Characteristics of persons who died by suicide in prison in France: 2017-2018

BACKGROUND

In northern countries, suicide rates among prisoners are at least three times higher for men and nine times higher for women than in the general population. The objective of this study is to describe the sociodemographic, penal, health characteristics and circumstances of suicide of French prisoners who died by suicide.

METHODS

This study is an intermediate analysis of the French epidemiological surveillance program of suicides in prison. All suicides in prison in 2017-2018 in France were included in the study. Archival sociodemographic and penal data and specific data on the circumstances of the suicidal act were provided by the National Prison Service. Health data was provided by physicians working in prison using a standardized questionnaire.

RESULTS

In 2017-2018, 235 prisoners died by suicide. The suicide rate was 16.8/10 000 person-years. Among suicide cases, 94.9% were male, 27.2% were under 30, 25.1% were aged 30 to 39, 27.7% were aged 40 to 49 and 20.0% were 50 or older. At the time of suicide, 48.5% were on custodial remand. Incarceration is associated with a threefold increase in the frequency of anxio-depressive disorders (24.6% in prison versus 8.2% before prison). The week before the suicidal act, 60% of prisoners visited the health unit and a significant event was detected for 61% of all cases. Suicide was less than 1 week after prison entry for 11.9% of prisoners, corresponding to a suicide rate 6.4 (CI_95% [4.3 - 9.5]) times higher than for the remaining time in prison, and was more than 1 year after entry for 33.7% of them.

CONCLUSIONS

The high frequency of events the week before suicide in our study suggests that events in prison could play a role in the occurrence of suicides. Comparative studies are needed to further explore the time association between events and suicide in prison. As most of prisoners who died by suicide visited the health unit the week before suicide, the identification of triggering factors could help psychiatrists and other health professionals to assess the short-term risk of suicide and to implement preventive measures.

Impact of meteorological factors on alcohol use disorders: A study in emergency departments

No data exist on the influence of meteorological factors on alcohol use disorders (AUD). The aim of this study was to investigate the relationship between meteorological factors and AUD. All patients who were admitted to an emergency department (ED) in the Paris-region for an alcohol-related condition were included using the Oscour® database over the period January 1, 2015 to December 31, 2019. Meteorological data were collected by Météo-France (French Weather service). All data were aggregated by week. We performed Pearson correlations between weather variables and the number of ED visits for AUD. We observed 98,748 ED visits for alcohol-related conditions over the study period. We found significant positive correlations between the number of alcohol-related ED visits and the mean temperature (r = 0.55; p = 1.87e ^-5, 95% Confidence Interval (CI) = 0.33, 0.72) and the duration of sunlight (r = 0.42; p = .0015, 95% CI = 0.17, 0.62). Negative correlations were also found significant with rain (r = -0.40; p = .0014, 95% CI = -0.62, -0.18), humidity (r = -0.41; p = .0023, 95% CI = -0.62, -0.16) and wind speed (r = -0.40; p = .0031, 95% CI = -0.60, -0.14). Emergency visits for AUD seem to increase with the temperature and duration of sunlight, and decrease with rain, humidity and wind speed. Further studies are needed on a larger scale and taking into account potential confounding factors to confirm these findings.

[Suicide in prison: Epidemiology and prevention]

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 », a program already applied in the general population, to the prison population.

Use of medical administrative data for the surveillance of psychotic disorders in France

BACKGROUND

Psychotic disorders are among the most severe psychiatric disorders that have great effects on the individuals and the society. For surveillance of chronic low prevalence conditions such as psychotic disorders, medical administrative databases can be useful due to their large coverage of the population, their continuous availability and low costs with possibility of linkage between different databases. The aims of this study are to identify the population with psychotic disorders by different algorithms based on the French medical administrative data and examine the prevalence and characteristics of this population in 2014.

METHODS

The health insurance system covers the entire population living in France and all reimbursements of ambulatory care in private practice are included in a national health insurance claim database, which can be linked with the national hospital discharge databases. Three algorithms were used to select most appropriately persons with psychotic disorders through data from hospital discharge databases, reimbursements for psychotropic medication and full insurance coverage for chronic and costly conditions.

RESULTS

In France in 2014, estimates of the number of individuals with psychotic disorders were 469,587 (54.6% males) including 237,808 with schizophrenia (63.6% males). Of those, 77.0% with psychotic disorders and 70.8% with schizophrenia received exclusively ambulatory care. Prevalence rates of psychotic disorders were 7.4 per 1000 inhabitants (8.3 in males and 6.4 in females) and 3.8 per 1000 inhabitants (4.9 in males and 2.6 in females) for schizophrenia. Prevalence of psychotic disorders reached a maximum of 14 per 1000 in males between 35 and 49 years old then decreased with age while in females, the highest rate of 10 per 1000 was reached at age 50 without decrease with advancing age. No such plateau was observed in schizophrenia.

DISCUSSION

This study is the first in France using an exhaustive sample of medical administrative data to derive prevalence rates for psychotic disorders. Although only individuals in contact with healthcare services were included, the rates were congruent with reported estimates from systematic reviews. The feasibility of this study will allow the implementation of a national surveillance of psychotic disorders essential for healthcare management and policy planning.

Particular difficulties faced by GPs with young adults who will attempt suicide: a cross-sectional study

Background

Suicide is a major public health problem in young people. General Practitioners (GPs) play a central role in suicide prevention. However data about how physicians deal with suicidal youths are lacking. This study aims to compare young adult suicide attempters (from 18 to 39 years old) with older adults in a primary care setting.

Methods

A cross-sectional study was carried. All suicide attempts (N=270) reported to the French Sentinel surveillance System from 2009 to 2011 were considered. We conducted comparison of data on the last GP’s consultation and GPs’ management in the last three months between young adults and older adults.

