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 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.

Supportive effect of body contact care with ylang ylang aromatherapy and mobile intervention team for suicide prevention: A pilot study

OBJECTIVES

To assess understudied, alternative suicide prevention modalities in a mental health care setting.

METHODS

This was a prospective study of patients (n = 140, 68 cases and 72 controls) who were admitted to hospital or who contacted an SOS suicide crisis line for suicidal ideation or attempts. Psychiatric diagnoses (Mini-International Neuropsychiatric Interview) and intensity of anxiety/depression/suicidality (Hamilton Anxiety Rating Scale, Montgomery-Åsberg Depression Rating Scale, and Beck Scale for Suicidal Ideation) were assessed. All intervention group subjects received a crisis card with a crisis line number, interviews with psychologists or volunteers and a telephone call on days 10 to 21, then 6 months later. These subjects also had a choice between two further 4-month interventions: body contact care or mobile intervention team visits.

RESULTS

The interventions significantly reduced the number of suicide attempts and suicide (3%) at 6 months compared with the control condition (12%). There were fewer losses to follow-up in the intervention group (7.35%) than in the control group (9.72%).

CONCLUSIONS

The results favour the implementation of integrated care and maintaining contact in suicide prevention.

Non-fatal suicidal behaviours in French Polynesia: Results of the WHO/START study and its implications for prevention

OBJECTIVES

This is the first research article examining non-fatal suicidal behaviours (NFSB) in French Polynesia. The study was conducted in the frames of the WHO/START Study in 2008-2010. The main objective of the investigation was to obtain reliable data in order to develop evidence-based suicide prevention strategies.

METHOD

Interviews with people presenting with NFSB at the Emergency Department (ED) of the French Polynesia Hospital (CHPF) were conducted by emergency and psychiatry departments' staff examining socio-demographic and clinical information and motives triggering suicidal behaviour. Odds ratios and rate ratios with 95% confidence intervals were calculated.

RESULTS

There were 556 presentations of NFSB by 515 persons at the ED of CHPF (ratio 1.08) with the average rate of 75 per 100,000 for those treated in the hospital. An estimate of cases occurring in remote islands might bring the rate for the whole French Polynesia around 94 per 100,000. NFSB was more prevalent in females; rates for both genders were highest in the age group 25-35 years and 15-24 years. The main suicide method was drug poisoning by psychotropic drugs. The most frequent psychiatric disorder was mood disorder (45.3%); however, 26% of subjects had no 'major' psychiatric disorders, with 14.5% without a psychiatric diagnosis or only reactive disorders (F43-11.7%). There was a high prevalence of previous NFSB (52.1%).

LIMITATIONS

Study includes only NFSB seeking medical help from the biggest hospital in the country.

CONCLUSION

Suicide prevention activities specific to the findings and the socio-cultural context of French Polynesia should be considered.

Testing Brief Intervention and Phone Contact among Subjects with Suicidal Behavior: A Randomized Controlled Trial in French Polynesia in the Frames of the World Health Organization/Suicide Trends in At-Risk Territories Study

The World Health Organization Suicide trends in at-risk territories study is a multi-site regional research program operating first in French Polynesia and countries of the Western Pacific, then extended to the world. The aims of the study were to establish a monitoring system for suicidal behaviors and to conduct a randomised control trial intervention for non-fatal suicidal behaviors. The latter part is the purpose of the present article. Over the period 2008-2010, 515 patients were admitted at the Emergency Department of the Centre Hospitalier de Polynésie Française for suicidal behavior. Those then hospitalized in the Psychiatry Emergency Unit were asked to be involved in the study and randomly allocated to either Treatment As Usual (TAU) or TAU plus Brief Intervention and Contact (BIC), which provides a psycho-education session and a follow-up of 9 phone contacts over an 18-months period. One hundred persons were assigned to TAU, while 100 participants were allocated to the BIC group. At the end of the follow-up there were no significant differences between the two groups in terms of number of presentations to the hospital for repeated suicidal behaviors. Although the study could not demonstrate the superiority of a treatment over the other, nevertheless – given its importance – the investigation captured public attention and was able to contribute to the awareness of the need of suicide prevention in French Polynesia. The BIC model of intervention seemed to particularly suit the geographical and health care context of the country.