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Background Postvention aims to implement services adapted to the needs of a population that may be vulnerable after suicide. While a plethora of postvention programs exist, they are generally based less on solid evidence than on the judgment of health professionals. Using the Delphi method, an Australian study obtained a consensus among experts as to which postvention actions are to be engineered in a postvention program. Since no similar study has been carried out for programs in French-speaking countries, it seemed important to reproduce the same type of study and to compare the respective results. The present study is aimed at establishing a French inventory of postvention actions and at achieving a consensus among experts as to the actions to be included in a postvention program. Methods A systematic review of the scientific literature (PRISMA method) and the gray literature (documentation on the WEB) made it possible to identify the different actions that have been included in various postvention programs. Using the DELPHI method, experts endeavored to assess their relevance. Results An inventory of 190 postvention actions was established and they were classified according to a sequential axis (pre-event, at the time of the event, and post-event), according to type of action (environment-centered or people-centered). The experts identified 128 actions to be included in a postvention program. Conclusion Convergence was observed among the experts, as they identified the practices to be encouraged following a suicide. When comparing the results in French-speaking countries to the 548 actions selected in the Australian study, we observe similarities between the two studies regarding types of postvention actions. This study provides an update for health professionals on the most relevant practices to be included in a postvention program.

International audience; Helpline services have been identified as an important component of suicide prevention strategies. While the Covid-19 pandemic have raised major concerns about severe and longstanding mental health consequences, the French ministry of Health has recently decidedto implement a national professional helpline dedicated to suicide prevention. The 3114 has been launched on the 1st of October 2021. Accessible 24/7 from any point of the national territory, it offers remote assistance to individuals in distress or worried for a close one,professionals and bereaved persons. Spread in regional call centers, medically supervised nurses and psychologists provide callers with listening, evaluation, intervention (including possible dispatch of a rescue team) and, whenever needed, referral to adapted services. At the same time, the “3114 centers” contribute to the implementation of the regional suicide prevention strategies by stimulating the development of actions, promoting resources, monitoring at-risk events, and collaborating with professional and associative stakeholders. From a public health perspective, the inception of the 3114 has settled the conditions for a new paradigm in the French suicide prevention strategy. By dedicating specific resources to promote and organize interactions between stakeholders, it supports a major shift from the juxtaposition of efficient but segregated actions to the creation of an integrated prevention system. Embedded to the project, multidisciplinary and multilevel research will be carried out to evaluate the implementation, impact, and transferability of the 3114 model, conceived both as a helpline and territorial prevention strategy.

Resume La prise en charge des enfants et adolescents porteurs d’un diagnostic de Desordre de developpement du sexe (DDS) est aujourd’hui une question en debat et en discussion tant sur le plan des pratiques soignantes, que sur le champ social et politique. Une des preoccupations centrales des equipes de soins engagees autour de la prise en charge et l’accompagnement des personnes porteuses d’un DDS et de pouvoir proposer une prise en charge la plus efficiente dans l’objectif de promouvoir le meilleur epanouissement possible des personnes concernees. Si l’un des points centraux des echanges actuels porte sur la question des indications de prises en charge medicochirurgicales precoces, la question se porte tout autant sur la place et les modalites d’assignation de genre d’un enfant a sa naissance et des differentes consequences pour lui dans sa vie future. La question du devenir des enfants nes et porteurs d’un DDS en termes d’inscription dans une identite de genre est etudiee depuis les annees 1950 et s’est developpee sur des presupposes theoriques tres divers ; du champ psychodynamique et psychanalytique a des presupposes biologiques. La litterature scientifique est particulierement heterogene sur le sujet et recoupe des methodologies de type reports d’experience, des etudes cas temoins comme des methodologies issues de l’Evidence Based Medecine. En appui des elements issus de la litterature scientifique et en appui d’un travail collaboratif du reseau national des Centres de reference maladies rares du developpement genital: du fœtus a l’adulte, ce travail vise a definir les contours des modalites d’organisation et des aspects deontologiques actuels des equipes engagees autour de cette activite sur le territoire francais.

