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A body of research indicates that people are prone to overestimate the affective impact of future events. Here, we developed a novel experimental paradigm to study these affective forecasting biases under laboratory conditions using subjective (arousal and valence) and autonomic measures (skin conductance responses, SCRs, and heart rate). Thirty participants predicted their emotional responses to 15 unpleasant, 15 neutral, and 15 pleasant scenarios (affective forecasting phase) to which they were then exposed in virtual reality (emotional experience phase). Results showed that participants anticipated more extreme arousal and valence scores than they actually experienced for unpleasant and pleasant scenarios. The emotional experience phase was characterized by classic autonomic patterns, i.e., higher SCRs for emotionally arousing scenarios and greater peak cardiac acceleration for pleasant scenarios. During the affective forecasting phase, we found only a moderate association between arousal scores and SCRs and no valence-dependent modulation of cardiac activity. This paradigm opens up new perspectives for investigating affective forecasting abilities under lab-controlled conditions, notably in psychiatric disorders with anxious anticipations. 13;1

Objective. Literacy of suicide is the corner stone of numerous prevention programs but is a difficult construct to appraise. To bring methodological and epistemological clarifications, we aimed to investigate the actual content and psychometric properties of the available tools designed to inquire knowledge of suicide.Methods. We conducted a systematic review of the literature. Electronic databases were searched for questionnaire assessing literacy, attitudes, knowledge or misconceptions about suicide. After checking the quality of validation procedures, we exhaustively collected the psychometric properties of the scales. Contents were submitted to a qualitative thematic analysis.Results. We identified 18 unique instruments from 48 papers. On the metrological level, general poor to fair compliance with validation standards and variability of psychometric properties stand out as the most prominent results. As regards to the constructs that instruments appraise, we derived 6 thematic categories of knowledge: epidemiology, consequences of media coverage and 4 common myths about the presumed monocausality, unpredictability, harmlessness and unpreventability of suicidal behaviors. Overall, five scales emerge as robust and/or valid enough tools to probe knowledge of suicide.Limitations. We chose selection criteria based on a priori conceptions of literacy. This may have restricted the scope of retrievable scales and limited our inferences about what is explored under the labels “knowledge” or “literacy”.Conclusions. To design refined instruments about literacy of suicide, scholars should consider differentiating the types of knowledge under exploration. Adapted rating procedure with clearer standards about the truthfulness of statements could improve psychometric quality and interpretability.

Background: Many suicide risk factors have been identified, but traditional clinical methods do not allow the accurate prediction of suicide behaviors. To face this challenge, we developed emma, an app for Ecological Momentary Assessment/Intervention (EMA/EMI) and prediction of suicide risk in high risk patients.Objective: We wanted to test the feasibility of implementing this mHealth-based suicide risk assessment and prevention tool and its impact in subjects at high risk of suicide in real world conditions.Methods: The EMMA Study is an ongoing longitudinal interventional multicenter trial in which patients at high-risk for suicide (n=100) use emma for 6 months. During this period, they complete four EMA types (daily, weekly, monthly, spontaneous) and may use EMI modules. Participants undergo clinical assessment at month 0, 1, 3 and 6 after inclusion.Results: Among the 43 patients already recruited in the EMMA Study, 14 participants had completed the follow-up. Their data were analyzed to evaluate emma implementation and impact on suicide risk management. EMA completion rates were extremely heterogeneous among the 14 participants with a sharp decrease over time. The completion rates of the weekly EMA (25% to 87.5%) were higher than for the daily EMA (0% to 53.3%). Most patients (n=10/14) answered the EMA questionnaires spontaneously. Similarly, the Safety Plan Modules use was very heterogeneous (2 to 75 times). Specifically, 11 patients used the Call Module (1 to 29 times), designed by our team to help them to get in touch with healthcare professionals and/or relatives during a crisis. All patients used the Breathing Space Module and 8 the Emotion Regulation Module (1 to 46 times). The diversity of patient profiles and use of the EMA and EMI modules proposed by emma was highlighted by three case reports.Conclusions: These preliminary results suggest that it is possible and acceptable to collect longitudinal fine-grained contextualized data (EMA) and to offer personalized intervention (EMI) in real time to people at high risk of suicide. Patients have different clinical and digital profiles and needs that require a highly scalable, interactive and customizable app. To become a complementary tool for suicide prevention, emma should be integrated in the existing emergency procedures.

