"A sign that I am not alone": A grounded theory-informed qualitative study on spirituality after suicide bereavement.

Suicide bereavement is known to be highly distressing and to negatively affect the mental health of the bereaved. The role of religion and spirituality after suicide bereavement remains understudied. We aimed to specifically explore the role of spirituality after suicide bereavement by conducting a qualitative study through semi-structured interviews with fifteen people bereaved by suicide. The grounded theory-informed thematic analysis identified five main themes, namely "continuing bonds with the deceased," "lightening the burden," "grounded spirituality," "perceptual and conceptual shift" and "the movement of giving." For many participants, spirituality was a resource that facilitated the process of accepting their loss by offering a larger entity to which to hand over their suffering. Moreover, the continuing bonds with the deceased helped them to get through this ordeal. Our results can enable mental health professionals to better understand how spirituality can facilitate post-traumatic growth in people bereaved by suicide.

The use of social media after bereavement by suicide: results from a French online survey.

BACKGROUND: According to recent research, the Internet and social media are shaping and changing how we die and mourn. However, the use of social media after bereavement by suicide remains poorly understood. Thus, emerging research is needed to better assess the role that social media can play after bereavement by suicide. The objective of our study was to evaluate the use of social media in French people bereaved by suicide and to assess their expectations toward social media. METHOD: We conducted a national cross-sectional online survey including French people bereaved by suicide assessing their use of social media after the death of their relative. All adults bereaved by suicide were eligible to participate in the study. An online 26-item questionnaire collected sociodemographic and loss-related characteristics and evaluated four dimensions: (1) the use of social media in daily life, (2) the perceived needs regarding suicide bereavement, (3) the use of social media associated with the suicide loss, and (4) the expectations regarding the development of an online resource for people bereaved by suicide and proposals regarding the development of such a resource. RESULTS: Among 401 participants, 61.6% reported using social media after the death of their relative by suicide, especially those recently bereaved, those receiving counseling and bereaved parents. The participants mainly used social media to reach peers bereaved by suicide and to memorialize, while they expected social media to help them finding information on suicide and accessing bereaved peers. Younger participants were more prone to use social media to memorialize, while bereaved partners and those bereaved by the suicide of a parent were less prone to use them with such aim. DISCUSSION: A large part of people bereaved by suicide use social media for their grief process, mainly to contact peers bereaved by suicide and to memorialize their loved one. According to or results, social media contributes to contemporary grief processes after suicide bereavement and can be seen as putative means to improve the well-being of people bereaved by suicide.

Mental health outcomes of multiracial individuals: A systematic review between the years 2016 and 2022.

BACKGROUND: Emerging evidence suggests that multiracial individuals are at high risk for mental health problems. Systematic and ongoing synthesis of literature is necessary to understand mental health among multiracial individuals. METHODS: We conducted a systematic review of scholarly articles published during the years 2016-2022. Studies must have focused explicitly on mental health outcomes of biracial/multiracial individuals using quantitative methods. A total of 22 articles met criteria for this review. RESULTS: Studies were mainly from the United States, with one study from the United Kingdom and one from the Netherlands. Sample sizes ranged from 57 to 393,681. Findings revealed a complicated picture between multiracial identity and mental health, which may be a function of how multiracial identity is defined and empirically examined. Among studies comparing multiracial individuals with monoracial groups, multiracial individuals tended to have worse mental health, with notable exceptions depending on the multiracial subgroup, the mental health outcome, and the reference group. Among studies that only examined multiracial individuals, discrimination and ethno-racial identity emerged as complex explanatory factors that can shape mental health, though each of these constructs can be explored more deeply across social milieu. LIMITATIONS: The review focused on studies explicitly examining multiracial mental health, published during a limited time frame. CONCLUSION: Multiracial individuals tended to have worse mental health outcomes compared to their monoracial counterparts, with variations depending on the outcomes, populations/subgroups, contexts, and reference groups. Racial discrimination and ethno-racial identity may shape mental health trajectories of multiracial people, calling for more research to inform targeted interventions.

