BackgroundSuicide within the Amerindian community of Camopi (1741 inhabitants) in French Guiana has been an increasing problem widely reported in the media leading the French Government to mandate a parliamentary mission to investigate the matter. The purpose of the study was to describe this phenomenon and identify factors associated with suicide attempts.MethodsA retrospective observational study was conducted from the health centers’ medical records. All suicide attempts and suicides committed between 2008 and 2015 by Amerindians living in Camopi and Trois Sauts were compiled. Contextual factors and suicide representations were also analyzed.ResultsDuring the study period, the annual attempted suicide rate and the suicide rate were higher in the last 3 years. The overall annual rate was equal to 6.9/1741 or 396 per 100, 000 inhabitants for attempted suicide and 172 per 100,000 inhabitants for suicide, which is more than 10 times higher than the suicide rate in mainland France. The mortality rate was 30.4% versus 8.2% in mainland France. The 10–20 year-old age group represented 70% of suicide deaths. There was no significant difference between genders. A recent death and interpersonal conflict were the main stressful life events reported by respondents (55 and 52%, respectively). Alcohol addiction (30% of the respondents) was associated with suicide attempts under the influence of alcohol (p = 0.03). Repetition of suicide attempts was associated with cannabis consumption (p = 0.03). Depression was reported among 45% of the respondents. A third of respondents reported having been abused during their childhood. Over half of respondents reported that their suicide attempt was motivated by a spirit (58%).ConclusionsDespite limitations due to the small population size and limited time frame, this is the first study to describe the epidemiology of suicide among Amerindians living in Camopi. In contrast with other French territories, the suicide rate was very high, the sex ratio was balanced and younger age groups were most affected.
Objectives To assess understudied, alternative suicide prevention modalities in a mental health care setting. Methods This was a prospective study of patients (n = 140, 68 cases and 72 controls) who were admitted to hospital or who contacted an SOS suicide crisis line for suicidal ideation or attempts. Psychiatric diagnoses (Mini-International Neuropsychiatric Interview) and intensity of anxiety/depression/suicidality (Hamilton Anxiety Rating Scale, Montgomery–Åsberg Depression Rating Scale, and Beck Scale for Suicidal Ideation) were assessed. All intervention group subjects received a crisis card with a crisis line number, interviews with psychologists or volunteers and a telephone call on days 10 to 21, then 6 months later. These subjects also had a choice between two further 4-month interventions: body contact care or mobile intervention team visits. Results The interventions significantly reduced the number of suicide attempts and suicide (3%) at 6 months compared with the control condition (12%). There were fewer losses to follow-up in the intervention group (7.35%) than in the control group (9.72%). Conclusions The results favour the implementation of integrated care and maintaining contact in suicide prevention.
La situation de la Guyane-Française, département français d’Amérique, est un exemple fort de l’exigence de prendre en compte les paramètres transculturels pour comprendre et agir sur la prévention du suicide. On distingue, dans cette région, la population vivant sur le littoral ayant accès aux principales ressources et la population vivant dans les communes de l’intérieur. En effet, les peuples de la Guyane sont irrégulièrement répartis sur 84 000 km2. Certains villages sont éloignés des structures de soins et de santé parfois de plusieurs jours de pirogues. Les dernières études de l’OMS démontrent que les risques du suicide croissent avec l’éloignement des centres urbanisés. La population résidant sur les deux fleuves de la Guyane et à l’Intérieur (espace forestier amazonien) présente une vulnérabilité au suicide supérieure à tous les autres segments de la société guyanaise et française. Ces suicides sont essentiellement le fait de jeunes. La question du suicide chez les populations autochtones de la Guyane révèle un mal être profond qui dépasse la simple conception médicopsychologique du risque de passage à l’acte. Les causes de ce phénomène sont pluridimensionnelles et regroupent entre autres des facteurs psychologiques, sociaux, anthropologiques, écologiques et politiques. Si les passages à l’acte sont dans la majorité des cas liés à une consommation excessive d’alcool et déclenchés par des motifs au premier abord anodins (différends familiaux, obstacle à l’achat de produits de consommation), ils résultent plutôt de la manifestation extrême d’un mal-être bien plus profond. Pertes de repères liés à la modification brutale des modes de vie, déstructuration de la cellule familiale, inactivité en particulier chez les jeunes, échecs scolaires, absence de perspectives d’avenir et isolement sont des motifs qui peuvent expliquer le comportement suicidaire. Un partenaire majeur dans cette réflexion est le CCPAB (Conseil consultatif des populations amérindiennes et Bushininge de Guyane), instance auprès de la future collectivité unique, siégeant à la Préfecture, spécifique aux DOM, qui fait du suicide des autochtones un axe prioritaire de lutte. C’est une démarche intégrative de ces dimensions pour une évaluation globale avec des outils spécifiques que nous construisons au sein de l’équipe Inserm (Ipsom) à laquelle est adossée la CeRMEPI (cellule régionale pour le mieux être des populations de l’intérieur) créée par le préfet. Cette prise en charge holistique permettra d’aider le travail plus spécifiquement médical de prévention et de soins qui est actuellement effectué par les services de psychiatrie de Guyane grâce aux équipes mobiles et à la CUMP (cellule d’urgence médicopsychologique).
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