Le geste suicidaire chez l’enfant : mesure du phénomène, caractéristiques épidémiologiques et recommandations de base

RésuméLe geste suicidaire chez l’enfant est un phénomène rare et dramatique. En 2011, 36 enfants se sont donnés la mort (Cepidc). Dans l’ordre de fréquence, les moyens les plus utilisés sont la pendaison, l’auto-intoxication, le saut dans le vide et la décharge par arme à feu. Le développement de la notion de mort chez l’enfant s’acquiert progressivement. Le sens du mot suicide est compris aux alentours de 8 ans mais il n’est pas nécessaire que l’enfant ait une représentation aboutie de la mort pour effectuer un geste suicidaire. La médiatisation de tels gestes, l’émoi qu’ils provoquent ainsi que la difficulté à les étudier scientifiquement nous invitent à une rigueur particulière sur la lecture des études et l’interprétation des résultats. Nous ne disposons pas encore de théories ni de recherches sur le traitement du processus suicidaire chez l’enfant. Les principales recommandations consistent à prendre au sérieux les idées suicidaires, à privilégier la sécurité du patient en cas de situation aiguë, à mener une multiple évaluation, à empêcher l’accès aux moyens létaux et à mettre en œuvre une prise en charge maximaliste, dirigée et planifiée.

SummaryThe suicidal gesture at the child is a rare and dramatic phenomenon. In 2011, 36 children committed suicide in metropolitan France. Among these children, 27 (75%) died by hanging, strangulation and oppression, 4 (11%) died by auto-poisoning, 4 (11%) died further to a jump in the space and 1 (3%) died by discharge of a firearm. Twenty-three were boys and 13 of the girls. Suicide attempts at the child are more difficult to quantify. Three French studies having concerned the suicide attempts of the minors under age 15 show that the girls are more numerous than the boys. Most of the suicide attempts take place in the family place of residence by voluntary medicinal ingestion. The development of the notion of death at the child acquires itself gradually and requires to understand five fundamental notions: the termination of biological office, the irreversibility, the unpredictability, the universality, the determinism and the inescapability. The sense of the word commits suicide is understood near 8 years whereas most of the children know how to name at least a means of potentially mortal auto-aggressive acting out. The clinical presentations show that it is not necessary that the child has an accomplished representation of the death to make a suicidal gesture. The suicidal gesture does not still mean a real will to die but frequently the wish to obtain a change of his own internal state or the state of its environment. Rather than to die, the patients wonder how to exist. The mediatization of such gestures, the emotion, which they so cause, and the difficulty studying them scientifically invites us in a particular rigor on the reading of the studies and the interpretation of the results. It seems besides essential to distinguish the childhood of the adolescence in the epidemiological studies, to watch the definition of the suicidal gesture which is used, to be all eyes in the excessive generalization of the results, to distinguish staff and rates of committed suicide, to distinguish the causes and the suicidal motives, to study the rate of rescue and to examine the method of interrogation of the patients. We do not still arrange theories nor researches on the treatment of the suicidal process at the child. The main recommendations consist (1) to take seriously suicidal elements (ideation, threat), (2) to practice a somatic examination in case of actual suicidal gesture, (3) to use a protocol of dismantling of the crisis, (4) to practice a multidisciplinary evaluation following the rule of “4 evaluations” (evaluation of the risk factors, the family and social situation of the child and the possible elements of danger, evaluation of a psychiatric pathology, evaluation of the psychological processes, evaluation of the suicidal process [preparatory behavior, suicidal ideation…]), (5) to relieve immediately the suffering of the child, (6) to imply families and social network and to inform the patient and the circle of acquaintances about the care, (7) to prevent the access to the lethal means, (8) to practice a structured, managed and strategic maximalist care, (9) to implement a suicidal monitoring at the exit of hospitalization (regular and moved closer consultations, phone reminder, house call), (10) to operate a follow-up of prevention of the suicidal relapses, (11) to establish the long-term treatment (ambulatory, psychotherapy, etc.). Most of the authors recommend the development of a better accessibility of the professionals to the formations in suicidology and a regular supervision for those who are daily confronted with acts or threats containing such violence.