Evaluation of the level of training of French psychiatrists on borderline personality disorder: An online survey.

BACKGROUND: Borderline personality disorder is a common and treatable personality disorder that is often underdiagnosed and untreated, mainly due to a lack of training of psychiatrists and to a lack of accessibility to specialized therapies. However, no study has been conducted in France regarding this issue. Thus, we aimed to evaluate on a national scale the level of training, knowledge, and general attitude toward BPD diagnosis of French psychiatrists. METHODS: We conducted an online survey in an unselected population of residents and senior French psychiatrists between January and March 2022, the results of which are presented descriptively. RESULTS: 228 psychiatrists fully answered the questionnaire, and 21 more psychiatrists answered it partially. We found that most of the responders were unsatisfied with the residency training or the continuing medical education offered regarding BPD, a lack of training resulting in a low level of self-confidence regarding BPD management, in a low number of evidence-based therapies trained psychiatrists in issues regarding diagnostic disclosure, and in misconceptions regarding some aspects of the disorder. CONCLUSIONS: These results underlie a clear lack of training of French psychiatrists, as well as a request from the latter for more opportunities to learn. This calls for a rethinking of the teaching system to incorporate more knowledge and tools related to BPD.

Psychiatric trainees as second victims after exposure to patient suicide: a French qualitative study.

Background: The exposure to patient suicide (PS) has been identified as one of the most frequent and troubling professional experience for psychiatric trainees. Further studies are needed to better understand how residents cope with these experiences and the association between perceived support and the impacts of PS. Method: In this qualitative study, we aimed to assess the impact of exposure to PS during psychiatric residency on trainees' professional career and practical experience. A total of 19 French psychiatric residents participated in 4 focus-groups performed between November 2017 and May 2019. Results: A total of 4 thematic clusters were identified through a five-step content analysis, namely: (a) reactions to the exposure; (b) coping strategies; (c) professional impact; and (d) prevention and postvention proposals. All participants described the critical impact of the support provided after PS, especially by their senior staff. Those who felt supported by their superior reported less negative impact, both in emotional and professional dimensions. Participants also shared proposals to improve the prevention and postvention issues related to the exposure to PS. Conclusion: We performed the first qualitative study based on focus groups on the impact of PS on psychiatric residents, which allowed for an in-depth understanding of the participants' lived experiences of the exposure to PS. The narratives inform the need and means to implement prevention and postvention strategies designed to buffer the negative impact of the exposure to PS in psychiatric trainees.

Sexual Minority Status and Psychotic Experiences Among Young Adult College Students in the United States.

2020-2021 Healthy Minds Study, and used multivariable logistic regression to examine the associations between sexual minority status and psychotic experiences, adjusting for age, gender, and race/ethnicity. We then tested whether psychosocial factors accounted for the association. Sexual minority status was associated with 1.87 times greater odds of having psychotic experiences over the past 12 months (aOR: 1.87; 95% CI: 1.77-1.99; N = 110,551). Several factors mediated the association between sexual orientation and psychotic experiences such as loneliness (26.93%), anxiety (30.90%), depression (33.18%), and marijuana use (13.95%); all factors together accounted for 59.01% of the association between sexual minority status and psychotic experiences. Food insecurity, recent abuse, and discrimination did not significantly mediate the association. Findings should raise clinical awareness that psychotic experiences are more common among sexual minorities than among heterosexuals, which is largely explained by mental health factors, calling for targeted outreach and intervention.

The Needs, Use and Expectations of People Bereaved by Suicide Regarding Online Resources: An Online Survey.

