Les suicides et tentatives de suicides en milieu civil professionnel sont généralement peu documentés. Le Service de Santé des Armées a organisé un système de surveillance de ces événements. Tout acte suicidaire fait l'objet d'une déclaration anonyme. Elle est accompagnée d'une fiche standardisée, détaillant les circonstances et les motifs de survenue du geste suicidaire. Pour les militaires professionnels, 145 fiches ont été recueillies au cours de l'année 1998. Il s'agissait de 40 suicides et 105 tentatives de suicides. Le taux d'incidence des suicides était de 14,1 p 100 000 personnes-année (PA), il s'agissait exclusivement d'hommes. Le taux d'incidence des tentatives de suicide est de 31,7 p 100 000 PA, il n'y avait pas de différence significative selon le sexe. Les difficultés affectives étaient le principal facteur favorisant des conduites suicidaires. La prévention des suicides et tentatives de suicide dans les armées repose sur une stratégie multidisciplinaire impliquant les médecins d'unité, l'encadrement, les services sociaux, les services de psychiatrie des armées, mais aussi les structures locales civiles de prise en charge des conduites suicidaires.

Little data exists concerning suicides and attempted suicides on professional duty. Now that the French Army is becoming professional, it is necessary to describe methods of self-destruction, in order to facilitate preventive measures. Methods : The French Army operated a surveillance system to record all instances of suicide and attempted suicide. Under this surveillance system, all suicidal acts and attempts must be reported through an anonymous standard form completed by a military physician. This form records demographic data, the circumstances and known motives. For the epidemiological analysis, we used the chi square test and the Student test. A method of indirect standardization was employed to enable comparisons between military suicides and those within the general French population in 1996. We chose a risk of error of 5 %. Results : During the course of 1998, 145 forms were gathered for professional armed forces. Of these, 40 were recorded as actual suicides and 105 as attempted suicides. The suicide rate corresponded to 14 p 100.000. Suicides were limited exclusively to males, the average age at death was 36. Comparisons with the French male population at large (using the indirect method of standardization) showed a standardized mortality rate of 0,43 (p > 0.05). Methods of self-destruction employed were mostly hanging and using firearms. Attempted suicide rate was 31.5 p 100.000, with a relatively even balance between males and females. The average age was 30. Methods of self-destruction employed were mostly drug ingestion and laceration. Difficulties with personal relationships were the principal motive recorded, whilst instances of psychiatric diseases were rare. Previous suicide attempts were known in 21 % of recorded suicide attempts in 1998 and in 10 % of actual suicide. There was no suicidal act during or linked to an outside army operation. The ratio suicide-attempted suicide was 0.38. Discussion : The fact that the rate of suicide in the French Army is lower than the national average could be explained by the medical criteria used to select army personnel on active duty. These results should be interpreted with caution : our data only covers a single year. Moreover, there is a certain bias in the surveillance system used. Measures in the French Army to prevent suicide are based on a significant medical component within units, particularly during operational tours where there is sometimes a psychiatrist. Although the military physician is constrained by professional secrecy, he must execute his duty as an advisor to the commanding officer to signal human factors that need to be taken into account. Responsibility for knowing men and living conditions lies with the commanding officer. Epidemiological surveillance is a key element of analyzing the risks of suicidal. Its contributing role should be regularly reevaluated.