Assessment of a Suicide Prevention Gatekeeper Training Program for Nursing Home Staff.

INTRODUCTION: Older adults have one of the highest age-specific suicide rates in France, and the risk of suicide is higher for those living in nursing homes. The aim of our study was to assess the effectiveness of gatekeeper training for nursing home staff on the knowledge and stigmas towards suicidal crisis and the impact on suicidal behaviour rates. METHOD: A total of 427 nursing or administrative staff from 110 nursing homes received gatekeeper training in the Hauts-de-France French region between September 2016 and June 2018. First, knowledge and stigmas on suicidal crisis were assessed through a pretest and posttest survey. Second, a retrospective survey was conducted to determine suicide behaviour rates before and after training in nursing homes. Then, changes between pre- and posttraining scores and suicide rates were evaluated with a paired samples T test and rate difference calculation (P value of <0.05 was considered statistically significant). RESULTS: A total of 315 trainees completed the questionnaires on knowledge and stigmas related to suicidal crisis, and we found a significant difference in the total scores (P < 0.01). Moreover, we found a significant decrease in the incidence of suicide attempts (SAs) after training (P = 0.002), but the incidence of deaths by suicide was not significantly different prior to and after the training course (P = 0.46). CONCLUSION: We highlighted an improvement in knowledge and stigmas after training and a reduction in the rates of SAs with our gatekeeper suicide prevention program. Future research is needed to improve suicide prevention for nursing home residents.

Suicide mortality in people with mental disorders: a register-based study in north France.

INTRODUCTION: Suicide is very common among people with mental disorders. In addition, suicide mortality rates are stable in this group, while they are decreasing in the general population. METHODS: The vital statuses of adult inpatients admitted to French psychiatry departments in 2008-2009 were researched in death databases on 31 December 2013. Suicide probability was calculated using a Kaplan-Meier analysis, and standardized mortality ratios (SMRs) were calculated in relation to the population of the study area. RESULTS: Among the 13,979 patients included in the study, (7416 men and 6563 women; mean age 43.6 ± 14.6 years), 1454 died in total, among whom 286 died by suicide an average of 4.9 years after the date of their enrolment. The cumulative probability of suicide was 0.8% at 1 year, 1.3% at 2 years and 2.5% at 6 years. The SMR value, which was 1492 for the whole group of patients and was twice as high in women (2494) as in men (1220), decreased with age (from 2078 in patients aged 18-34 years to 1278 in patients aged 75 years or more). DISCUSSION: Our study confirms that suicide mortality is higher in inpatients admitted to French psychiatry units than in the general population and advocates specific prevention programmes for this group.

Mental disorders on admission to jail: A study of prevalence and a comparison with a community sample in the north of France.

BACKGROUND: The aim of the present study was to estimate prevalence rates of psychiatric and substance use disorders in male and female prisoners on admission to prison in the north of France and compare the frequency of these disorders to the general population. METHODS: This cross-sectional survey on Mental Health in the Prison Population (MHPP), conducted between March 2014 and April 2017, interviewed 653 randomly selected men and women who had recently been committed to the French general population prison system in the Nord and Pas-de-Calais departments. For each subject, the Mini International Neuropsychiatric Interview (MINI), a standardized psychiatric interview, was used to screen for psychiatric and substance use disorders. The prevalence rates were then compared with data from the Mental Health in the General Population (MHGP) survey, a general population survey that used the same assessment methodology as MHPP in the Nord and Pas-de-Calais departments. A control sample was taken from the MHGP survey with a ratio of one case (MHPP) to three controls (MHGP) matching on age and sex. RESULTS: The sample was primarily composed of French men, most of them single with low educational levels at the time of imprisonment. The mean age was 31.7 (standard deviation = 9.9; min = 18; max = 67). Most of the subjects included were first-time prisoners. The prevalence of affective disorders among newly incarcerated individuals was 31.2% with higher rates for major depressive disorder (27.2%). The prevalence of anxiety disorders was 44.4% with higher rates for generalized anxiety disorder (25.2%). The prevalence of psychotic syndromes was 6.9%. The prevalence of substance use disorders was 53.5% and a suicide risk was identified in 31.4% of the prisoners interviewed. Higher prevalence rates were found in the MHPP when compared with the MHGP for all psychiatric and substance use disorders assessed except for dysthymia and current isolated psychotic syndrome. CONCLUSIONS: Our study shows very high levels of prevalence for psychiatric and substance use disorders in recently committed French prisoners.

Long-term occupational trajectories and suicide: a 22-year follow-up of the GAZEL cohort study.