BACKGROUND: Online resources constitute a new and effective way to obtain support or information during bereavement processes. However, little is known about the needs, use and expectations of people bereaved by suicide regarding online resources. METHOD: The objective of our national cross-sectional online survey was to collect the use, needs and expectations of people bereaved by suicide regarding online resources. The data were collected from July to October 2021 through a 26-item online questionnaire hosted on the website LimeSurvey. RESULTS: A total of 401 respondents fully completed the questionnaire. Their mean age was 45.7. The majority of participants were women bereaved by the suicide of their child or partner. Half of the participants were bereaved for less than 3 years and benefited from counselling during their bereavement process. Three-quarters of the participants used the Internet for their bereavement process, mainly to obtain information on suicide bereavement and suicide prevention and to access testimonies of other people bereaved by suicide. Three-quarters of the participants found that available online resources for people bereaved by suicide are insufficient and expected a dedicated web platform to be developed. Finding information on suicide bereavement and on suicide prevention, discussing with a mental health professional and accessing testimonies of other people bereaved by suicide were expected by a majority of the participants regarding the future platform. Receiving counselling and being bereaved by the death of a child were the most important factors in explaining patterns of use and expectations regarding online resources. DISCUSSION: Our results offer precise insights into the needs, use and expectations of people bereaved by suicide regarding online resources. The development of web platforms offering access to reliable information on suicide bereavement and on suicide prevention to peers bereaved by suicide and help to seek counselling are urgently needed.

Lived Experiences of Suicide Bereavement within Families: A Qualitative Study.

BACKROUND: The lifetime prevalence of suicide exposure in the family is estimated at 3.8% in the general population. Familial bonds can constitute a crucial factor in determining individual bereavement outcomes via the interactional and communicational aspects of the bereavement process within the family. However, the literature on the lived experiences of suicide bereavement within the family remains scarce. METHOD: Our objectives were to qualitatively (a) assess the impact of suicide on different types of family members, (b) evaluate the interactions between the familial and individual bereavement processes, and (c) obtain precise insights into the familial interactions that occur following a suicide. We performed a qualitative study by conducting semidirected interviews with family members who had been bereaved by suicide. Computer-based and manual thematic analyses were used for data analysis. In order to mitigate biases related to the qualitative design of the data collection, two main measures were undertaken, namely triangulation and saturation. RESULTS: Sixteen family members bereaved by suicide participated in our study, including a majority of women (n = 12). Mean age of participants was 56.4 and mean duration of suicide bereavement was 10.5 years. Most of the relatives deceased by suicide were middle-aged men who died by hanging or firearm. A total of six themes emerged from the analyses, namely (1) "familial trauma", (2) "external adversity", (3) "individual bereavement and familial interactions", (4) "communicational and relational processes within the family", (5) "perceived help and support within the family" and (6) "evolution over time". CONCLUSION: We reported that suicide bereavement significantly impacts internal familial interactions via complex emotional and communication processes. Family conflicts, taboos or cohesion can occur in the aftermath of a suicide. We also found that familial coping strategies can shape individual reactions to the death on the part of each member of the family.

Patients' and relatives' views on unmet mental health care needs through a qualitative study: Symptoms are a major barrier.

Unmet needs in mental health care are a prominent issue and concern almost half of people with such disorders. Psymobile is a mobile outreach psychiatric team whose objective is to facilitate access to psychiatric services. Its intervention is at the request of relatives or social workers, making it possible to encounter situations of long-standing unmet needs. Our objective was to understand the barriers to accessing mental health care as perceived by patients and their relatives. We conducted a qualitative study with patients and their relatives using face-to-face semi-structured interviews and a hierarchical thematic analysis. Four major themes were identified: psychological and behavioural barriers, socio-economic barriers, structural barriers and physical barriers. Anosognosia or lack of insight is cited as a primary barrier, as are fear of stigma, and former negative experiences. The complexity of the French care system and the lack of literacy about mental illnesses were also emphasized by the participants. Physical determinants, such as the distance to healthcare facilities, were rarely mentioned. As a conclusion, outreach teams appear to be an appropriate way to address the issue of unmet mental health care needs when they provide psychiatric care.

