Participation à une recherche en situation de deuil : Satisfaction et considérations éthiques

Si des études ont mesuré la satisfaction des individus ayant participé à une recherche, peu d’entre elles se sont penchées sur la satisfaction des individus plusieurs mois après leur participation à une recherche. L’étude actuelle a pour but de comparer la satisfaction de deux groupes de personnes ayant participé à une recherche alors qu’elles étaient en situation de vulnérabilité. Un groupe de 20 personnes endeuillées après un suicide ont été interviewées immédiatement après le processus de recherche, et 20 personnes, également endeuillées après un suicide, ont été questionnées une année après leur participation à une recherche scientifique. Les résultats des deux groupes sont semblables et démontrent un haut niveau de satisfaction. Tous les participants accepteraient de recommencer l’expérience et recommanderaient à d’autres personnes endeuillées de participer à une telle étude. Ainsi, les recherches qui sollicitent la participation d’individus endeuillés après un suicide peuvent être bénéfiques pour les participants et respecter toutes les normes éthiques quant à la validité du consentement.Several researchers were interested in the satisfaction of the persons having participated in a study while in situation of vulnerability. If most research verified the satisfaction of the individuals at the end of research process, few investigated participant’s satisfaction several months after the end of the research. The current study aims at comparing the satisfaction of two groups of persons having participated in a research. A group of 20 persons in grief after a suicide was interviewed after the process of research, while a group of 20 persons, also in grief after a suicide, were questioned one year after their participation in a scientific research. The results of both groups were similar and demonstrate a high level of satisfaction. All the participants would agree to participate in the experiment again and all of them would recommend other people in grief to participate in such a study. The researches which seek individuals’ participation in grief after a suicide can be beneficial for the participants and respect all the ethical standards as for the validity of the consent

L’impact du suicide d’un patient chez des professionnels en santé mentale : Différences entre les femmes et les hommes

Cet article rapporte les résultats d’une recherche réalisée auprès de 141 professionnels en santé mentale pratiquant au Québec et ayant vécu le suicide d’un patient. Les professionnels ont réagi à cet événement différemment en fonction de leur sexe. Les femmes y ont répondu par un niveau de stress élevé au cours du premier mois, alors que les hommes ont dévoilé un niveau de stress faible. Le niveau élevé de stress relevé chez les femmes était accompagné de répercussions initialement plus intenses sur leur pratique professionnelle : tendance accrue à hospitaliser des patients suicidaires ou précautions accrues dans leur traitement, évaluation d’un plus grand nombre de patients comme présentant un risque de suicide, sentiment accru d’impuissance lors de l’évaluation ou du traitement de patients suicidaires, consultation plus fréquente de collègues et de superviseurs, attention accrue aux aspects légaux dans la pratique. L’article tente de mieux comprendre les différences entre les réactions des professionnels observées selon leur sexe, à la lumière des théories de la socialisation et du développement professionnel.This article presents the results of a study of 141 mental health professionals who have experienced a patient’s suicide. Results indicate that mental health professionals reacted to such suicides in different ways according to gender. Women generally responded with elevated stress levels in the first month, while men experienced stress levels that were subclinical on average. The high stress response found in women was also initially accompanied by more profound impacts on their professional practice : increased hospitalizations of suicidal patients or greater precautions in their treatment, increased evaluation of patients as being at risk for suicide, increased helplessness while assessing or treating suicidal patients, more frequent consultation of colleagues and supervisors and more attention to legal issues. Gender differences found in this study are discussed in the light of socialization and professional development theories

L’après-suicide, une expérience unique de deuil?

Le groupe d'étude national sur le suicide au Canada suggère que les personnes qui vivent un deuil suite à un suicide forment un groupe à risque suicidaire. La littérature rapporte que ces endeuillés ont un taux de suicide neuf fois plus élevé que la population générale. Des auteurs suggèrent que ce type de deuil est plus intense et plus long que d'autres formes de deuil, constat que d'autres ont remis en doute. Qu'en est-il? Le deuil suite à un suicide est-il différent? S'agit-il d'une expérience unique de deuil? Un examen attentif de l'ensemble des études nous apprend que le deuil suite à un suicide présente des caractéristiques particulières, qui se manifestent davantage chez des personnes plus vulnérables.Canada's national task force on suicide suggests that people who mourn a suicide make up a group that is itself at risk. Literature shows that mourners of a suicide have a suicide rate that is nine times higher than average. While some authors suggest that this type of mourning is more intense and of a longer duration that for other types of mourning, other authors doubt this hypothesis. But what happens in reality ? Is suicide mourning truly different from other types of mourning? Is it really a unique mourning experience? These are some of the questions the authors of this article have attempted to answer. Following an in-depth review of studies on the matter, the authors conclude that the mourning of a suicide encompasses certain characteristics that manifest themselves especially in more vulnerable people

Données récentes d’études scandinaves. Traiter la dépression : une stratégie efficace de prévention du suicide?

