[Suicide mortality in Rhône-Alpes psychiatric sectors. Or the difficulties in a study]

Mandated by the Social Welfare and Health Regional Office, the Regional Health Observatory realized a study on mortality by suicide in the psychiatric sectors. This work is based mainly on the definitions of a new map of the psychiatry, set on June 1994. Its objective was to give to each sector team a set of quantitative data on deaths due to suicide, happened on their area, both in term of progress (1982-1989) and of comparison (respective level of each sector compared to the "département" mean). This descriptive study is based on the regional cumulated mortality data from 1981-1983 and 1988-1990, given by the National Institute of Health and Medical Research (INSERM) and on the data of General population census in 1990. Epidemiological studies on suicide generally get as reference a delimitated geographical basis, accordingly to most of the important statistical databanks (nation wide, region wide...). The general psychiatric sectors are quite different, as the repartition is complex and their number is important (more than 80 for Rhône-Alpes Region) as well as the diversity of local needs and the organization in psychiatry. This repartition, responding to the needs of a medical and preventive practice, causes a great number of difficulties when one tries to approach this reality with statistics: the frontiers between sectors are determined with a degree of precision overtaking the one of demographical and epidemiological data sources. Taking into account the small size of the sectors, the number of deaths by suicide (mean of 10 to 20 by sector) does'nt enable to estimate the significance of the results. Despite the difficulty of different limitations, the data show inter-sectorial particularities, which could justify a regular epidemiologic survey (i.e.g., a growth in number of death by suicide in the "département" of Rhône between 1982 and 1989 is to be noticed more in urban areas). Such monitoring suggests a better acknowledgment of the feasibility of statistical surveys based on the sectors, and its use in the map of psychiatric services as well as the implementation of means, allowing data to be release quickly at the local level.