Investigating Predictive Factors of Suicidal Re-attempts in Adolescents and Young Adults After a First Suicide Attempt, a Prospective Cohort Study. Study Protocol of the SURAYA Project.

Introduction: Suicide is the fourth leading cause of death in youth. Previous suicide attempts are among the strongest predictors of future suicide re-attempt. However, the lack of data and understanding of suicidal re-attempt behaviors in this population makes suicide risk assessment complex and challenging in clinical practice. The primary objective of this study is to determine the rate of suicide re-attempts in youth admitted to the emergency department after a first suicide attempt. The secondary objectives are to explore the clinical, socio-demographic, and biological risk factors that may be associated with re-attempted suicide in adolescents and young adults. Methods: We have developed a single-center prospective and naturalistic study that will follow a cohort of 200 young people aged 16 to 25 years admitted for a first suicide attempt to the emergency department of Lyon, France. The primary outcome measure will be the incidence rate of new suicide attempts during 3 months of follow-up. Secondary outcomes to investigate predictors of suicide attempts will include several socio-demographic, clinical and biological assessments: blood and hair cortisol levels, plasma pro- and mature Brain-Derived Neurotrophic Factor (BDNF) isoforms proportion, previous infection with toxoplasma gondii, and C-Reactive Protein (CRP), orosomucoid, fibrinogen, interleukin (IL)-6 inflammatory markers. Discussion: To our knowledge, the present study is the first prospective study specifically designed to assess the risk of re-attempting suicide and to investigate the multidimensional predictive factors associated with re-attempting suicide in youth after a first suicide attempt. The results of this study will provide a unique opportunity to better understand whether youth are an at-risk group for suicide re-attempts, and will help us identify predictive factors of suicide re-attempt risk that could be translated into clinical settings to improve psychiatric care in this population. Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT03538197, first registered on 05/29/2018. The first patient was enrolled 05/22/2018.

Psychotic experiences, sexual minority status, and suicidal behavior among young adult college students in the United States.

Psychotic experiences significantly predict suicidal behaviors; however, it is unknown whether these associations are conditional on sexual minority status. We analyzed cross-sectional data from the Healthy Minds Study (N = 109,975), which was collected between September 2020 and June 2021 from young adult (aged 18-34) students from across 140 colleges across the United States. Having psychotic experiences and sexual minority status were associated with significantly greater odds of reporting suicidal ideation, suicide plan, and suicide attempt, adjusting for sociodemographic characteristics. We found significant interactions between psychotic experiences and sexual minority status, such that the relations between psychotic experiences and suicidal behaviors were stronger among heterosexual students than among sexual minority students. However, the interactions disappeared for suicidal ideation and plans after adjusting for socio-behavioral risk factors. Future research can explore whether psychotic experiences predict suicide attempts among sexual minority status behavior socio-behavioral risk factors.

Perception of the use of a telephone interpreting service during primary care consultations: A qualitative study with allophone migrants.

OBJECTIVES: The language barrier prevents allophone migrant patients from accessing healthcare when arriving in a country, and interpreters are often needed to help them to be understood. This study aimed to understand perceptions and experiences of allophone migrant patients who used a telephone-interpreting service during primary care consultations. STUDY DESIGN: A qualitative study using semi-structured interviews was undertaken between September 2019 and January 2020. Interviews were transcribed and analysed using thematic analysis framework. SETTING: Allophone migrant patients from an accommodation centre for asylum-seekers who used a telephone-interpreting service during primary care consultations with a general practitioner. PARTICIPANTS: A purposive sample of allophone migrant patients (n = 10). RESULTS: From the semi-structured interviews, we identified three themes: (1) multi-level difficulties of being an allophone migrant in the primary care pathway (i.e., before, during, and after the consultation); (2) the key role of the interpreter in the doctor-patient relationship, participating in improving the patient's management by establishing a climate of trust between the two; and (3) advantages and limitations of the TIS. However, even if a telephone-interpreting service is very helpful, allowing quick access to interpreters speaking the allophone patient's native language, certain situations would require the interpreter to see the patient to better guide the doctor during the consultation. CONCLUSION: Telephone-interpreting services enable improving communication and comprehension between allophone migrant patients and doctors. Nevertheless, the interpreter may sometimes need to physically see the patient to better guide the doctor. To do so, interpreting services using videoconferencing deserve wider development.

