Prevalence of suicidal thoughts and behaviors among young adults between 2000 and 2021: Results from six national representative surveys in France.

The study examines the prevalence of 12-month suicidal thoughts and lifetime suicide behaviors among young adults between 2000 and 2021. Data were drawn from the Health Barometer survey, a cross-sectional survey on a French national representative sample. The 2000, 2005, 2010, 2014, 2017, and 2021 survey waves were pooled to examine time trends in 12-month suicidal thoughts and lifetime suicidal behaviors among respondents aged 18 to 25 (n = 13,326), categorized based on sex and on their occupational status: students, those employed, and those who are neither in employment, education or training (NEETs). The 12-month prevalence of suicidal ideation among young adults in 2021 (6.8 %) is no different from that of 2000 (7.0 %), despite a U-shape curve in between. In contrast, the overall prevalence of lifetime suicide attempts was significantly higher in 2021 as compared to what was observed on average in the previous 21 years. In multivariate models, females and NEETs were overall at greatest risk for suicidal ideation and suicidal behaviors. Additional attention and prevention efforts are needed to reach young adults who are neither in employment, education or training.

Prevalence of past-year major depressive episode among young adults between 2005 and 2021: Results from four national representative surveys in France.

BACKGROUND: The objectives are to examine time trends in the prevalence of past year major depressive episode (MDE) among young adults, and to identify differences by occupational status comparing students, those employed, and those who are not in employment, education or training (NEET). METHODS: Data were drawn from the Health Barometer survey, a cross-sectional computer-assisted telephone interview survey on a national representative sample of residents of metropolitan France and conducted approximately every 5 years. The surveys relied on the Composite International Diagnostic Interview-Short Form to determine the presence of DSM-IV past-year major depressive episode. Data from the 2005, 2010, 2017, and 2021 surveys were pooled and respondents aged 18 to 25 were selected (n = 7556) and categorized based on their occupational status: students, those employed, and NEET. RESULTS: Overall, significant differences in the prevalence of MDE was observed by occupational status: NEET had the highest rate (18.5 %) followed by students (14.3 %) and those employed (11.0 %). The prevalence of MDE among young adults was 10.1 % in 2005, 9.7 % in 2010 and 11.3 % in 2017, reflecting a stable prevalence between 2005 and 2017. The prevalence then nearly doubled in 2021, with 20.9 % of MDE, with a significant increase of 9.6 points between 2017 and 2021. LIMITATIONS: No assessment of lifetime psychopathology. CONCLUSIONS: The prevalence of major depression among young adults significantly increased between 2005 and 2021, those at greatest risk are females and those not in employment, education or training. The contribution of pandemic-related factors may be elucidated in future national health surveys.

Mental health of pregnant women during the SARS-CoV-2 pandemic in France: Evolution of self-perceived psychological state during the first lockdown, and anxiety frequency two months after the lockdown ended.

Previous pandemics and related lockdowns have had a deleterious impact on pregnant women's mental health. We studied the impact of the SARS-CoV-2/Covid-19 pandemic and France's first lockdown on pregnant women's mental health. A cross-sectional study was conducted in July 2020 using a web-questionnaire completed by 500 adult women who were pregnant during the first lockdown in France (March-May 2020). Questions focused on their self-perceived psychological state and affects they felt before and during the lockdown and anxiety symptomatology (HAD) two months after it ended. A robust variance Poisson regression model was used to estimate adjusted prevalence ratios (aPR) for anxiety and self-perceived psychological state evolution. One in five respondents (21.1%) reported psychological deterioration during lockdown. Associated determinants were: i) little or no social support (self-perceived) (aRP = 1.77, 95%CI[1.18-2.66]), ii) increased workload (1.65, [1.02-2.66]), and iii) poor/moderate knowledge about SARS-CoV-2 transmission (1.60, [1.09-2.35]). Seven percent of women reporting psychological deterioration had access to professional psychological support during lockdown, while 19% did not despite wanting it. Women reported heightened powerlessness (60.3%), frustration (64%) and fear (59.2%) during lockdown. One in seven respondents (14.2%, 95%CI[10.9-18.2]) had anxiety symptoms. Determinants associated: i) at least one pregnancy-related pathology (aPR = 1.82, 95%CI[1.15-2.88]), ii) overweightness or obesity (1.61, [1.07-2.43]), iii) one child under the age of six years in the household during the lockdown (3.26, [1.24-8.53]), iv) little or no social support (self-perceived) during the lockdown (1.66, [1.07-2.58]), v) friend or relatives diagnosed with Covid-19 or with symptoms of the disease (1.66; [1.06-2.60]), vi) no access to medication for psychological distress (2.86, [1.74-4.71]), and vii) unsuccessfully seeking exchanges with healthcare professionals about their pregnancy during the pandemic (1.66, [1.08-2.55]). Our results can guide prevention and support policies for pregnant women during pandemics, current or future, with or without lockdowns. Preventing perinatal mental health problems is essential to ensure a supportive environment for the child's development.