Suicide is a major public health issue given its huge human and economic consequences. Symptoms prior to suicide are often not specific. Nevertheless, the majority of suicidal people express suicidal thoughts, and nearly one in two meet a health professional in the period preceding the act. Being able to recognize the warnings and intervene during the suicidal crisis, defined as a mental crisis where the major risk is suicide, is to seize the opportunity to postpone the suicidal plan and to gain time to implement in place lasting strategies to combat suffering. Thus, the training for suicidal crisis intervention is a major axis of the suicide prevention strategy. Recently, crisis intervention training programs have been updated with knowledge accumulated since the early 2000's. In France, one of the countries most concerned by suicide, the Hauts-de-France region is one of the most impacted. In this context, the Regional Health Agency of Hauts-de-France included in its Regional Health Program of 2018-2023 the training of healthcare workers who work with high suicidal risk patients. The suicidal crisis intervention training program (SCIT) has been introduced to hospital staffs in Hauts-de-France. The purpose of this study was to evaluate this program.Eight training sessions with 15 to 21 participants were carried out from 2019 November to 2021 January in the Hauts-de-France region. Participants were volunteer healthcare professionals in direct contact with suicidal crisis patients. The training included three modules. The first one concerned the suicidal crisis intervention training: definition of the suicidal crisis, typology of the crisis, vulnerability development, crisis evaluation and crisis intervention practice. The second concerned the evaluation with the RED scale (Risk-Emergency-Danger) and the adequate patient orientation to a psychiatric unit. The third was dedicated to the Gatekeeper training with the constitution of a Gatekeeper network to enhance the capacity to detect suicidal risk and to orient the concerned person towards an adequate evaluation or care organization. We evaluated the first two levels of the Kirkpatrick's model: level 1) the participant's satisfaction (rated out of 10), and level 2) the degree of confidence in their professional abilities (rated out of 10) and their skills in responding to a person in a suicidal crisis (using the SIRI-2-VF - French version of the Suicide Intervention Response Inventory-2). The participants were interviewed before (T0), just after (T1) and at one month of training (T2).Among the 141 health professionals who followed the training, 139 answered the questionnaire at least one time (13 psychologists, 22 doctors, 97 nurses and 7 head nurses). The participation rates were 99.3 % at T0, 96.4 % at T1 and 46.0 % at T2. Most of the participants were nurses (69.8 %), and 33.1 % of the respondents declared they had already followed a suicidal crisis training. The satisfaction with the training was evaluated at 8.6 (± 1.3) out of 10. There was no significant difference among the professions, neither between those having already received or not a previous training. The self-perceived capacity to manage a suicidal crisis was rate 6.8 (± 1.8) out of 10 at T0. There was a significant increase just after the training (8.1±1.2 vs 6,8±1,8, p0,001) which persisted at 1 month (8.1±1.1 vs 6.8±1.8, P0.001). The score at the SIRI-2-VF was 15.0 (± 4.2) out of 30 at T0. There was a significant increase just after the training (17.5±3.5 vs 15.0±4.2, P0.001), which persisted at 1 month (17.0±4.0 vs 15.0±4.2, P0.001).This is the first evaluation of the suicidal crisis intervention training program. This program increased and homogenized the competency of the participants to manage suicidal ideation and behaviors. Those who followed a previous training maintained higher scores than the others, which shows the importance of repeated training to maintain a satisfying level of knowledge over the long term. One of the strengths of this training is the use of roleplay which enhances the learning and abilities to interact with people at suicidal risk. It seems important to integrate a suicidal crisis intervention training in the cursus of health students to avoid suicide and the dramatic consequences for the entourage and the health professionals who are confronted with it.The SCIT program showed encouraging results in terms of confidence and capacity of the healthcare professionals to intervene in suicidal crisis.