An integrative systematic review of online resources and interventions for people bereaved by suicide.

Suicide bereavement is frequent in the general population and it can have deleterious consequences on the mental health and social functioning of the bereaved individuals. However, those bereaved can face substantial barriers to receive support, and online resources may improve the accessibility of support. This systematic review aimed at examining the use and benefits of online resources dedicated to people bereaved by suicide and appraising the quality of the research in this field. Systematic review according to PRISMA guidelines, involving searches in Pubmed, Scopus and Web of Science, conducted in August 2020. The integrative systematic review involved extracting and merging qualitative and quantitative data. Quality assessment was conducted with the Mixed Methods Appraisal Tool (MMAT). The review included 12 studies, mostly of moderate quality. Online resources are predominantly used by middle-aged women, parents who lost their child by suicide, and recently bereaved individuals. Online resources offer a way for help-seeking around the clock for less educated, more disadvantaged and isolated people. People bereaved by suicide use online resources to seek and share support, share and find information, memorialize their loved one and for meaning-making. Negative effects of online resources are rare. The evidence on the use and benefits of online resources for people bereaved by suicide remains scarce but show encouraging results regarding their positive impact on the mental and psychosocial health of the users.

Can seizure therapies and noninvasive brain stimulations prevent suicidality? A systematic review.

BACKGROUND: Suicide is a major public health issue and the majority of those who attempt suicide suffer from mental disorders. Beyond psychopharmacotherapy, seizure therapies and noninvasive brain stimulation interventions have been used to treat such patients. However, the effect of these nonpharmacological treatments on the suicidal ideation and incidence of suicidality remains unclear. Here, we aimed to provide an update on the effects of seizure therapies and noninvasive brain stimulation on suicidality. METHODS: We conducted a systematic review of the literature in the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Elsevier ScienceDirect, and Wiley Online Library databases using the MeSH terms "Electroconvulsive Therapy", "Magnetic Seizure Stimulation", "repetitive Transcranial Magnetic Stimulation", "transcranial Direct Current Stimulation", "Cranial Electrostimulation" and "suicide". We included studies using seizure therapies and noninvasive brain stimulation as a main intervention that evaluated suicidality, regardless of diagnosis. RESULTS: Among 1,019 records screened, 26 studies met the inclusion criteria using either electroconvulsive therapy (n = 14), magnetic seizure therapy (n = 2), repetitive transcranial magnetic stimulation (n = 9), or transcranial direct current stimulation (n = 1). We observed that studies reported significant results, suggesting these techniques can be effective on the suicidal dimension of mental health pathologies, but a general statement regarding their efficacy is premature due to limitations. CONCLUSIONS: Future enquiry is necessary to address methodological limitations and evaluate the long-term efficacy of these methods both alone and in combination with pharmacotherapy and/or psychotherapy.

Medical students attitudes toward and intention to work with the underserved: a systematic review and meta-analysis.