Suicidal ideation and mental health care: Predisposing, enabling and need factors associated with general and specialist mental health service use in France.

BACKGROUND: Population-based studies have shown that less than one in two individuals reporting suicidal ideation also report past-year mental health service use. Only a few studies have looked at different types of providers consulted. There is a need to better understand the factors associated with different provider combinations of mental health service use in representative samples of individuals with suicidal ideation. AIMS: The aim of the current study is to assess, using Andersen's model of healthcare seeking behaviors, the predisposing, enabling and need factors associated with type of mental health service use in adults with past-year suicidal ideation. METHODS: Data were drawn from the 2017 Health Barometer survey, a representative sample of the general population aged 18 to 75 years, among whom 1,128 respondents had reported suicidal ideation in the past year were analyzed. Past-year outpatient mental health service use (MHSU) was categorized into mutually exclusive groups as no use, general practitioner (GP) only; mental health professional (MHP) only; and both GP and MHP. Multinomial regression analyses were used to model mental health service use as a function of predisposing, enabling and need factors. RESULTS: Overall, 44.3% reported past-year MHSU and this was higher in females than males (49.0% vs. 37.6%). Prevalence of GP only use in the overall sample was 8.7%, consulting with GP and MHP was 21.3%, consulting with MHP only was 14.3%. Higher education was associated with increased MHP use. Residing in a rural area was associated with increased GP only use. Presence of a suicide attempt within the year, a major depressive episode and role impairment were associated with consulting a GP and MHP, and MHP only, but not GP only. CONCLUSIONS: When controlling for need and predisposing factors, socio-economic factors related to employment and income were associated with higher levels of consulting with mental health professionals.

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.

Association between the experience of sexual violence and insomnia in a national sample of French adults.

PURPOSEL: The experience of sexual violence has been associated with sleeping disorders; however, few studies have examined this association using a large sample of the general population. This study investigates whether lifetime experience of sexual violence and childhood experience of sexual violence are associated with insomnia. METHODS: Our study is based on data from the 2017 French Health Barometer, a general population phone cross-sectional survey, which included 25 319 adults aged 18-75 years in 2017. Questions regarding sleep quality were asked to 12 560 participants, and insomnia was defined according to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). We conducted adjusted Log-binomial regressions to examine the association between the experience of sexual violence and insomnia by calculating adjusted Prevalence Ratios (PRa; 95% CI). RESULTS: The weighted prevalence of insomnia was 13.5%, with women more affected than men (17.9% vs 9.6%). The prevalence of lifetime experience of sexual violence was around 3 times higher among those who suffer from insomnia (12.3%) compared to those who do not (4.5%). The adjusted associations between lifetime experience of sexual violence and insomnia, as well as between childhood experience of sexual violence and insomnia were both statistically significant (PRa = 1.79; 95% CI: 1.59-2.02; and PRa = 1.42; 95% CI: 1.23-1.64 respectively). CONCLUSIONS: Sexual violence could explain the substantial sex-difference in insomnia. Our findings reiterate the importance of systematically screening for sexual violence among patients suffering from sleep disorders to propose adequate trauma-informed interventions.

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.

Non-presentation at hospital following a suicide attempt: a national survey.

BACKGROUND: A few previous studies suggest that a large number of individuals do not present at hospital following a suicide attempt, complicating recurrence prevention and prevalence estimation. METHODS: Data were extracted from a regular phone survey in representative samples of the French population aged 18-75 years old. Five surveys between 2000 and 2017 collected data about the occurrence of a previous suicide attempt and subsequent care contacts. A total of 102,729 individuals were surveyed. Among them, 6,500 (6.4%) reported a lifetime history of suicide attempt. RESULTS: Following their last suicide attempt, 39.3% reported they did not present to hospital (53.4% in 18-24 year-olds), with limited changes in rates with time. Risk factors for non-presentation were being male [adjusted odds ratio = 1.3, 95% confidence interval (1.1-1.5)], living with someone [1.2 (1.0-1.4)], being a non-smoker [1.4 (1.2-1.6)], and being younger at time of attempt [0.97 (0.96-0.98) per year]. Of those who did not present to hospital, only 37.7% reported visiting a doctor or a psychiatrist/psychologist after their act v. 67.1% in those who presented to hospital (as a second health contact). In both cases, half disclosed their act to someone else. Prevalence rates of suicide attempts reported in community were 4.6 times higher than those in hospital administrative databases. CONCLUSIONS: This survey at a national level confirmed that a large proportion of individuals does not go to the hospital and does not meet any health care professionals following a suicidal act. Assessment of unmet needs is necessary.