International audience; The psychological effects of isolation have already been described in the literature (polar expeditions, submarines, prison). Nevertheless, the scale of confinement implemented during the COVID-19 pandemic is unprecedented. In addition to reviewing the published studies, we need to anticipate the psychological problems that could arise during or at a distance from confinement. We have gone beyond the COVID-19 literature in order to examine the implications of the known consequences of confinement, like boredom, social isolation, stress, or sleep deprivation. Anxiety, post-traumatic stress disorder, depression, suicidal or addictive behaviours, domestic violence are described effects of confinement, but the mechanisms of emergence of these disorders and their interrelationships remain to be studied. For example, what are the mechanisms of emergence of post-traumatic stress disorders in the context of confinement? We also remind the reader of points of vigilance to be kept in mind with regard to eating disorders and hallucinations. Hallucinations are curiously ignored in the literature on confinement, whereas a vast literature links social isolation and hallucinations. Due to the broad psychopathological consequences, we have to look for these various symptoms to manage them. We quickly summarize the diagnostic and therapeutic approaches already in place, such as telemedicine, which is undergoing rapid development during the COVID-19 crisis.

It is widely acknowledged that adolescents and young adults are particularly vulnerable to suicidal behavior. However, the “service desert”—the persistent lack of access to care services—within this population remains a major obstacle to prevention. Although it has brought with it specific risks, the ubiquity of social media offers new ways of overcoming the traditional barriers to help-seeking, owing to the specific modes of interaction and communication that it involves. The Elios project (Équipe en ligne d’intervention et d’orientation pour la prévention du suicide/Online Intervention and Referral Team for Suicide Prevention) aims to harness the digital possibilities of social media to promote access to care for suicidal young people. It consists of a team of online clinicians who will provide suicidal young people with first-line assistance by intervening directly on social media platforms thanks to innovative and integrated technological solutions. Specifically, Elios will offer online counseling, motivational support, crisis intervention, and referral to mainstream care services. The system is due to be implemented as part of a randomized controlled trial. If proved effective, it could be used for other care situations within France’s conventional health care system., Bien que la vulnérabilité particulière des adolescents et des jeunes adultes aux conduites suicidaires soit largement établie, le défaut persistant d’accès aux soins dans cette population reste un obstacle majeur à la prévention. Sans être dénués de risques propres, les réseaux sociaux, dont l’utilisation s’est largement généralisée, offrent des modalités d’interaction et de communication qui pourraient permettre de dépasser les classiques obstacles à la recherche d’aide. Le projet d’Équipe en ligne d’intervention et d’orientation pour la prévention du suicide (Elios) vise à exploiter les potentialités du numérique pour favoriser l’accès aux soins chez les jeunes suicidaires. Il consiste en une équipe de web-cliniciens qui interviendront directement sur les réseaux sociaux, en utilisant des solutions technologiques innovantes et intégrées, pour apporter aux jeunes une première réponse, soutenir leur démarche de demande d’aide, les sécuriser lorsque nécessaire et les orienter vers des services de soins conventionnels. Actuellement mis en œuvre et évalué dans le cadre d’un essai contrôlé randomisé, le dispositif pourrait être généralisé comme une offre de soins de droit commun.