BACKGROUND: Experts in the field of medical education emphasized the need for curricula that improve students' attitudes toward the underserved. However, some studies have shown that medical education tends to worsen these attitudes in students. We aimed at systematically reviewing the literature assessing the change in medical students' attitudes toward the underserved and intention to work with the underserved throughout medical education, the sociodemographic and educational factors associated with favorable medical student attitudes toward and/or intention to work with the underserved and the effectiveness of educational interventions to improve medical student attitudes toward and/or intention to work with the underserved. METHOD: We conducted a systematic review on MEDLINE, Scopus, and Web of Science databases. Three investigators independently conducted the electronic search. We assessed the change in medical students attitudes toward the underserved by computing a weighted mean effect size of studies reporting scores from validated scales. The research team performed a meta-analysis for the sociodemographic and educational factors associated with medical students attitudes toward and/or intention to work with the underserved. RESULTS: Fifty-five articles met the inclusion criteria, including a total of 109,647 medical students. The average response rate was 73.2%. Most of the studies were performed in the USA (n = 45). We observed a significant decline of medical students attitudes toward the underserved throughout medical education, in both US and non-US studies. A moderate effect size was observed between the first and fourth years (d = 0.51). Higher favorable medical students attitudes toward or intention to work with the underserved were significantly associated with female gender, being from an underserved community or ethnic minority, exposure to the underserved during medical education and intent to practice in primary care. Regarding educational interventions, the effectiveness of experiential community-based learning and curricula dedicated to social accountability showed the most positive outcome. CONCLUSIONS: Medical students attitudes toward the underserved decline throughout medical education. Educational interventions dedicated to improving the attitudes or intentions of medical students show encouraging but mixed results. The generalizability of our results is impeded by the high number of studies from the global-North included in the review.

Impact of exposure to severe suicidal behaviours in patients during psychiatric training: An online French survey.

AIM: Patient suicide (PS) has been identified as a frequent and stressful "occupational hazard" for mental health professionals. Studies are needed to assess the impact on psychiatric trainees of the exposure to severe patient suicidal behaviours. METHODS: Our cross-sectional study aimed to measure the prevalence of exposure to PS and severe patient suicide attempts (SPSA) in French psychiatric trainees. We also assessed the emotional, traumatic and professional impacts and perceived support in the aftermath through a 62-item online questionnaire that included the French version of the IES-R, a composite emotional score and questions about professional practice and perceived support. All French psychiatric trainees were contacted regarding participation in the study through email and social networks between November 2017 and March 2018. RESULTS: A total of 409 trainees participated in the survey (response rate = 16.4%). 253 trainees fully completed the questionnaire. Of the 253 trainees, 43.2% were exposed to PS and 13.8% to SPSA. The exposure mostly occurred in the early stage of the training period. Ten to 15% of exposed trainees showed a high level of traumatic and emotional impact and 8.1% exhibited clinically relevant symptoms of post-traumatic stress disorder (PTSD). We found that 21.6% received no support in the aftermath, especially after PS. CONCLUSION: A large proportion of psychiatric trainees encounter severe suicidal behaviours of patients, and a substantial part of them is highly impacted. Our results thus stress the need for programmes dedicated to the prevention of the deleterious effects of the exposure to PS or SPSA in psychiatric trainees.

Development of an Online Resource for People Bereaved by Suicide: A Mixed-Method User-Centered Study Protocol.

Introduction: Suicide bereavement is known to be highly distressing and is frequently associated with mental health problems. Despite high-level of need regarding mental and physical health, people bereaved by suicide display low level of help-seeking and perceived support in the aftermath of the loss. The lack of accessibility and reliability of face-to-face counseling resources is notably reported by suicide survivors. Online resources can enhance early access to help and support for people bereaved by suicide. The primary objective of the study is to design and implement an innovative and adaptive online resource for people bereaved by suicide according to their needs and expectation regarding online solutions dedicated to suicide bereavement. Methods: The ESPOIR2S study is a mixed-method user-centered study. ESPOIR2S seeks to build the resource from the perspectives and needs of both people bereaved by suicide and professionals or volunteers working in the field of postvention. The Information System Research (ISR) Framework is used to guide the design of the study through a 3-step research cycle. The structure of the ESPOIR2S study relies on a simultaneous collection of qualitative and quantitative data which will be collected and analyzed during (a) the Relevance cycle through an online questionnaire and focus groups; (b) the Design cycle through focus groups; and (c) and the Rigor cycle through an online questionnaire and semi-structured interviews. The user-centeredness will be ensured by the active participation of people bereaved by suicide, members of associations for bereaved people and professionals of postvention. Discussion: The mixed-method and user-centered design of the ESPOIR2S study will offer an in-depth collection of the needs and expectation of suicide survivors regarding online resources. Through the implementation of an adaptive online solution, we aim to enhance the access to help and support for suicide survivors which are highly correlated with well-being and recovery.

