Fabienne Ligier

Child and adolescent mental health is increasingly recognized as a major public health concern worldwide. However, access to timely and coordinated mental health care remains uneven, particularly for children experiencing psychosocial, developmental or learning difficulties. Fragmentation across health, social care and education systems often contributes to discontinuous care pathways, especially in resource-constrained and rural settings. While a substantial body of literature on child mental health services originates from high-income countries, the organization of services differs significantly across national systems. In France, Child and Adolescent Medico-Social Centres (Centres Médico-Psycho-Pédagogiques, CMPP) are publicly funded outpatient services operating at the interface of healthcare, disability support and education sectors. Despite their central role in organizing care pathways, little is known about how these pathways are shaped and sustained in everyday practice. This qualitative study adopted an interpretive case study design within a French CMPP located in a predominantly rural territory. Data were collected as part of a collaborative action-research project and included 50 semi-structured interviews with families, CMPP professionals and territorial partners, as well as approximately 250 h of participant and non-participant observations. Data were analyzed using an abductive thematic approach supported by the qualitative coding software Taguette. Coding and interpretation were conducted collaboratively within an interdisciplinary research team combining perspectives from public health and management sciences. Regular analytic meetings were recorded and documented, enabling the research team to retrace the iterative development of codes and themes and to compare insights across interviews, observations and reflexive notes. Ten main themes were identified, highlighting organizational, relational and territorial mechanisms shaping child mental health care pathways over time. Results show that pathways are rarely linear and are marked by delays, uncertainty and discontinuities, particularly in contexts of limited resources. Families play a central role in sustaining continuity of care through coordination, information sharing and engagement, often compensating for systemic fragmentation. Professional practices rely on situated adjustments and informal coordination to manage constraints, while territorial characteristics such as rurality influence access to specialized resources and intensify reliance on local networks. This study provides an empirically grounded analysis of child mental health care pathways within a French medico-social service. The findings highlight how organizational constraints, territorial characteristics and intersectoral coordination practices shape care trajectories in practice. By examining pathways as lived and negotiated processes, the study contributes to health services research on care coordination and equity in child mental health systems, while highlighting the specific role of medico-social organizations such as CMPPs within the French context.

Background: The extent of the impact and the interconnections among factors within social and residential contexts during the COVID‐19 lockdowns on mental well‐being remain to be elucidated. We identified latent classes of each of social and residential context during the lockdown and examined their associations with mental well‐being among adolescents in France 1‐year after the first lockdown.Methods: We used data collected in 2021 in a cross‐sectional school‐based pilot study for EXIST, from 387 participants ages 12–15 years. Participants reported retrospectively on characteristics of their social and residential contexts during the lockdown, and their current mental well‐being in self‐report questionnaires. We used latent class analysis to identify latent classes of social and residential contexts, and linear regression models to examine the associations between these contexts and mental well‐being.Results: Four social context classes were identified: class 1 “Low opportunity for social contact at home,” class 2 “Moderate opportunity for social contact at home,” class 3 “High opportunity for social contact at home,” and class 4 “Very high opportunity for social contact at home.” Relative to class 4, lower levels of mental well‐being were observed among adolescents in class 1 (b = −4.08, 95% CI [−8.06; −0.10]) 1 year after the lockdown. We identified four residential context classes based on proximity to nature, type of residence (e.g., apartment, house), and level of neighborhood deprivation. No association was detected between residential context during the lockdown and adolescent mental well‐being one‐year later.Conclusion: A limited social context may negatively impact adolescent mental well‐being during crises.

