaviors.

METHODS

Data were drawn from the 2017 Health Barometer survey a large computer-assisted telephone survey on a representative sample of the general population aged 18-75 years living in France (n = 25,319). Logistic regression analyses were used to study past-year health service use for mental health reasons as a function of predisposing, enabling and need factors. Analyses were stratified according to suicidal ideation and sex.

RESULTS

Among individuals with suicidal ideation, 45.1 % of adults, 50.4 % of females and 37.6 % of males, reported past-year health service use for a mental health reason. Increased odds of health service use were observed regarding predisposing (female sex, younger age, higher education), enabling (income level), and need factors (prior suicide attempts, role impairment and major depression). Among males, the only significant factors included age 65-75 (aOR = 0.16, 95%CI = 0.03-0.84) and major depression (aOR = 2.79, 95%CI = 1.79-4.36).

LIMITATIONS

Self-reported service utilization. Cross-sectional survey.

CONCLUSIONS

In a country with a high level of medical coverage, further research is needed to identify sex-specific socio-demographic, economic and clinical differences in the use of different types of health services as well as perceived need for care, structural and attitudinal barriers to treatment.

Psychological support in general population during the COVID-19 lockdown in France: Needs and access

INTRODUCTION

With France one of the European countries most strongly affected by COVID-19 in the spring of 2020, French authorities imposed a nationwide lockdown for 8 weeks (March 17-May 10). This study explored the perception of the adult population about the need for-and access to-psychological support from health care professionals (HCP) in response to concerns about the psychological needs during lockdown.

MATERIAL AND METHOD

This online cross-sectional survey of a representative sample of the adult general population of mainland France (N = 2,003) took place during the last four days of the French lockdown (May 7-10, 2020).

RESULTS

One in eight respondents (12.2%) perceived a need for psychological support from an HCP during the lockdown; most had symptoms of depression and/or anxiety of at least moderate intensity. Only a third (29.8%, 3.6% of the entire sample) actually obtained this support. Factors associated with this perceived need included: age under 35, economic difficulties due to lockdown, pre-lockdown use of psychological support, infection with COVID-19, serious worries about becoming infected, and heavy media use to obtain information about the disease. Among those who perceived a need for psychological support, the elderly were the most likely not to consult an HCP. People aged 35-64, those with high income, and those seriously worried about developing COVID-19 were the most likely to forgo seeking access to care because of their fear of infection by the coronavirus-2019.

CONCLUSION

The perceived need for psychological support from an HCP and access to it appeared to be strongly associated with COVID-19 exposure factor. More research about this association is needed to improve the health authorities' understanding of the population's psychological needs in this situation and to enhance HCPs' abilities to meet them. In particular, further research of its specific impact on youth is necessary.

Sexual and Nonsexual Interpersonal Violence, Psychiatric Disorders, and Mental Health Service Use

Exposure to potentially traumatic events (PTEs) increases an individual's risk of suffering from psychiatric disorders. However, only a small proportion of individuals exposed to PTEs use health care services (HCS). Few studies have examined how exposure to different types of PTEs affect the odds an individual will suffer from a psychiatric disorder and access HCS. The present study aimed to examine the associations among lifetime exposure to sexual and nonsexual violence, psychiatric disorder presence, and utilization of HCS. Data were drawn from a large cross-sectional survey (N = 19,958) representative of four regions of France. Lifetime occurrence of traumatic events, past-year DSM-IV Axis I psychiatric disorders, and past-year use of HCS were assessed using the CIDI-SF. Lifetime exposure to violence, particularly sexual violence, was associated with significantly higher odds of suffering from common psychiatric disorders in the past year, including major depression, aOR = 1.70, 95%CI [1.34, 2.17], which was present among 36.9% of participants who reported sexual violence exposure, 20.9% of those who reported exposure to nonsexual violence, and 7.1% of those exposed to neither. Compared to participants who were not exposed to sexual violence, victims of sexual violence were more likely to have contacted health care professionals due to a mental health problem and to have received psychotropic medication. However, a significant portion of individuals with psychiatric disorders did not report receiving potentially beneficial HCS. The present findings highlight the need to identify victims of violence and improve access to appropriate services for this population.