Objective Most suicides occur among individuals of working age. Risk is elevated in some occupational groups, however relations between long-term occupational trajectories and suicide are not well known. We describe career-long occupational trajectories and examine their influence on suicide. Methods Data come from GAZEL, a French cohort study set among employees of a large national utilities company. Occupational grade was obtained from company records from the time of hiring (1953‒1988). Group-based trajectory models were used to define occupational trajectories over a mean time period of 25.0 (standard deviation 6.5) years. Causes of mortality, coded using the International Classification of Diseases, were recorded from 1993‒2014 and studied using Cox regression models. Results Of the 20 452 participants included in the study, 73 died by suicide between 1993‒2014. Results suggested an increased risk of suicide [hazard ratio (HR) 2.57, 95% confidence interval (CI) 1.08-6.15] among participants with persistently low occupational grade compared to those with higher occupational grade and career development. After adjustment for all covariates, especially psychological factors, this association was reduced and no longer statistically significant (HR 2.02, 95% CI 0.82-4.95). Conclusions Persistently low occupational grade could be related to an elevated risk of suicide. This association partly reflects psychological and health characteristics, which can influence occupational trajectories and be reinforced by unfavorable work conditions.

Which work-related characteristics are most strongly associated with common mental disorders? A cross-sectional study.

OBJECTIVES: Studies exploring work-related risk factors of common mental disorders (CMDs), such as major depressive disorder (MDD), generalised anxiety disorder (GAD) or alcohol abuse, have generally focused on a limited set of work characteristics. For the first time in a primary care setting, we examine simultaneously multiple work-related risk factors in relation to CMDs. METHOD: We use data from a study of working individuals recruited among 2027 patients of 121 general practitioners (GPs) representative of the Nord-Pas-de-Calais region in the North of France (April-August 2014). CMDs (MDD; GAD; alcohol abuse) were assessed using the Mini-International Neuropsychiatric Interview. Six worked-related factors were examined (work intensity, emotional demands, autonomy, social relations at work, conflict in values and job insecurity). Several covariates were considered (patient, GP and contextual characteristics). To study the association between workplace risk factors and CMDs, we used multilevel Poisson regression models adjusted for covariates. RESULTS: Among study participants, 389 (19.1%) met criteria for MDD, 522 (25.8%) for GAD and 196 (9.7%) for alcohol abuse. In multivariable analyses adjusted for covariates, MDD/GAD was significantly associated with work intensity (RR 1.16, 95% CI 1.06 to 1.27) (absolute risk=52.8%), emotional demands (RR 1.24, 95% CI 1.13 to 1.35) (absolute risk=54.9%) and social relations at work (RR 0.78, 95% CI 0.70 to 0.87) (absolute risk=15.0%); alcohol abuse was associated with social relations at work (RR 1.25, 95% CI 1.01 to 1.53) (absolute risk=7.6%) and autonomy (OR 0.82, 95% CI 0.67 to 0.99) (absolute risk=8.9%). CONCLUSIONS: Several workplace factors are associated with CMDs among working individuals seen by a GP. These findings confirm the role of organisational characteristics of work as a correlate of psychological difficulties above and beyond other sources of risk.

[Psychiatric readmissions: individual and organizational factors]. / La réhospitalisation en psychiatrie. Facteurs individuels, facteurs organisationnels.

BACKGROUND: Psychiatric readmission often constitutes a criterion to assess the effects of various therapies, as well as the impact of organizational changes in the healthcare system. It is used to characterize relapse or decompensation. The purpose of this study was to determine readmission rates and identify individual and organizational factors associated with significant variations in these rates. METHODS: Adult psychiatric readmissions were identified from the full-time hospital stays registered in psychiatric wards in 2011-2012 in the Nord and Pas-de-Calais departments of France, available in the medical the RimP psychiatric admission database. Readmission rates for various follow-up periods after discharge were measured by Kaplan-Meier survival analysis and multivariate analysis was conducted using the Cox proportional hazards model. RESULTS: Approximately 30,000 adults were hospitalized full-time in psychiatric units of the region during the study period. The 24-month readmission rate was 51.6% (95%CI: 50.8-52.3%). The Cox model showed that a diagnosis of schizophrenia (F2 - HR = 1.72 - 95%CI: 1.61-1.84 - p < 0.001) and personality disorder (F6 - HR = 1.45 - 95%CI: 1.32-1.58 - p < 0.001) was associated with a higher readmission rate. Readmission rates were higher among dependent patients in non-profit private hospitals. CONCLUSION: Psychiatric readmission is a very frequent event and is linked to organizational as well as individual factors.

[Continued use of hypnotic initiated as part of antidepressant treatment]. / La poursuite de consommation d’'hypnotiques initiée lors d'’un traitement antidépresseur.