International audience; In terms of suicide prevention, population-based prevention devices often struggle to demonstrate an effect in terms of reducing suicidal acts of suicide, often focusing on the evolution of the number of suicide attempts, on time too short to statistically interpret changes in mortality. The consolidated figures for mortality in France are provided by the CepiDC with a delay of approximately three years. We therefore had to try to work with an approximation of the phenomenon, and we tested the proxy value of the enumeration of corpses, body examinations and medico-legal autopsies for suicide by the forensic doctors of the Nord-Pas-de-Calais region in France. In parallel, we conducted a comprehensive mortality study for 2016 in the VigilanS cohort.; En termes de prévention du suicide, les dispositifs de prévention populationnels peinent souvent à démontrer un effet sur la de réduction des passages à l’acte suicidaires, se concentrant souvent sur l’évolution du chiffre des décès par suicide, sur des temps trop courts pour interpréter statistiquement des variations de mortalité. Les chiffres consolidés de la mortalité en France sont fournis par le CepiDC avec un délai d’environ trois ans. Il nous fallait donc tenter de travailler avec une approximation du phénomène et nous avons testé la valeur de proxy du dénombrement des levées de corps, examens de corps et autopsies médico-légales pour suicide par les médecins légistes de la région Nord-Pas-de-Calais. De façon parallèle, nous avons mené une étude exhaustive de mortalité sur l’année 2016 dans la cohorte VigilanS.

International audience; BackgroundAttempted suicide is a major risk factor of further re-attempts and death. Self-harm behaviors are related to multiple causes explaining why it is ineffective to have a single and simple strategy to offer after the clinical assessment in reducing morbidity and mortality. Furthermore, treatment adherence is known to be especially poor in a context where social connection seems compromised and a source of pain. Effective interventions can be divided into two categories: intensive intervention programs (care at home, supported by a series of brief psychotherapy interventions) and case management programs that rely on a “stay in contact” dimension. These programs, initiated by Jerome Motto and its short letters may consist of: (1) sending letters or postcards after discharge of the ER; (2) giving a crisis card that offers a crisis telephone line and a crisis unit for hospitalization if needed, and; (3) placing a phone call at some time distance after the discharge. The aim is to enhance a “connectedness feeling” with the patient. These different strategies have proven to be even more effective in some specific subgroups, highlighting the heterogeneity of this population. Each modality of contact was well accepted and generated a positive involvement of the patients.MethodIt led to the idea of combining these different strategies in an algorithm built on the specificity of identified subgroups. A randomized controlled trial, named ALGOS was carried out in France to test this algorithm in 2011. The algorithm consisted of: (1) delivering a crisis card for first attempters; (2) giving a phone call for re-attempters to re-assess their situation between the 10th and 21st day after their discharge, and to propose a new intervention if needed, and; (3) in case of an unsuccessful call or a refusal of proposed care, sending personalized postcards for 6 months. All of this was supported with shared information to the general practitioner of the patient. This study was further adapted to routine care in 2015 in the northern departments of France, Nord and Pas-de-Calais (4.3 million people), taking the name of VigilanS. The inclusion consists of sending a form for every patient assessed after a suicide attempt in the two departments to the medical staff of VigilanS in order to provide information about the patient and the context of his suicide attempt. The algorithm has been modified in giving the crisis card to all the patients whether it is a first attempt or not. An information letter, explaining the aim of the monitoring is also given to the patient, and to his general practitioner. The calling staff is composed of 4 nurses and 4 psychologists, all trained in suicidal crisis management. They use a phone platform located in the Emergency Medical Assistance Service (SAMU) of the Nord department on a halftime basis and manage the incoming calls from the patients as well as the outgoing calls towards the patients, their relatives and their medical contacts. A set of 4 postcards (1 per month) can be sent if needed in case of an inconclusive or a failed phone call.ConclusionBuilt on a monitoring philosophy, VigilanS has further developed a real crisis case management dimension requiring enough time to insure an effective medical supervision and strong networking abilities. A specific time is also needed to take care of all the technical aspects of the organization. This program expertise, designed by Northern departments to prevent suicide, can be shared with other French or even foreign