Epidemiological Surveillance of Suicidal Behavior

Surveillance of suicidal behavior enables the production of regular or ad hoc epidemiological indicators in the general population or in specific settings, such as those related to the workplace or among prisoners.

To this end, Santé publique France relies on:

• data on healthcare utilization, including emergency room visits for psychiatric reasons (via SurSaUD);

• data from the National Health Data System (SNDS);

• mortality data from electronic death certificates for suicides from CépiDc-Inserm;

• the Cosmop program, to produce mortality indicators by occupational activity;

• epidemiological surveys that can be repeated over time.

In addition, Santé publique France leads the “Surveillance of Suicides and Suicide Attempts” working group of the National Suicide Observatory (ONS), established by decree in September 2013 and chaired by the Drees. Its diverse membership reflects the variety of stakeholders involved in suicide prevention.

Role of Santé publique France in the ONS

The ONS is organized into two working groups:

• The first is led by Santé publique France and focuses on the surveillance of suicides and suicide attempts.

• The second, led by Drees, is responsible for improving understanding of the mechanisms underlying suicides and suicide attempts and for promoting research on this topic.

Santé publique France contributed to the drafting of the ONS reports available on the Drees website.

• Learn more about the ONS’s missions

The main surveys conducted by Santé publique France:

In the general population

Santé publique France regularly analyzes and publishes data on hospitalizations for suicide attempts at the national, regional, and subregional levels by utilizing the PMSI-MCO program (Medicalization of Information Systems in Medicine, Surgery, Obstetrics, and Dentistry) and through data reports on emergency department visits from the Oscour® network (Coordinated Emergency Surveillance Organization).

This work is supplemented by surveys of the general population (Santé publique France Barometer), which help to expand the monitoring of suicidal behaviors (suicide attempts not followed by hospitalization, suicidal thoughts) and analyze associated factors and treatment approaches, in order to better guide prevention policies.

In the workplace

Public Health France studies the link between suicide and work by analyzing suicidal behavior by occupation (without prejudging the links between suicide and work):

• Prevalence of suicidal thoughts among the employed population based on data from the Santé publique France Barometer.

• Suicide surveillance by occupation or sector of activity through the linkage of mortality data from CépiDc-Inserm with other databases containing employment information, such as the Annual Declaration of Social Data (DADS) and the Permanent Demographic Sample (EDP).

• Suicide surveillance using retrospective cohorts from a company or institution (e.g., the prison system) or occupational data from the Agricultural Social Mutual Fund (MSA).

• Surveillance of suicides potentially related to work using data from forensic medical institutes (IML).

Among Prisoners

A study of suicide deaths among prisoners in France between 2017 and 2021 was conducted by Santé publique France, in partnership with the Prison Administration Directorate of the Ministry of Justice and with prison health units. The objectives of this study are to identify individuals who died by suicide in prison, describe their sociodemographic characteristics, and document the circumstances of the suicide. All suicide cases occurring between January 1, 2017, and December 31, 2021, will be included in the study.

Measures to prevent suicide and suicide attempts

Santé publique France is supporting the rollout of several initiatives:

• maintaining contact with individuals who have attempted suicide, through the evaluation (implementation and effectiveness) of the VigilanS program;

• providing information to the public and professionals through partnership agreements (agreement with Psycom, PSSM France agreement);

• remote health prevention and assistance (PADS) by providing financial and methodological support to organizations offering listening services for people experiencing distress and/or at risk of suicide.

Evaluation of the VigilanS program – prevention of repeat suicide attempts

VigilanS is a post-hospital care program. It involves systematically re-establishing contact with and monitoring patients who have been hospitalized following a suicide attempt. It thus allows patients to remain in contact after leaving the hospital with members of a monitoring team who accompany, listen to, and support them. The objective of VigilanS is to contribute to a reduction in suicide-related morbidity and mortality.

Santé publique France is responsible for evaluating the program’s impact to determine the extent to which it reduces the rate of repeat suicide attempts among patients who were contacted after being enrolled in the VigilanS program.

Remote Health Support

To meet the public’s need for information and assistance, several remote support services (hotlines, online support) are available. Santé publique France supports several nonprofit remote support initiatives working in the field of mental health through a targeted grant program.

• Hotlines working in the field of suicide prevention and mental distress: SOS Amitiés, SOS Suicide Phénix, Suicide Ecoute, and Phare enfants-parents.

• More specialized services, such as the Ligne Azur helpline run by SIS Association, designed for LGBT+ individuals in distress, or Fil Santé Jeunes, a general helpline for those under 25 run by the School for Parents and Educators of Île-de-France.

In addition, Santé publique France produces informational materials for healthcare professionals and the general public, which are available under the “Tools” tab.