Nous utilisons la méthode d’autopsie psychologique pour identifier les déterminants des suicides en population générale, ainsi que d’éventuelles failles dans le processus de soin. Sur un an, on recense 146 suicides en Sarthe ; 47 ont pu être analysés. Les deux tiers ont eu un contact en santé mentale sur la vie entière ; la moitié lors de la dernière année de vie. Au moment du décès, 87,2 % présentent un trouble mental. Un quart a été placé/abandonné durant l’enfance, 70 % a été victime de carences affectives précoces. Les trois quarts des actifs disent souffrir d’une détresse psychique majeure et durable au travail. Les experts estiment que la maladie mentale est le déterminant le plus important du suicide. La majorité des personnes souffrant d’éthylisme n’est pas suivie ; les personnes abandonnées durant l’enfance échappent totalement aux soins. L’expertise souligne le besoin d’une approche thérapeutique de type antidépresseurs plus psychothérapie, en actant les bénéfices de l’ambulatoire de crise.Le texte complet de cet article est disponible en PDF.
The suicide rate is significantly larger in the French department of Sarthe than in other departments. Our objectives were: determine the biopsychosocial risks factors of suicide; to describe the primary care and mental health care.
We have chosen to collect information using the “psychological autopsy method”. All people (included teenager and children) committing suicide in Sarthe will be included in the study. In each case, two informants will be selected. Three levels of analysis are retained (psychological, biomedical and social). Key informants were a member of the family, a colleague or a close friend. They were interviewed by trained clinicians, specialized in suicidology and grief support. Several standardized questionnaires are used: MINI (psychopathology, axis I on DSM-IV), UPPS-Short (impulsivity), EPICES (social precariousness), SSQ-6 (social support), and a life-event inventory. All cases were appraised by two experts (psychiatrist and general practitioner) in order (1) to determine the risk factors for each suicide: a burdensomeness score was suggested from 1 (no adversity) and 6 (major adversity), and (2) to evaluate mental health care.
Suicides which occurs during 12 months were explored. Between September 2015 and August 2016, 146 people died by suicide. Of these cases, 47 were analyzed. Sixty-eight percent of the suicide cases were men, and the mean age is 62 years. Ninety percent of cases are workers or employees. Hanging is the major method used to commit suicide (68%), followed by drowning (11%), and firearms (9%). One third had visited their general practitioner last week before they died and two thirds had a lifespan contact with mental health professional (50% the last year). At the time of death, 87.2% had a mental disorder (depression: two thirds; alcohol use disorder: 57.7%). Seventy percent experienced childhood abuse and neglect. For 75% of the workers, there is a major and chronic psychological distress at work. For experts, mental illness is the most important determinant of suicide, followed by childhood abuse and neglect and dysfunctional interpersonal relationships. However, among workers, the distress relative to the professional activity is a major risk factor. Important differences exist between individuals treated in psychiatry and those who are not. For example, people suffering from alcohol-related disorders are mostly untreated, and people abandoned in childhood have any contact with mental health care. Moreover, they have an atypical clinical profile, unfortunately difficult to detect.
According to the experts, antidepressant prescriptions need to be improved and psychotherapy must be more widely applied. Our findings highlight the importance of outpatient care. Coordination with families should also be improved and the assessment of suicidal risk should be systematic.Le texte complet de cet article est disponible en PDF.
Mots clés : Autopsie psychologique, Enquête rétrospective, Facteur de risque, Pathologie psychiatrique, Profil psychologique, Sarthe, Suicide
Keywords : Psychiatric pathology, Psychological autopsy, Psychological profile, Retrospective investigation, Risk factor, Sarthe, Suicide