Results

In comparison with older adults, young adults consulted their GP less frequently in the month preceding the suicidal attempt (40.9 vs. 64.6%, p=.01). During the last consultation prior to the suicidal attempt, they expressed suicidal ideas less frequently (11.3 vs. 21.9%, p=.03). In the year preceding the suicidal attempt, GPs identified depression significantly less often (42.0 vs. 63.4%, p=.001). In the preceding three months, GPs realized significantly less interventions: less psychological support (37.5 vs. 53.0%, p=.02), prescribed less antidepressants (28.6 vs. 54.8%, p<.0001) or psychotropic drugs (39.1 vs. 52.9%, p=.03) and made fewer attempts to refer to a mental health specialist (33.3 vs. 45.5%, p=.05).

Conclusion

With young adults who subsequently attempt suicide, GPs face particular difficulties compared to older adults, as a significant proportion of young adults were not seen in the previous six months, as GPs identified less depressions in the preceding year and were less active in managing in the preceding three months. Medical training and continuing medical education should include better instruction on challenges relative to addressing suicide risk in this particular population.

[The current state of mental health surveillance in France]

The purpose of health surveillance is to contribute to health planning, information and prevention. Surveillance involves repeated data collections based on epidemiological studies and follow-up of data collected from medical-administrative databases. This paper provides an overview of mental health surveillance in France and examines the relevance and limitations of the collected data.

METHOD

The prevalence of major depressive episodes (MDE) in the general population was recently examined in seven studies. Among these studies, the Health Barometers involved two data collections at a five-year interval using the same method. Mortality and hospitalization data are important for suicide and suicide attempt (SA) surveillance. Health insurance databases provide key information about psychotropic drug use and serious psychiatric illnesses defined as long-term.

RESULTS

The prevalence of 12‑month MDE remained stable at 7.8% between 2005 and 2010. Mortality data show a suicide rate of 16 per 100,000 inhabitants. Hospital data show that the rate of hospitalization for SAs is approximately ten times that of suicide. Data from emergency wards indicate that approximately 220,000 SAs are admitted to hospital emergency services every year. Currently, depressive disorders are the primary reason for new admissions under the ALD23.

DISCUSSION

A comparison of data from different sources is required to provide a basis for mental health surveillance in France and to help identify those populations that need to be targeted as a matter of priority by prevention measures.

Asthma and major depressive episode in adolescents in France

RATIONALE

The association between asthma and anxiety disorders in teenagers is well documented, but data about the association with mood disorders are scarce.

METHODS

We analyzed data from a cross-sectional study conducted among ninth grade schoolchildren in France in 2003-2004. The teenagers were selected by two-stage sampling and interviewed by school doctors/nurses using a standardized questionnaire including questions about asthma and asthma-like symptoms. They also completed a self-administered questionnaire in which the occurrence of major depressive episodes (MDEs) during the past 12 months was assessed by the Composite International Diagnostic Interview-Short Form.

RESULTS

A total of 7000 teenagers (mean age 15.1 years) were included. The prevalence of wheezing in the past 12 months was 10.0% and that of current asthma (wheezing in the past 12 months in children who had already had asthma attacks, or treatment for wheezing or asthma in the past 12 months) was 8.5%. The prevalence of MDE during the past year was 14.2% in teenagers with current asthma versus 9.2% among the others. The association between current asthma and past-year MDE remained significant after adjustment for age, gender, family structure, and the father's employment status. Asthma was uncontrolled (at least four attacks of wheezing, one awakening per week due to wheezing, one severe wheezing, four unplanned medical visits, or one hospitalization for a wheezing attack in the past year) in more than half (58.3%) of asthmatic teenagers with an MDE in the past year versus 35.3% of those without an MDE.

CONCLUSION

Asthma is associated with a higher prevalence of MDE. Among adolescents with asthma, MDE is associated with poorer asthma control. These findings highlight the need for a comprehensive care management of asthma in France that takes the psychological dimension into account.

Utilization of mental health services and risk of 12-month problematic alcohol use

OBJECTIVE

To examine whether mental health service utilization modifies the association between lifetime anxiety or depressive disorders (ADD) and risk of 12-month problematic alcohol use.

METHODS

Randomly selected members (n=6518) of a mutual health-insurance company were evaluated for lifetime ADD (DSM-IV), mental health service utilization for ADD, and risk of 12-month problematic alcohol use (DSM-IV and CAGE).

RESULTS

Risk of 12-month problematic alcohol use was reduced when mental health services had been used for several ADD (OR=3.3 vs 5.8), but not for one ADD.

CONCLUSIONS

These results show the importance of taking mental health service use into account as a potential effect-modifier of psychiatric comorbidity.

Medical and social differences between French and migrant patients consulting for the first time for HIV infection

The objectives of the study were to describe the medical and social characteristics of patients consulting for the first time after diagnosis of HIV-infection and to compare the medical and social characteristics between French and migrant patients. From 1 January 2001 to 31 December 2002, all consecutive adults consulting for the first time for HIV infection in two HIV outpatient clinics located in the western suburb of Paris, agreed to an interview based on an administered questionnaire regarding their medical and socioeconomic characteristics. Of the 203 patients (98 women, 105 men), one-third (n=70) was of French nationality. Delay (+/-SD) in access to HIV outpatient clinic after diagnosis was shorter in migrant than in French patients, respectively 7.6+/-29.6 months (median=0.5, range=0 to 196.6) and 23.8+/-51.4 months (median=0.9, range=0 to 199.7); p=0.005. There was no significant difference in the medical characteristics between the two groups of patients on their first consultation. However, most of the migrants were living in very poor socio-economic conditions with minimal resources thus sometimes delaying initiation of HAART. The development of social facilities for HIV-positive migrants should be a public health priority.