Recours à la psychothérapie en France chez les adultes avec tentative de suicide : résultats d’une vaste enquête épidémiologique

Abstract

ObjectivesThe current study aims to identify the factors associated with the use of psychotherapy among adults with a history of suicide attempt. MethodsA large cross-sectional survey (N=22,138) was conducted in four regions of France to characterize mental health care needs in the general population. Data were collected between April and June 2005 by trained interviewers using a computer-assisted telephone interviewing system (CATI). Sociodemographics, past-year mental disorders, lifetime and 12-month history of suicide attempts, and use of psychotherapy were assessed. ResultsOverall, 7.1% of adults reported having undergone psychotherapy in the course of their life, and 2.0% in the previous 12 months. While 8.3% of adults with a lifetime suicide attempt (prior to the previous 12 months) underwent a psychotherapy in the previous 12 months, 27.5% of adults with a past-year suicide attempt underwent a psychotherapy in the previous 12 months. Psychotherapy was provided by psychiatrists (49.5%), psychologists (28.2%), and psychoanalysts (10.6%). While the frequency of psychotherapy sessions was greater among those with a prior attempt as compared to those with no prior attempt [Chi2 (10)=21.35, P=.019], there was no difference in therapy duration [Chi2 (8)=6.71, P=.568]. Compared to adults who did not report a prior attempt, those with a prior suicide attempt were 3,3 more likely to undergo psychotherapy with a psychologist [AOR=3.31 (2.54–4.31)]. Among adults with a prior suicide attempt, increased odds of undergoing a psychotherapy in the course of their life was predicted by higher education [AOR=2.81 (1.56–5.06)], living in the Paris region [AOR=2.06 (1.32–3.23)], and being a woman [AOR=1.50 (1.08–2.09)]. Increased odds of undergoing a psychotherapy in the previous 12 months was predicted by a major depressive disorder [AOR=2.59 (1.57–4.27)], any anxiety disorder [AOR=1.79 (1.07–2.97)], higher education [AOR=3.60 (1.29–10.0)], living in a city of 20,000 to 100,000 inhabitants [AOR=2.71 (1.13–6.50)] and more [AOR=2.50 (1.12–5.57)] (outside of the Paris region), a 2000 to 3000 euros monthly income [AOR=2.37 (1.15–4.85)]. DiscussionOne third of adults with a lifetime suicide attempt and close to half of those with a past-year attempt have received some form of psychotherapy in the course of their life. In line with prior work, higher education and income level predicted past-year use of psychotherapy among adults with a prior suicide attempt. These findings highlight the association between major depressive disorder or anxiety disorders and increased odds of undergoing psychotherapy in the previous 12 months among adults with prior attempt. While pharmacological treatment, inpatient hospitalizations for mental health problems, visits with a general practitioner or specialized physician are free of charge in France, psychotherapy provided by psychologists or psychotherapists is currently not covered by the French Social Security health care system. As the treatment of mental disorders plays an important role in the reduction of suicide risk, supporting evidence-based psychotherapy through its reimbursement appears to be an important public health issue.