Postvention aims to implement services adapted to the needs of a population that may be vulnerable after suicide. While a plethora of postvention programs exist, they are generally based less on solid evidence than on the judgment of health professionals. Using the Delphi method, an Australian study obtained a consensus among experts as to which postvention actions are to be engineered in a postvention program. Since no similar study has been carried out for programs in French-speaking countries, it seemed important to reproduce the same type of study and to compare the respective results. The present study is aimed at establishing a French inventory of postvention actions and at achieving a consensus among experts as to the actions to be included in a postvention program.A systematic review of the scientific literature (PRISMA method) and the gray literature (documentation on the WEB) made it possible to identify the different actions that have been included in various postvention programs. Using the DELPHI method, experts endeavored to assess their relevance.An inventory of 190 postvention actions was established and they were classified according to a sequential axis (pre-event, at the time of the event, and post-event), according to type of action (environment-centered or people-centered). The experts identified 128 actions to be included in a postvention program.Convergence was observed among the experts, as they identified the practices to be encouraged following a suicide. When comparing the results in French-speaking countries to the 548 actions selected in the Australian study, we observe similarities between the two studies regarding types of postvention actions. This study provides an update for health professionals on the most relevant practices to be included in a postvention program.

Introduction L’adolescence est une periode a risque pour la sante mentale. En 2018, le service sanitaire pour tous les etudiants en sante (SSES) a ete cree et une thematique sante mentale et prevention du suicide (SMPS) a ete proposee dans le Nord-Pas-de-Calais (NPDC). L’objectif principal de l’etude etait d’evaluer les connaissances des jeunes sur la depression et la recherche d’aide puis d’evaluer la thematique SMPS en matiere de satisfaction des adolescents quant a la formation recue et d’amelioration des connaissances. Methodes Les collegiens et lyceens du NPDC ayant recu la formation SMPS en 2018-2019 ont ete invites a repondre a un questionnaire avant (T0) et apres (T1) la formation. Les connaissances a T0 ont ete decrites puis la thematique SMPS a ete evaluee en explorant les 2 premiers niveaux du modele de Kirkpatrick : satisfaction et connaissances. La satisfaction a ete mesuree via la Student Satisfaction Scale a T1, et les connaissances via une adaptation francaise du Friend in Need Questionnaire a T0 et T1. Cette adaptation comprenait 2 personnages (Chole, depressive, et Lea, non depressive) a evaluer. L’evolution des reponses entre T0 et T1 ont ete comparees au moyen de tests de Chi2 ou de Fisher et de t-tests apparies. Resultats Au total, 676 eleves ont ete analyses dont 69,6 % etaient collegiens. Les eleves etaient plus inquiets pour Chloe (p Conclusion Bien que les eleves differencient l’etat de Chloe et Lea, ils sont encore tres nombreux a ne pas identifier la detresse et la necessite d’aide pour des camarades en difficultes. La thematique SMPS n’a pas ameliore les connaissances. Des etudes complementaires visant a reaxer la formation ou ameliorer l’evaluation sont necessaires.

In France, one adolescent out of ten has already attempted suicide. In this population, suicide reattempts are frequent and significantly impact the vital, morbid and functional long-term prognosis. For about fifteen years, surveillance and brief contact intervention systems (SBCIS) have been used to complete the French suicide reattempt prevention arsenal for youth. The relevance of such strategy appears once the mental health service gap observed at this period of life is considered. In addition to prompting better coordination between the different professional stakeholders, the SBCIS help to alleviate the adolescent's help-seeking barriers, especially the ambivalence between conquest of autonomy and need for help. The first results from the French SBCIS dedicated to children and adolescents are encouraging. Although they have to deal with specific challenges, we argue that they relevantly complement and potentiate the already available prevention resources, thus optimizing the whole prevention system for suffering youth.