Witnessing interparental violence in childhood and symptoms of depression in adulthood: data from the 2017 French Health Barometer.

BACKGROUND: Every year, it is estimated that 143 000 French children are exposed to interparental violence (IPV). This exposure may have deleterious lifelong impact on mental health. OBJECTIVE: To investigate the associations between exposure to IPV in childhood and, as adults, the presence of depressive symptoms during the past year, suicidal thoughts and lifetime suicide attempt. METHODS: Our study is based on data from the 2017 French Health Barometer, a general population cross-sectional phone survey. 25 319 adults living in Metropolitan France responded. Data were weighted to obtain a representative sample of the French population. Associations between childhood exposure to IPV and each of three outcomes in adulthood-symptoms of depression, suicidal ideation in the past year and lifetime suicide attempt-were studied by calculating odds ratios (ORs) and their 95% confidence intervals (CIs), stratifying by sex and using multivariate models (logistic regression). RESULTS: After adjustment for age, social variables, negative life events in childhood and lifetime history of sexual violence, reporting witnessed IPV is significantly associated with the presence of symptoms of depression during the past 12 months (aORmen = 1.88, 95% CI = 1.49-2.38, and aORwomen = 2.00, 1.72-2.32), suicidal thoughts in the past 12 months (aORmen = 1.97, 1.48-2.64, and aORwomen = 2.35, 1.89-2.93), and at least one lifetime suicide attempt (aORmen =2.39, 1.83-3.11 and aORwomen = 2.66, 2.25-3.16). CONCLUSION: Associations shown between a history of exposure to IPV and three mental health indicators in adulthood underline the need to study the lifelong impact of IPV.

Determinants of Preventive Behaviors in Response to the COVID-19 Pandemic in France: Comparing the Sociocultural, Psychosocial, and Social Cognitive Explanations.

In absence of effective pharmaceutical treatments, the individual's compliance with a series of behavioral recommendations provided by the public health authorities play a critical role in the control and prevention of SARS-CoV2 infection. However, we still do not know much about the rate and determinants of adoption of the recommended health behaviors. This paper examines the compliance with the main behavioral recommendations, and compares sociocultural, psychosocial, and social cognitive explanations for its variation in the French population. Based on the current literature, these 3 categories of factors were identified as potential determinants of individual differences in the health preventive behaviors. The data used for these analyses are drawn from 2 cross-sectional studies (N = 2,000 in survey 1 and 2,003 in survey 2) conducted after the lockdown and before the peak of the COVID-19 epidemic in France. The participants were drawn from a larger internet consumer panel where recruitment was stratified to generate a socio-demographically representative sample of the French adult population. Overall, the results show a very high rate of compliance with the behavioral recommendations among the participants. A hierarchical regression analysis was then performed to assess the potential explanatory power of these approaches in complying with these recommendations by successively entering sociocultural factors, psychosocial factors, social cognitive factors in the model. Only the inclusion of the cognitive variables substantially increased the explained variance of the self-reported adoption of preventive behaviors (R 2 change = 23% in survey 1 and 2), providing better support for the social cognitive than the sociocultural and psychosocial explanations.

Verbal victimisation, depressive symptoms, and suicide risk among sexual minority adults in France: results from the nationally-representative 2017 Health Barometer survey.