territories.; Les tentatives de suicide constituent un facteur de risque majeur de récidives et de décès. Les comportements suicidaires sont polyfactoriels et rendent inefficace une stratégie unique de prévention. L’adhésion aux soins est mauvaise dans un contexte où les liens sociaux sont souvent en souffrance. Deux catégories de programmes ont montré leur efficacité : les dispositifs d’intervention intensive et les dispositifs de veille. Ces derniers peuvent recouvrir différentes modalités : envois de courriers, remise de carte de crise comportant un numéro d’urgence, rappels téléphoniques. Un essai contrôlé randomisé, ALGOS, a combiné ces différentes stratégies dans l’algorithme suivant : délivrance d’une carte de crise pour les primosuicidants ; rappel téléphonique des non-primosuicidants 15jours après leur sortie des urgences ; envoi de cartes postales personnalisées mensuellement pendant 6 mois en cas d’échec de l’appel ; information du médecin traitant. Cette étude a été adaptée en soins courants en 2015 dans les départements du Nord et du Pas-de-Calais sous le nom de VigilanS. L’algorithme a été légèrement modifié par la remise de la carte de crise à tous. L’équipe de recontact, formée à la gestion de crise, gère tous les appels sortants et entrants vers les patients, leurs proches et leurs soignants. Un jeu de 4 cartes postales peut être envoyé en cas d’appel téléphonique non concluant. S’appuyant sur une philosophie de veille, VigilanS a développé un véritable savoir-faire de gestion de crise, nécessitant une supervision médicale constante et de solides capacités de mise en réseau. Background : Attempted suicide is a major risk factor of further re-attempts and death. Self-harm behaviors are related to multiple causes explaining why it is ineffective to have a single and simple strategy to offer after the clinical assessment in reducing morbidity and mortality. Furthermore, treatment adherence is known to be especially poor in a context where social connection seems compromised and a source of pain. Effective interventions can be divided into two categories: intensive intervention programs (care at home, supported by a series of brief psychotherapy interventions) and case management programs that rely on a “stay in contact” dimension. These programs, initiated by Jerome Motto and its short letters may consist of: (1) sending letters or postcards after discharge of the ER; (2) giving a crisis card that offers a crisis telephone line and a crisis unit for hospitalization if needed, and; (3) placing a phone call at some time distance after the discharge. The Aim : is to enhance a “connectedness feeling” with the patient. These different strategies have proven to be even more effective in some specific subgroups, highlighting the heterogeneity of this population. Each modality of contact was well accepted and generated a positive involvement of the patients. Method It led to the idea of combining these different strategies in an algorithm built on the specificity of identified subgroups. A randomized controlled trial, named ALGOS was carried out in France to test this algorithm in 2011. The algorithm consisted of: (1) delivering a crisis card for first attempters; (2) giving a phone call for re-attempters to re-assess their situation between the 10th and 21st day after their discharge, and to propose a new intervention if needed, and; (3) in case of an unsuccessful call or a refusal of proposed care, sending personalized postcards for 6 months. All of this was supported with shared information to the general practitioner of the patient. This study was further adapted to routine care in 2015 in the northern departments of France, Nord and Pas-de-Calais (4.3 million people), taking the name of VigilanS. The inclusion consists of sending a form for every patient assessed after a suicide attempt in the two departments to the medical staff of VigilanS in order to provide information about the patient and the context of his suicide attempt. The algorithm has been modified in giving the crisis card to all the patients whether it is a first attempt or not. An information letter, explaining the Aim : of the monitoring is also given to the patient, and to his general practitioner. The calling staff is composed of 4 nurses and 4 psychologists, all trained in suicidal crisis management. They use a phone platform located in the Emergency Medical Assistance Service (SAMU) of the Nord department on a halftime basis and manage the incoming calls from the patients as well as the outgoing calls towards the patients, their relatives and their medical contacts. A set of 4 postcards (1 per month) can be sent if needed in case of an inconclusive or a failed phone call. Conclusion Built on a monitoring philosophy, VigilanS has further developed a real crisis case management dimension requiring enough time to insure an effective medical supervision and strong networking abilities. A specific time is also needed to take care of all the technical aspects of the organization. This program expertise, designed by Northern departments to prevent suicide, can be shared with other French or even foreign territories.