Introduction La necessite d’un effort de prevention dedie a la sante mentale des etudiants en sante est regulierement soulignee dans la litterature. En 2018, le service sanitaire pour tous les etudiants en sante (SSES) a ete cree et une thematique sante mentale et prevention du suicide (SMPS) a ete proposee dans le Nord-Pas-de-Calais (NPDC). L’objectif de l’etude etait d’evaluer l’impact de cette thematique chez les etudiants en sante. Methodes Les etudiants du NPDC engages dans le SSES 2018–2019 ont repondu a un questionnaire en septembre (T0) et en mai (T1). Les etudiants du groupe SMPS ont ete compares a ceux affectes a un autre groupe. Pour evaluer la thematique, les 3 premiers niveaux du modele de Kirkpatrick ont ete explores : – la satisfaction via la Student Satisfaction Scale ; – les representations via le Suicide Behavior Attitude Questionnaire (SBAQ) et le questionnaire Attitudes Toward Seeking Professional Psychological Help Scale-Short Form ; – les comportements en demandant aux etudiants s’ils avaient identifie ou aide des personnes ayant un probleme de sante mentale ou s’ils avaient consulte pour raison de sante mentale. Un appariement 2 :1 sur un score de propension a ete realise, ainsi qu’une imputation multiple par equations chainees. La satisfaction et les comportements ont ete compares a T1 via des tests de Student ou de Chi2. Les changements de representations ont ete detectes via un terme d’interaction temps*groupe dans des modeles lineaires mixtes ajustes sur le score de propension. Resultats Cent quarante-quatre participants apparies (48 dans le groupe SMPS) ont ete analyses. Les etudiants du groupe SMPS etaient plus satisfaits de la formation (4,7 vs 3,6, p Conclusion Le theme MHSP montre des resultats encourageants quant a sa capacite a changer les representations et les comportements des etudiants en sante. Des recherches supplementaires sont necessaires pour evaluer l’impact de la formation MHSP sur les donnees cliniques (niveau 4 du modele de Kirkpatrick).

Les liens sociaux et interpersonnels, autant que le vecu subjectif d’etre en lien, sont des determinants fondamentaux de la sante mentale. Les prolongements pratiques du concept theoricoclinique de reliance (ou connectedeness) ont fait la preuve de leur pertinence en matiere de therapeutique et de prevention, en particulier s’agissant du suicide [1]. Fonde sur le principe meme du maintien du lien, le dispositif de veille et de recontact VigilanS a par exemple montre son efficacite dans la prevention ciblee de la recidive suicidaire [2]. La survenue d’une exacerbation du risque suicidaire survient le plus souvent lorsque le sujet est dans son environnement naturel, eloigne du systeme de soins, aussi, la detection du risque en temps reel permettrait de deployer des interventions d’action immediate. Or seules les interventions online peuvent permettre cela. Aujourd’hui, EMMA est la premiere application francaise developpee afin d’evaluer, de predire et de prevenir le risque suicidaire, en se fondant sur une strategie de « reliance augmentee ». Demain, le dispositif ELIOS permettra d’entrevoir les reseaux sociaux comme une facon de distribuer le souci de l’autre dans une prevention ciblee de large ampleur. Adosse a VigilanS, ELIOS consistera en une equipe de web-cliniciens que les adolescents et jeunes adultes pourront contacter depuis la proximite de leur environnement numerique. Amorcant une accroche minimale via WhatsApp, Facebook ou Twitter, ELIOS travaillera a renforcer le lien – connu pour etre fragile – entre les adolescents en detresse et les dispositifs de soin. Le futur de la prevention par la reliance, c’est aussi un lien qui s’etend et se renforce d’etre augmente par l’intelligence artificielle. Les fondements methodologiques sont suffisamment matures pour envisager un reperage sensible des individus les plus a risque a partir de leurs productions et metadonnees numeriques4. Avec la reserve d’une exigence ethique dont les bases restent a poser, un tel reperage ouvrirait la prevention au champ de « l’aller-vers » digital, et a la proactivite dans la reliance numerique.