Cet article vise à éclairer les planificateurs en santé publique, le personnel clinique et les intervenants en prévention du suicide au Québec ainsi que les familles et le public francophone à propos de récentes études sur le traitement de la dépression comme stratégie de prévention du suicide. Les auteurs en résument les conclusions, passent en revue les méthodes et examinent les résultats dans une perspective de santé publique visant à établir une stratégie efficace de prévention. Ils soulignent que le traitement de la dépression pourrait non seulement réduire les taux de suicide mais avoir des effets importants sur la santé publique en réduisant les incapacités liées à la dépression, en plus d'avoir un impact sur les futures générations à risque. Les obstacles au développement d'une telle stratégie sont soulignés en référence spécifique à la situation du Québec.Treating depression is an effective population suicide prevention strategy: recent evidence from Scandinavian studies This article's objective is to signal to the Quebec and the francophone audience of public planners and decision makers, clinical and suicide prevention workers, staff, relatives as well as the public of these recent breakthrough findings that provides strong evidence now that increasing the treatment of depression is an effective suicide prevention strategy. The article summarizes the evidence published recently and then critically reviews the methods and if the evidence fits within a complete public health perspective demonstration of an effective suicide prevention strategy. It highlights that the treatment of depression may not only decrease suicide rates but have much more larger public health effects by decreasing the disability associated with depression and have impact on future generations at risk of depression and suicide. The obstacles to developing such nation-wide strategy of increasing the treatment of depression will be highlighted with specific reference to the situation in Quebec.Datos recientes de investigaciones escandinavas. Tratar la depresión: ¿una estragegia eficaz de prevención del suicidio? El artículo quiere alumbrar los planificadores en salud pública, el personal clínico y los intervenantes en prevención del suicidio en Quebec asi que las familias y el público francófono sobre estudios recientes tocando el tratamiento de la depresión como estrategia de prevención del suicidio. Los autores resumen las conclusiones, pasan revista las métodas y examinan los resultados desde una perspectiva de salud pública con objeto de establecer una estrategia eficaz de prevención. Subrayan que el tratamiento de la depresión podria no solamente reducir las tasas del suicidio pero tener efectos importantes sobre la salud pública reduciendo las incapacidades ligadas a la depresión y además tener un impacto sobre generaciones futuras a riesgo. Los obstáculos al desarrollo de tal estrategia estan subrayados con referencia específica a la situación del Québec.Dados recentes de estudos escandinavos. Tratar a depressão: uma estratégia eficaz de prevenção contra o suicídio? Este artigo visa informar os promotores em saúde pública, os funcionários clínicos e os assistentes em prevenção contra o suicídio no Quebec, e também as famílias e o público francófono a respeito dos estudos recentes sobre o tratamento da depressão como estratégia na prevenção contra o suicídio. Os autores resumem aqui as conclusões, analisam os métodos e examinam os resultados em uma perspectiva de saúde pública visando estabelecer uma estratégia eficaz de prevenção. Eles ressaltam que o tratamento da depressão poderia, não apenas diminuir a taxa de suicídio, mas ter efeitos importantes na saúde pública, reduzindo a incapacidade ligada à depressão, além de ter um impacto nas futuras gerações em risco. Os obstáculos ao desenvolvimento de tal estratégia são ressaltados fazendo referência específica à situação do Quebec

Mental health service utilization among students and staff in 18 months following Dawson College shooting

The aim of this study was to investigate service utilization by students and staff in the 18 months following the September 13, 2006, shooting at Dawson College, Montreal, as well as the determinants of this utilization within the context of Canada’s publicly managed healthcare system. Methods A sample of 948 from among the college’s 10,091 students and staff agreed to complete an adapted computer or web-based standardized questionnaire drawn from the Statistics Canada 2002 Canadian Community Health Survey cycle 1.2 on mental health and well-being. Results In the 18 months following the shooting, there was a greater incidence and prevalence not only of PTSD, but also of other anxiety disorders, depression, and substance abuse. Staff and students were as likely to consult a health professional when presenting a mental or substance use disorder, with females more likely to do so than males. Results also indicated that there was relatively high internet use for mental health reasons by students and staff (14% overall). Conclusions Following a major crisis event causing potential mass trauma, even in a society characterized by easy access to public, school and health services and when the population involved is generally well educated, the acceptability of consulting health professionals for mental health or substance use problems represents a barrier. However, safe internet access is one way male and female students and staff can access information and support and it may be useful to further exploit the possibilities afforded by web-based interviews in anonymous environments

Redução de fatores de risco em jovens suicidas através de oportunidades de estabelecimento de laços sociais em serviços comunitários