INTRODUCTION: Chronic hypnotic prescription is common, but not recommended. This study analysed whether hypnotic use at the beginning of antidepressant treatment could be the starting point for future hypnotic use. METHODS: Concomitant hypnotic and antidepressant prescriptions were retrieved from the National Health Insurance Fund for employees of the Nord-Pas-de-Calais database. Dispensing of hypnotics during the two quarters following discontinuation of antidepressant treatment was investigated. RESULTS: 8.9% of patients continued using hypnotics after having stopped antidepressants. Factors associated with this continued dispensing were female gender, age greater than or equal to 45 years, quarterly dispensing of hypnotics during antidepressant treatment, dispensing of three or more hypnotics per quarter during antidepressant treatment, and previous dispensing of opioid substitution therapy. CONCLUSION: A minority of patients continued using hypnotics after stopping antidepressant treatment initiated with hypnotics.

Mortality of people suffering from mental illness: a study of a cohort of patients hospitalised in psychiatry in the north of France.

BACKGROUND: The mortality of people suffering from psychiatric illnesses is far higher than that of the general population, all categories of diagnosis combined; mortality statistics can be used as an index of quality of care. The aim of this study was to assess the all-cause mortality in psychiatric patients covering all diagnostic groups. METHODS: The living or deceased status of 4,417 patients of majority age hospitalised in a public mental health establishment between 2004 and 2007 were requested from French National Institute for Statistics and Economic Studies on 1st January 2011. The cause of death of those people who had died was obtained from French National Institute for Health and Medical Research and comparative standardized mortality ratios (SMR) were established from the population in a region of northern France of the same age in 2006. RESULTS: The study population was made up of 54% men and 46% women, median age 41 and 45 years old, respectively. Four hundred and seventy-three people died during the period studied. The SMR were 421 for men (95% CI 378-470) and 330 for women (95% CI 281-388). The highest SMRs were found in patients aged 35-54, with a 20-time higher mortality risk than the general population of the same age. CONCLUSION: Our study confirms the considerably higher mortality in psychiatric patients than in general population, particularly in mean age and mostly due to an unnatural cause.

[Prescription of psychotropic medicines to pregnant women in Nord-Pas-de-Calais, France]. / La prescription de psychotropes durant la grossesse dans le Nord-Pas-de-Calais.

AIM: Prescription of psychotropic medicines carries risks to pregnancy. It is therefore appropriate to measure the prescription rate of these compounds in pregnant women. METHOD: We studied the prescription rate for psychotropic agents to pregnant women from the Cnamts medicines reimbursement data and we compared this to prescriptions in non-pregnant women in the same age group. RESULTS: There is a fall in the use of psychotropic agents in women during pregnancy compared to a non-pregnant population of the same age. Pregnant women receive 2.17 times less psychotropic agents. Nevertheless, approximately one out of every twenty women is prescribed a proprietary product with known risk to the neonate and four out of a thousand are prescribed a proprietary product which carries a risk of malformation during the first trimester. CONCLUSION: Medical practice takes account of embryo-fetal risk in prescribing psychotropic agents in general although more communication is needed about the risk of some compounds during pregnancy.

[Influential factors in regular and intensive use of psychoactive drugs]. / Les facteurs qui influencent la consommation intensive et régulière de médicaments psychotropes.

The article attempts to construct a typology to the use of psychoactive drugs and the study of the various factors linked to their use, whether heavy or regular. The results draw on the exploitation of databases containing medicines presented for reimbursement by medical insurance in the Nord - Pas-de-Calais region. In 2007 and 2008, 20.7% of the insured population (764,650 people) benefited from reimbursements for this type of medication. Among the beneficiaries, about a third (30.5%) had an intense consummation. Age, the CMUs benefits and the fact that a person is or not followed by a psychiatrist are the most influential variables on the intensity and the regularity of intake. The observed regularity of the recourse to benzodiazepines does not conform with the current recommendations.

[Recourse to psychotropic medication in the Nord - Pas-de-Calais Region (France)]. / Le recours aux médicaments psychotropes dans le Nord - Pas-de-Calais (France).

The prescriptions for psychoactive drugs presented to the Health Insurance system for reimbursement of charges are a source of information about some psychological illnesses and disorders in the context of the overuse of these drugs in France. In Nord - Pas-de-Calais Region, out of a total of 5 070 160 prescriptions in 2007, 576 493 individuals benefited from at least one such drug. Over the period of the study, 15.6% of the population of the region covered took at least one psychotropic medication. The rate of use was 11.7% for benzodiazepines, 7.6% for anti-depressants, 1.8% for anti-psychotics, 0.5% for treatment of alcohol dependence and 0.3% for opiate substitution therapy (OST). For the first three of these classes rate of use increased steadily with age. It was invariably much higher in women than in men. Men were treated more frequently for alcoholism and heroin dependency; the proportion taking medication initially increased with age (up to 40-49 years for alcohol dependency and 30-39 years for OST), before falling thereafter.