Rising suicide attempts in french polynesia: urgent need for targeted mental health strategies

A recent study conducted in French Polynesia has shed light on the increase in suicide attempts (SAs) during the COVID-19 pandemic (1). The study spanned 36 months, beginning in 2020 and ending in 2023, capturing 895 registered and confirmed SAs among 764 individuals. During this period, we witnessed a stark rise in SA rates, with a corresponding annual crude rate of 106.7 SAs per 100,000 inhabitants. This translates to an alarming 54.9% increase in SA incidence compared to the rates observed in 2008-2010.

Demographic and Geographic Characteristics

The study revealed that the 10–19 and 20–29 age groups accounted for most SA cases, constituting 49.3% of all SAs. The mean age of individuals attempting suicide was 33.0 years, with a notable decline in SA incidence with increasing age. Gender-wise, 54.1% of SAs were females, indicating a slight gender disparity in favor of women. However, this gender difference was particularly pronounced in the under-20 age group, highlighting a concerning vulnerability among young women.

Geographically, the vast majority of SAs (81.6%) occurred in the most populous island of Tahiti. The Leeward Islands, Moorea, Tuamotus-Gambiers, Austral Islands, and Marquesas collectively accounted for the remaining SAs. Tahiti, being the most urbanized and economically developed island, exhibited significantly higher SA rates compared to other regions.

Time Course of Suicide Attempts

The study also examined the temporal trends in SA rates during the 36 months. It discovered notable fluctuations in the average monthly SA rates across the years. In the third year of the study, representing the peak of the COVID-19 pandemic, we witnessed a substantial increase in SA rates compared to the first and second years. This upward trajectory underscores the enduring psychological impact of the pandemic, signaling that the crisis's repercussions may persist beyond its official conclusion.

Methods of Suicide Attempts

Voluntary drug intoxication emerged as the most common method of suicide, accounting for 56.8% of all sales, followed by hanging at 19.9%. Gender disparities were evident in the choice of ways, with depending being significantly more common among men, while voluntary drug intoxication was predominant among women. The study also highlighted a statistical preference for physical force methods, such as hanging and cutting, among individuals aged 20–29.

Associated Psychiatric Diagnoses and Hospitalization

Surprisingly, nearly half of the SA cases (49.6%) had no current or past psychiatric diagnosis. Psychiatric diagnoses primarily included a history of isolated suicidal behavior, depressive episodes, and psychotic disorders. Notably, more males had psychotic disorders, while females were more prone to anxiety and neurotic disorders.

Furthermore, the study revealed that 36.3% of SAs resulted in hospitalization in psychiatric inpatient wards, a rate that increased to 52.7% when individuals had a psychiatric diagnosis. Younger patients and those with comorbid psychotic or bipolar disorders were more likely to be hospitalized.

Repeated Suicide Attempts

SAs were divided into subgroups: those with only one subject and those with recurrent issues. The latter group accounted for 14.7% of all SAs, including individuals with multiple suicide attempts. The mean time to recurrence was 193 days, highlighting the importance of ongoing support and intervention for these individuals. Notably, this subgroup exhibited a similar gender ratio and age distribution to the general cohort.

Standardized Rates by Age and Geographic Area

Given the unique geographic distribution of French Polynesia's islands, the study examined SA rates after adjusting for age and locality. Tahiti, the most urbanized island, displayed the highest annual incidence of SAs, particularly among individuals under 40 years old. Young women in Tahiti, aged 10 to 20, faced a particularly alarming standardized SA incidence of 310.4 per 100,000 per year.

Discussion

The study's findings underscore the significant increase in suicide attempts during the COVID-19 pandemic in French Polynesia, especially among young individuals. This surge in SA rates during the third year of the pandemic, coupled with the upward trajectory observed over the study's duration, raises concerns about the long-term psychological effects of the crisis.

Notably, a substantial proportion of SAs occurred in the most urbanized region of Tahiti, reflecting the complex interplay of sociocultural factors in suicide risk. The study also highlighted the role of physical force methods, such as hanging and cutting, among the young population. Surprisingly, nearly half of the SA cases lacked psychiatric diagnoses, emphasizing the importance of addressing acute stressors and environmental difficulties during crises like the pandemic.

The study calls for urgent attention to mental health prevention and intervention strategies, particularly in the aftermath of catastrophes such as the COVID-19 pandemic. Recognizing the vulnerability of young individuals, especially women, is crucial for tailoring targeted mental health support programs. These initiatives should aim to mitigate the negative impact of social isolation, economic instability, and uncertainty, exacerbated by the pandemic and might persist in its aftermath. 

Efforts to combat the rising rates of suicide attempts in French Polynesia must also focus on destigmatizing mental health issues, increasing awareness, and improving access to mental health services. Public health campaigns should be designed to educate the population about the signs of emotional distress, available resources, and avenues for seeking help. Reducing the stigma associated with mental health problems can encourage individuals to seek support early, potentially preventing suicide attempts.

Furthermore, the findings suggest the need for improved psychiatric assessment and intervention protocols, especially for individuals who have previously attempted suicide. Early identification and intervention for psychiatric conditions, even in cases where a formal diagnosis is absent, can be instrumental in preventing further suicide attempts.

The study's geographic distribution of suicide attempts also emphasizes the importance of tailoring interventions to address regional disparities in mental health. While Tahiti exhibited the highest SA rates, attention must also be directed toward the other islands, where access to mental health services might be limited. Telemedicine and telepsychiatry services could be explored to reach individuals in remote areas.

In conclusion, the increase in suicide attempts in French Polynesia during the COVID-19 pandemic highlights the pressing need for comprehensive mental health support and suicide prevention strategies. Understanding the demographic, geographic, and methodological patterns of suicide attempts is a crucial step in designing effective interventions. However, addressing this issue requires a multi-faceted approach that includes clinical care, public awareness campaigns, community support networks, and efforts to reduce mental health stigma. It is essential to prioritize mental health and well-being as part of the broader public health response to crises like the COVID-19 pandemic to protect the most vulnerable individuals in society.

Reference

1. Suicide attempts in French Polynesia during the era of COVID-19: a prospective analysis over three years Sebti, Johan et al. The Lancet Regional Health – Western Pacific, Volume 0, Issue 0, 100899