Aim: This study examined the trajectory (life course) of youths, referred to community services following their suicidal behavior, in order to measure the extent to which these young people have taken this opportunity to modify connectedness with family, school, and workplace, and to change high-risk factors related to suicidal behaviors (mental health problems, delinquency, drug consumption). Method: Fifteen youths (aged 16-19), who made one or more suicide attempts or had serious ideation in the previous 24 to 48 months, were referred to community services (Vallée-Jeunesse). They were interviewed using an intensive personal interview measures (Trajectory Instrument Measure, TIM) in order to document significant life events and adversities that occured during different periods of their life.In addition, we administered the Structured Clinical Interview for DSM-IV Axis-I and Axis-II disorders (SCID-I and SCID-II) to identify past and current psychopathologies. Results: Several important changes took place following their entry into the community services: a reduction in delinquency and substance abuse/dependence, and positive changes in occupational status and suicidal behaviors (ideation and suicide attempt). Conclusion: Our findings can inform policies and strategies that support the prevention of suicidal behavior among young adults. Community services providers can play a role in the prevention of suicidal behaviors for the most vulnerable youths. These types of services could complement traditional suicide prevention strategies, which are mostly mental-health based.Objetivo: Este estudo analisou a trajetória (curso de vida) de jovens encaminhados para serviços comunitários após comportamento suicida, a fim de verificar em que medida aproveitaram essa oportunidade para modificar a ligação à família, escola e local de trabalho, e mudar fatores de alto risco relacionados com comportamentos suicidas (problemas de saúde mental, delinquência, consumo de drogas). Método: Quinze jovens (16-19 anos) que fizeram uma ou mais tentativas de suicídio ou manifestaram ideação suicida nos últimos 24 a 48 meses foram referenciados para serviços comunitários (Vallée-Jeunesse). Estes foram entrevistados através de entrevistas pessoais intensivas (Trajectory Instrument Measure, TIM), a fim de registar eventos significativos e adversidades que ocorreram durante diferentes períodos de sua vida. Adicionalmente, foi utilizada a Entrevista Clínica Estruturada para perturbações do Eixo-I e Eixo-II do DSM-IV (SCID-I e SCID-II) para identificar psicopatologias passadas e atuais. Resultados: Várias mudanças importantes ocorreram após a sua entrada nos serviços comunitários: uma redução na delinquência e abuso/dependência de substâncias, e mudanças positivas na situação ocupacional e comportamentos suicidas (ideação e tentativa de suicídio). Conclusão: Os resultados podem fundamentar políticas e estratégias que apoiem a prevenção do comportamento suicida em jovens adultos. Os prestadores de serviços comunitários podem desempenhar um papel na prevenção de comportamentos suicidas para os jovens mais vulneráveis. Esses tipos de serviços poderão complementar estratégias tradicionais de prevenção do suicídio, que são principalmente baseadas em abordagens da saúde mental

Evaluation of the Dawson College shooting psychological intervention: moving toward a multimodal extensive plan

In 2006, following the shooting at Dawson College, the authorities implemented an intervention plan. This provided an opportunity to analyze the responses to services offered, and afforded a learning opportunity, which led to the proposal of an extensive multimodal short- and long-term psychological plan for future needs. Both quantitative and qualitative data were gathered 18 months after the event, involving the participation of 948 students and staff. Mental health problems and the perception of services offered after the shooting were investigated, using standardized measures. Second, focus groups and individual interviews were conducted among a subgroup of participants (support team members; teachers and employees; students and parents) and permitted to gather data on services received and services required. Individual report of events, the extent of psychological impact and services offered and received were analyzed in terms of the following dimensions: intervention philosophy, training, ongoing offer of services and finally, detection and outreach. A significant incidence of disorders and a high rate of exacerbation of preexisting mental disorders were observed within the 18 months following the shooting. Postimmediate and short-term intervention appeared adequate, but the long-term collective vision toward community support and availability of mental health services were lacking. Lessons learned from this evaluation and other school shootings suggest that preparedness and long-term community responses are often overlooked. A multimodal extensive plan is proposed based on a theoretical model from which interventions strategies could be drawn

Trajectoire de vie et « résilience » des personnes suicidaires

Comment comprendre l’apport des séparations précoces, des difficultés relationnelles, des problèmes de santé mentale dans la vie des personnes qui se suicident ? Bien que la dépression soit une variable qui explique en partie les comportements suicidaires, il semble y avoir chez les personnes décédées par suicide une trajectoire de vie caractérisée par un cumul de souffrances, de pertes et d’abandons qui se conjuguent à un moment précis de la trajectoire de vie et engendrent chez celles-ci une incapacité d’encaisser encore d’autres pertes. Quelles expériences ont une influence marquante ? De quelle manière ces expériences peuvent-elles avoir une emprise, positive ou négative, au cours de la vie ? L’enjeu consiste à identifier les combinaisons d’événements qui placent les individus à risques de psychopathologie et, en fin de compte, de passage à l’acte suicidaire. On comprend bien que dans cette chaîne d’interactions, les relations d’attachement et l’histoire familiale soient centrales et constituent le début, soit protecteur, soit malheureux du processus d’engrenage.How can we better understand the contribution of early-life separations, relationship troubles, and mental health problems in the lives of suicidal individuals? Although depression is a variable that partially explains suicidal behavior, it seems that the life path of those who have died as a result of suicide creates an accumulation of suffering, losses and abandons that work together at a specific moment in one’s life path and generate within such persons an inability to be resilient to other losses. Which experiences have a major impact? How can these experiences have a hold, either positive or negative, during the course of one’s life? The challenge consists of identifying the combinations of events that place individuals at psycopathological risks and, ultimately, lead them to commit suicide. It is well understood that within this chain of interactions, relationships of attachment and family history are crucial and represent the albeit protective and unfortunate beginning of a vicious circle