The overall picture reveals a deterioration in mental health, marked by an increase in suicidal ideation and suicide attempts during and following the health crisis, against a backdrop of regional and subregional variations.

These reports are part of the ongoing development of mental health surveillance at the regional level and include an update of data since the first regional publication on the topic (February 2019) and a focus on changing trends during the health crisis.

The overall finding, common to all regions, is a continuous deterioration, beginning in the fall of 2020, in indicators related to emergency department visits for suicidal ideation and suicidal acts, and hospitalizations for suicide attempts, particularly among young people aged 10 to 24 and females. This trend continued into 2021 and even intensified in 2022 (first half), with no observable impact on suicide mortality until March 2021.

The significant increase in emergency room visits for suicidal ideation, particularly among young people, points to a sense of distress that appears to be persistent. The impact of the health crisis is likely, but other potential causes of distress (such as economic difficulties, the international situation, or environmental issues) could contribute to a persistent decline in mental health and an increased risk of suicide. Maintaining reactive mental health surveillance across all life stages remains a priority in Santé publique France’s monitoring missions.

Beyond this overall observation, there is a wide variation in regional and subregional situations.

Increase in hospitalizations for suicide among young people during the health crisis

Since 2010, the general trend has been a decline in hospitalization rates for suicide attempts among both men and women, though this decline was less pronounced after 2014, in all regions except Nouvelle-Aquitaine (stable) and Réunion (increasing from 2010 to 2015).

During the health crisis, over the 2020–2021 period, hospitalization rates for suicide attempts in the periods before, during, and after the first two lockdowns show a decline during the first lockdown followed by a continuous increase in France and in metropolitan regions, particularly among girls and women aged 10 to 24.

In 2021, the annual regional hospitalization rate for suicide attempts among those aged 10 and older stood at 150 per 100,000 inhabitants in France. It varies by metropolitan region, ranging from 70 per 100,000 inhabitants in Corsica to 268 per 100,000 in Hauts-de-France—nearly four times higher. In the overseas departments and regions (DROM), hospitalization rates for suicide attempts are among the lowest in France, with the exception of Réunion (139 per 100,000 inhabitants). The hospitalization rate for suicide attempts is about one and a half times higher among women than among men, though this ratio varies by region.

Nevertheless, no upward trend in suicide deaths has been observed

Based on available data, no increase in suicide mortality in France was observed during the health crisis through March 2021, according to a study based on death certificates.

Analysis of mortality at the regional level, available through 2017, shows a general downward trend in suicide deaths since 2010. In 2017, the suicide mortality rate among those aged 10 and older stood at 14 per 100,000 inhabitants in France. Rates varied across metropolitan regions, ranging from 7 per 100,000 inhabitants in Île-de-France to 22 per 100,000 inhabitants in Brittany. In the DROMs, mortality rates were among the lowest in France.

The heterogeneity of regional situations with regard to indicators of suicidal behavior and their trends highlights the importance of regionally tailored mental health and suicide surveillance.

Suicide prevention: a priority for the entire population

While the current distress among young people is concerning and requires targeted interventions, the fact remains that the majority of suicide deaths involve adults over 40, predominantly men, not to mention that, by age group, the highest suicide rates per 100,000 inhabitants are observed among seniors.

Suicide prevention is therefore a public health priority at all stages of life, involving the direct prevention of suicidal acts through measures implemented at the national level; it is also part of a broader strategy to promote mental health and prevent psychological distress.

• 1. Suicide prevention is the focus of a strategy targeting those most at risk of acting on suicidal thoughts

Santé publique France supports the development and implementation of the national suicide prevention strategy through its expert work (studies, evaluations).

This strategy proposes combining, at the regional level, a set of interventions designed to protect, treat, and support those most at risk of acting on their suicidal thoughts (people who express suicidal thoughts or have already attempted suicide).

Santé publique France is notably involved in the monitoring and support of:

• the VigilanS system, which monitors and follows up on patients discharged from the hospital following a suicide attempt,

• the national suicide prevention hotline, 3114, which offers support and a listening ear from a healthcare professional specifically trained in suicide prevention. This number, accessible 24/7, free of charge, throughout France, also has a website that provides resources to better understand suicidal crises and advice on how to overcome them.

In addition to 3114, numerous organizations offer help and support tailored to specific issues. In April 2020, Santé publique France created a section dedicated to mental health on its website, listing all remote support services, categorized by population group (children, students, seniors, etc.) or by topic (psychological distress, violence, grief, addiction, parenting, etc.).

• 2. Suicide prevention is part of a broader strategy to promote mental health and prevent psychological distress

While it is crucial to intervene close to the time of the act to reduce the number of suicides and suicide attempts, it is also essential to intervene early to strengthen protective factors and prevent mental disorders and psychological distress. To this end, Santé publique France is committed to implementing initiatives:

• developing children’s psychosocial skills and supporting parenting (Family and Parenting Support Program, the First 1,000 Days program, etc.), which are major determinants of the population’s mental health,

• information and communication to increase the public’s knowledge of mental health, encompassing well-being, psychological distress, and mental disorders (determinants, signs, symptoms, causes, treatments, professionals, available resources, supportive behaviors, etc.). The challenge is to advocate for the development of behaviors and environments more conducive to mental health (family, school, city, workplace, etc.), to promote the early identification and management of psychological distress (before disorders take hold and worsen), and finally to combat stigma and promote the social inclusion of people with mental health disorders.