PURPOSE: Our study estimates rates of depressive symptoms and suicide risk according to sexual minority status, and examines the mediating effect of verbal victimisation in the association between sexual minority status and mental health outcomes. METHOD: Analysis is based on data from the 2017 French Health Barometer, a general population phone survey, which recruited 25,198 adults aged 18-75 years. Data were weighted to be representative of the French adult population. Four mental health outcomes occurring in the preceding year or currently were examined in relation to sexual minority status using multivariate logistic regressions: (a) current depressive symptoms, (b) having experienced a major depressive episode, (c) suicidal ideation, and (d) suicide attempt. Further we conducted mediation analyses to evaluate the contribution that verbal victimisation experienced in the preceding year has in the association between sexual minority status and the listed outcomes. All analyses were also stratified by sex. RESULTS: Sexual minority adults were more likely to experience verbal victimisation in the last year compared to heterosexual individuals (22% vs 11.4%). They were also more likely to have experienced each of the four mental health outcomes, even after adjusting for potential confounders. In adjusted mediation analysis, verbal victimisation in the preceding year was found to significantly mediate the association between sexual orientation and mental health outcome with mediated proportions varying between 15 and 22%. CONCLUSION: Sexual minority individuals are more at risk of depressive symptoms and suicidal ideation compared to heterosexuals, and this may be partially mediated by verbal victimisation.

Increased risk of suicidal ideation among French women: the mediating effect of lifetime sexual victimisation. Results from the nationally representative 2017 Health Barometer survey.

Sexual victimisation has been associated with suicidal ideation, especially among women; however data on this association from a large sample of general population is surprisingly limited. Also, no study quantifies sex differences in the effect of sexual victimisation on suicide risk. We used data from the French Health Barometer, a general population phone survey, which recruited 25,319 adults aged 18 to 75 years in 2017. Data were weighted to be representative of the French adult population. Three outcomes were examined: (a) suicidal ideation in the preceding year, (b) suicidal imagery (having thought about how to commit suicide), and (c) suicide attempt in the preceding year. We conducted adjusted mediation analyses, using the counterfactual approach, to evaluate the contribution that lifetime sexual victimisation has in the association between sex and suicide risk. Women were around five times more likely to report lifetime sexual violence (9.1% vs 1.9%) and were more at risk of any suicidal ideation (Ora = 1.20 (95%CI: 1.07-1.36)) and suicidal imagery (Ora = 1.39 (95%CI: 1.20-1.61)), but not suicide attempt compared to men in adjusted analysis. In mediation analysis, sexual victimisation explained 49 and 40% of the increased risk women have compared to men in suicidal ideation and suicidal imagery, respectively. Sexual violence is more prevalent among women and explains a substantial share of sex difference in suicide risk. Our findings reiterate the importance of the prevention of sexual violence and an adequate care for victims, especially women, in public health and mental health policies and initiatives.

[Reducing the impacts of hot weather in a context of climate change]. / Réduire les impacts de la chaleur dans un contexte de changement climatique.

The impact of climate change on the health of individuals raises fears of significant long-term effects. Certain repercussions are already evident. Health professionals, particularly those working with vulnerable people, play a key role in health promotion and taking into account the challenges posed by hot weather. They need to be better trained in order to promote behaviours more favourable to health.

Temporal trend in socioeconomic inequalities in the uptake of cancer screening programmes in France between 2005 and 2010: results from the Cancer Barometer surveys.

OBJECTIVES: Cancer screening is a form of secondary prevention for a disease which is now the leading cause of death in France. Various socioeconomic indicators have been identified as potential factors for disparities in breast, cervical and colorectal cancer screening uptake. We aimed to identify the socioeconomic inequalities, which persisted in screening uptake for these cancers, and to quantify these disparities over a 5-year period. SETTING: The Cancer Barometer was a population-based-survey carried out in 2005 and 2010 in France. PARTICIPANTS: A randomly selected sample of participants aged 15-85 years (n=3820 in 2005 and n=3727 in 2010) were interviewed on their participation in breast, cervical and colorectal cancer screening-programmes and their socioeconomic profile. PRIMARY AND SECONDARY OUTCOME MEASURES: For each type of screening programme, we calculated participation rates, OR and relative inequality indices (RII) for participation, derived from logistic regression of the following socioeconomic variables: income, education, occupation, employment and health insurance. Changes in participation between 2005 and 2010 were then analysed. RESULTS: Participation rates for breast and colorectal screening increased significantly among the majority of socioeconomic categories, whereas for cervical cancer screening there were no significant changes between 2005 and 2010. RIIs for income remained significant for cervical smear in 2005 (RII=0.25, 95% CI 0.13 to 0.48) and in 2010 (RII=0.31, 95% CI 0.15 to 0.64). RIIs for education in mammography (RII=0.43, 95% CI 0.19 to 0.98) and cervical smear (RII=0.36, 95% CI 0.21 to 0.64) were significant in 2005 and remained significant for cervical smear (RII=0.40, 95% CI 0.22 to 0.74) in 2010. CONCLUSIONS: There was a persistence of socioeconomic inequalities in the uptake of opportunistic cervical cancer screening. Conversely, organised screening programmes for breast and colorectal cancer saw a reduction in relative socioeconomic inequalities, even though the results were not statistically significant. The findings suggest that organised cancer screening programmes may have the potential to reduce socioeconomic disparities in participation.

