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.

Suicide and suicide attempts in the Pacific Islands: A Systematic Literature Review.

BACKGROUND: The Pacific Islands have some of the highest rates of suicide in the Western Pacific region. The purpose of this study was to systematically review the literature on suicidal behaviour in the Pacific Islands. METHODS: A comprehensive search of Web of Science, PubMed, PsycINFO, Cochrane, CINAHL and Embase databases was conducted for all articles published until 1st February 2021. Inclusion criteria included papers that referred to a pre-specified list of Pacific Islands. Papers referring exclusively to other countries were excluded. Other exclusion criteria included not being about suicide or suicide attempts or not presenting original research. Narrative synthesis was applied without meta-analysis. The review followed PRISMA guidelines. FINDINGS: A total of 36 papers were included for review. Of the Pacific Islands, Kiribati has the highest age-standardised rate of suicide mortality. Key risk groups across the Islands included youth, people of Indian ethnicity in Fiji (a prominent ethnic group in Fiji), and Indigenous peoples across other Islands. Prominent methods were self-poisoning and hanging. A distinct lack of intervention studies was found. INTERPRETATION: Overall, the Pacific Islands appear to have relatively high rates of suicide and suicide attempts compared to other countries in the region. This was particularly striking among youth. This review provides important directions for future suicide prevention activities, including means restriction, sensitive media/community coverage, enhanced surveillance, and the development and evaluation of interventions tailored to the needs of young people and other cultural groups. FUNDING: None.

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.

International study of definitions of English-language terms for suicidal behaviours: a survey exploring preferred terminology.

OBJECTIVES: Explore international consensus on nomenclatures of suicidal behaviours and analyse differences in terminology between high-income countries (HICs) and low/middle-income countries (LMICs). DESIGN: An online survey of members of the International Organisation for Suicide Prevention (IASP) used multiple-choice questions and vignettes to assess the four dimensions of the definition of suicidal behaviour: outcome, intent, knowledge and agency. SETTING: International. PARTICIPANTS: Respondents included 126 individuals, 37 from 30 LMICs and 89 from 33 HICs. They included 40 IASP national representatives (65% response rate), IASP regular members (20% response rate) and six respondents from six additional countries identified by other organisations. OUTCOME MEASURES: Definitions of English-language terms for suicidal behaviours. RESULTS: The recommended definition of 'suicide' describes a fatal act initiated and carried out by the actors themselves. The definition of 'suicide attempt' was restricted to non-fatal acts with intent to die, whereas definition of 'self-harm' more broadly referred to acts with varying motives, including the wish to die. Almost all respondents agreed about the definitions of 'suicidal ideation', 'death wishes' and 'suicide plan'. 'Aborted suicide attempt' and 'interrupted suicide attempt' were not considered components of 'preparatory suicidal behaviour'. There were several differences between representatives from HICs and LMICs. CONCLUSION: This international opinion survey provided the basis for developing a transcultural nomenclature of suicidal behaviour. Future developments of this nomenclature should be tested in larger samples of professionals, including LMICs may be a challenge.

The WHO/START study in New Caledonia: A psychological autopsy case series.

BACKGROUND: Limited information is available about suicidal behavior in the Pacific Islands. Forty percent of the New Caledonian population is indigenous Kanak; insights into the characteristics of suicide deaths in this population compared to other ethnic groups would be valuable. The aim of this paper is to deepen our understanding of the cultural underpinnings of suicide in New Caledonia by presenting the results of the WHO/START psychological autopsy study. METHOD: A case-series psychological autopsy study was conducted based on medical, police files, and interviews with relatives of 52 individuals who died by suicide in 2014 and 2015 in New Caledonia. RESULTS: Kanak indigenous individuals represented more than half of suicides. Prevalence of mental disorders was identified in 62% of suicide decedents; a previous suicide attempt was frequent (37% of cases). A serious argument with a partner was the most prevalent life event (60%). Few warning signs were present among young people and Kanak in general. CONCLUSION: Comparison with information on the general population suggests indigenous Kanak are more vulnerable and that having a mental health disorder plays an important role in suicide. Violent arguments with a partner could also be a major risk factor. Traditional protective factors (being employed, living with their family or partner, religion) appeared to have limited effect on suicide. Mental health promotion, prevention, and care should be prioritized. Prevention strategies, including domestic violence prevention are recommended in New Caledonia. Further research is needed to better identify young and Kanak subjects at risk of suicide.