Suicidal behaviors and ideation during emerging viral disease outbreaks before the COVID-19 pandemic: A systematic rapid review.

The current COVID-19 pandemic is the most severe pandemic of the 21st century, on track to having a rising death toll. Beyond causing respiratory distress, COVID-19 may also cause mortality by way of suicide. The pathways by which emerging viral disease outbreaks (EVDOs) and suicide are related are complex and not entirely understood. We aimed to systematically review the evidence on the association between EVDOs and suicidal behaviors and/or ideation. An electronic search was conducted using five databases: Medline, Embase, Web of Science, PsycINFO and Scopus in April 2020. A rapid systematic review was carried out, which involved separately and independently extracting quantitative data of selected articles. The electronic search yielded 2480 articles, of which 9 met the inclusion criteria. Most of the data were collected in Hong Kong (n = 3) and the USA (n = 3). Four studies reported a slight but significant increase in deaths by suicide during EVDOs. The increase in deaths by suicide was mainly reported during the peak epidemic and in older adults. Psychosocial factors such as the fear of being infected by the virus or social isolation related to quarantine measures were the most prominent factors associated with deaths by suicide during EVDOs. Overall, we found scarce and weak evidence for an increased risk of deaths by suicide during EVDOs. Our results inform the need to orient public health policies toward suicide prevention strategies targeting the psychosocial effects of EVDOs. High-quality research on suicide risk and prevention are warranted during the current pandemic.

The SUPPORT-S Protocol Study: A Postvention Program for Professionals After Patient or User Suicide.

BACKGROUND: Exposure to patient or user suicide (PUS) is identified as a challenging occupational hazard for mental health and social work professionals. Professionals exposed to PUS may encounter several ranges of emotional, traumatic or professional impacts in the aftermath. A high proportion of exposed professionals reports a lack of support in the aftermath of PUS. SUPPORT is a postvention program designed to provide a comprehensive, adaptative and effective support to professionals impacted by PUS. The aims of the SUPPORT-S study are to (1) improve the design of the SUPPORT program, (2) evaluate the effectiveness of the program to buffer the emotional, traumatic and professional impacts and to improve the perceived social support for professionals exposed to PUS, and (3) provide more insights into the consequences of PUS on both professionals and organizations. METHOD: The SUPPORT-S study is a mixed method collaborative and participatory action research. The simultaneous and complementary collection and analysis of qualitative and quantitative data will offer an in-depth evaluation of the implementation and the effectiveness of the program. The qualitative evaluation includes: (a) an ethnographic observation; (b) 25 semi-directed interviews with randomized participants; (c) an activity analysis with providers of the program; and (d) collaborative sharing of the results with providers and participants. The quantitative evaluation includes pre- and post-measures in participants of: (a) emotional impact (Differential Emotions Scale IV); (b) traumatic impact (Impact of Event Scale-Revised); (c) professional impact (non-validated questionnaire); and (d) perceived social support (Perceived Social Support Scale for Professionals). The action research design will rely on: (a) the cycling process of implementation/evaluation/data sharing/adjustment and (b) the participatory approach through data sharing with providers and participants. Triangulation, saturation, randomization, and participatory design will also reduce the risk of biases and will improve the generalizability of conclusions. EXPECTED RESULTS: We expect the SUPPORT-S study to evaluate and improve the design of the SUPPORT program to effectively help professionals to cope with PUS. CONCLUSION: The results of the study will allow us to disseminate an effective and adaptive postvention program for professionals and institutions encountering PUS.