Perceptions of Alzheimer's Disease in the French Population: Evolutions between 2008 and 2013 and Associated Factors in 2013.

BACKGROUND: The negative image surrounding AD has a substantial impact on caregiving and on those affected by the disease. Opinion surveys were created as part of the 2008-2012 Alzheimer Plan in France, which included two surveys of the general population, at the beginning and at the end. OBJECTIVE: To evaluate changes of the French population in perceptions, knowledge and beliefs over 5 years and to analyze dimensions with sociodemographics criteria and proximity with AD. METHODS: After selection by quota sampling, 2013 French people aged 18 years and over were interviewed by phone in 2008 and 2509 in 2013. Chi-squared tests were carried out to measure the changes between two periods and multivariate logistics regressions were used to assess perceptions. RESULTS: People who cited AD as one of the three most serious diseases increased in 2013 (33.6% versus 26.7% in 2008; p <  0.001). There was no significant change as regards the fear, the sense of being informed and the feeling of embarrassment. Opinions "there are treatments available to improve the wellbeing of patients" and "it is normal to suffer memory loss as you get older" decreased in 2013. Close family carers had a greater sense of the seriousness, a higher risk perception, a better sense of being informed and a greater ease in the presence of a person with AD. CONCLUSIONS: The results serve as indicators of the effects of the Alzheimer Plan on French society and testify to the rather weak impact of the Plan on public opinion.

[Effective interventions to prevent health damage related to ultraviolet exposure: a review of the literature]. / Les interventions efficaces en prévention des problèmes de santé liés à l’exposition aux ultraviolets naturels: une synthèse de littérature.

The purpose of this paper is to review the current scientific knowledge on health promotion interventions designed to prevent health damage caused by natural ultraviolet (UV) exposure. The current state of knowledge in this area was assessed using a specific method including a review of literature reviews and a classification of health promotion interventions identified using scientific databases. We found a large number of promising programmes. Briefly, some interventions based on environmental changes and provision of shade were considered to be promising. Health education programmes delivered at school have been proven to be effective in various settings, from nursery school to college. Some parentbased interventions designed to promote children's sun protection behaviours have been shown to be relevant. Appearance-based actions, using for instance photoaging information, may be effective. Finally, some multi-component interventions in community settings appear to be promising. These findings present a number of limitations due to the marked diversity of outcome measures and the general quality of the documents reviewed. Furthermore, most interventions are poorly described in the reviews. The present study should therefore be considered to be a first step that needs to be completed by a more detailed description of the promising interventions and of their transposition to the French context.

Exposure to indoor tanning in France: a population based study.

BACKGROUND: Tanning lamp sessions have increased in Europe in recent years. Recent epidemiological studies have confirmed a proven link between melanoma and artificial UV exposure. However, in France, little information is available to determine the exposure of the population. This article presents the results from the 'Baromètre cancer 2010' concerning the proportion of users exposed to artificial UV radiation in France, their characteristics and level of information on the risks associated. METHODS: A two stage random sampling telephone survey assisted by CATI system (household, individual) was performed from 3 April 2010 to 7 August 2010 on a sample of 3,359 people aged 15 to 75 years old. RESULTS: In 2010, 13.4% of the French population reported to have tanning lamp sessions at least once in their lifetime and 3.5% of the total population reported the use of artificial UV radiation over the last twelve months. Exposure over the last twelve months is most commonly seen among females (5.0%) and young population between 20-25 years old (9.6%). In addition, 3.5% of those under 18 years report having attended UV booths at least once during their lifetime even though they are forbidden to minors. Moreover, more than one the third of users reported more than 10 exposures within a year. The places of exposure cited most often were beauty salons (50%) and tanning centers (46%). Only 49.2% of those surveyed felt that they were well informed on the risks of cancer associated with UV booths. Furthermore, the population was found to have misconceptions about artificial UV radiation. One quarter of the population, believe that artificial UV radiation use before vacation protects the skin from sunburn. CONCLUSIONS: This first study on artificial UV radiation exposure in France has better quantified and characterized the users. It has also defined the state of knowledge and the perception of risk by the general French population. This work will contribute to determine actions of prevention to reduce cancer risk related to artificial UV radiation.