Contemporary Classifications of Suicidal Behaviors.

Background: The absence of agreed-upon terminology, definitions, and operational classifications has hampered research in the field of suicidology for many decades. Aims and Method: We systematically reviewed contemporary classifications of suicidal behavior using the scope of the classification (comprehensive vs. restricted or single behaviors), and the presence or absence of a classification scheme and an operational definition of intent as features to enable analysis and comparison. Results: A chronological perspective shows that classification systems tend to be more and more precise and operational for clinical and research field work. However, on an international level, the development of classifications appears to precede the establishment of agreed-upon definitions and terms to describe suicidal behavior. Limitations: The review was conducted in English only. Conclusion: Universal agreement on definitions and terms for suicidal behavior should precede the development of classifications.

International Study of Definitions of English-Language Terms for Suicidal Behaviours: protocol of an opinion survey.

INTRODUCTION: The objective of present paper is to outline the methodology of the International Study of Definitions of English-Language Terms for Suicidal Behaviours (ISDELTSB). The aim of the study is to survey existing English language terms and definitions used around the world for suicidal behaviour. METHODS AND ANALYSIS: The ISDELTSB is a worldwide survey based on one 'designated expert' per each WHO-registered country. 'Experts' were contacted through the International Association for Suicide Prevention (IASP), the World Psychiatric Association and the World Organization of Family Doctors. Each individual was sent an invitation to participate and a link to an online questionnaire. A comparison sample was created by inviting all IASP members to respond to the questionnaire. The questionnaire was designed to assess respondents' preferences about a particular set of terms and definitions by using the four major criteria of the definition of suicide identified in the literature (outcome, intent, knowledge and agency). The questionnaire used a multiple-choice question format. Participants were asked to choose one term in the list for each of the proposed definitions. Statements and definitions in the questionnaire were elaborated using the four main features of the definition of suicide, starting by the definitions and terms for which there is already a certain degree of consensus and then progressing to definitions and terms less agreed on. ETHICS AND DISSEMINATION: The study protocol obtained approval of Griffith University's Ethics Committee (ethics reference number 2017/601) and in accordance with the Australian National Statement on Ethical Conduct in Human Research. Respondents are asked if they accept to be personally acknowledged in any output originating from this study, and if so to provide their full name, title and affiliations. If respondents do not accept, they are informed that the conduct of this research respects Griffith University's Privacy Plan and that identified personal information is confidential and that anonymity will at all times be safeguarded. As detailed in the questionnaire cover letter, by answering the online or paper version of the questionnaire, respondents express their consent to participate. Dissemination of results will be done through a peer-reviewed journal article publication. This study aims to map the international use of definitions and terms for suicidal behaviour and ideation and favour the future use of an internationally shared set of terms and definitions. This will hopefully avoid undue duplication of efforts and reliably permit meta-analysis of data produced in different countries.

Contemporary Definitions of Suicidal Behavior: A Systematic Literature Review.

To address the lack of comparability around the world, we conducted a systematic review of existing definitions of suicide and suicidal behaviors. In the literature, four key features appear to cover the vast majority of concepts underpinning definitions: agency, knowledge of a potential fatal outcome, intent, and outcome. Intent and outcome appear to be the most consensual features of definitions of suicide, albeit revealing interesting conceptual variations. The four key features could be used to devise a research tool able to explore the meanings of suicide across different countries and different cultures.

Contemporary Nomenclatures of Suicidal Behaviors: A Systematic Literature Review.

Addressing the lack of comparability of research results around the world, a systematic literature review of existing nomenclatures was conducted. After distinguishing the concepts of nomenclature and classification, 13 contributions to nomenclature of suicidal behavior are described and summarized using outcome and intent as guiding concepts for analysis. The issue of what is being defined in nomenclatures is fundamental and impacts the way intent and outcome are used. The existing confusion between classification and nomenclature stems from conflicting purposes of the nature of definition; that is, to communicate concepts versus to be descriptive of reality.