Objective: Across the globe more than 35,000 children a year are adopted by non-relatives, and some studies suggest that adopted individuals may be more vulnerable to developing mental disorders. To map the differences in suicide risk factors in adopted and non-adopted individuals, this study will compare the development of mental disorders as well as life events occurring before the age of 18 for both adopted and non-adopted individuals deceased by suicide. Methods: This study included 13 adopted and 26 non-adopted individuals deceased by suicide as well as 26 non-adopted living control individuals. Cases were taken from a data bank created over the last decade by researchers of [our institution] comprising a mixture of 700 suicide cases and living control individuals aged from 14 to 84. Adopted and non-adopted individuals deceased by suicide; adopted individuals deceased by suicide and non-adopted living control individuals were each compared on Axis I and II disorders, early life events, and burdens of adversity. Results: Results show significant differences, with a higher rate of Attention Deficit Hyperactivity Disorder, mental health comorbidity and Cluster C personality disorders among adopted individuals. Furthermore, adopted individuals have higher adversity scores prior to the age of 15. Conclusion: This study underlines the fact that adoptive families need to be supported throughout adoption. Health care professionals need specialized training on this matter, and the psychological challenges adopted individuals face need to be treated at the earliest juncture.

Background: Anorexia nervosa is a serious, albeit common mental illness that generally occurs during adolescence. Although outpatient care is recommended, hospitalisation is sometimes required. There is a dedicated hospitalisation unit caring for children and adolescents presenting with anorexia nervosa in Nancy, France. However, on 16 March 2020, a national lockdown was declared by the French government as the COVID-19 pandemic escalated in France. This resulted in the adjustment of hospital admissions accompanied by premature discharge and an intensive outpatient care programme. In the light of such changes, consideration should be given to the potential impact of changes in the care pattern for anorexic patients and their parents. The purpose of our study was to explore the experiences of anorexia nervosa patients hospitalised in the unit, and their parents, following changes in the care strategy. Methods: The study was conducted between weeks four and eight after lockdown was announced. The study cohort included all the patients treated for anorexia nervosa and hospitalised in the treatment unit before 16 March 2020 and their parents. A qualitative method was used and every subject was offered a semi-structured interview. Data were analysed by means of inductive thematic analysis. Results: Seven superordinate themes were identified: positive aspects, concerns, preparation, loss of landmarks and hospital security, gradual return to a “normal” life, relational aspects and the likelihood of disease progression. Moreover, all the parents and patients were satisfied with the intensive outpatient care offered on discharge. Conclusion: Despite initial ambivalence, all patients and their parents viewed this unexpected hospital discharge positively in these exceptional conditions. This suggests that restructuring the care programme could prove beneficial with increasing use of outpatient management, thereby reducing the length of the hospital stay and adjusting the return to school. Trial registration: ID-RCB 2020-A01101-38—This project was approved by the Comité de Protection des Personnes (CPP) Sud Méditerranée IV [South Mediterranean IV Ethics Committee (EC)] on 5 May 2020.

Background: The early detection of patients at risk of developing schizophrenia and bipolar disorder, and more broadly mood spectrum disorder, is a public health concern. The phenotypical overlap between the prodromes in these disorders calls for a simultaneous investigation into both illness trajectories. Method: This is an epidemiological, retrospective, multicentre, descriptive study conducted in the Grand-Est region of France in order to describe and compare early symptoms in 205 patients: 123 of which were diagnosed with schizophrenia and 82 with bipolar disorder or mood spectrum disorder. Data corresponding to the pre-morbid and prodromal phases, including a timeline of their onset, were studied in child and adolescent psychiatric records via a data grid based on the literature review conducted from birth to 17 years of age. Results: Two distinct trajectories were highlighted. Patients with schizophrenia tended to present more difficulties at each developmental stage, with the emergence of negative and positive behavioural symptoms during adolescence. Patients with mood spectrum disorder, however, were more likely to exhibit anxiety and then mood-related symptoms. Overall, our results corroborate current literature findings and are consistent with the neurodevelopmental process. We succeeded in extracting a decision tree with good predictability based on variables relating to one diagnosis: 77.6% of patients received a well-indexed diagnosis. An atypical profile was observed in future mood spectrum disorder patients as some exhibited numerous positive symptoms alongside more conventional mood-related symptoms. Conclusion: The combination of all these data could help promote the early identification of high-risk patients thereby facilitating early prevention and appropriate intervention in order to improve outcomes.

Maintaining cell phone contact with adolescents attempting suicide (AASs) may be useful in preventing recurrence. Health-related quality of life and social support are two characteristics involved in suicidality and, potentially, in how cell phones are used. MEDIADO was designed as a cross-sectional study to compare cell phone use, health-related quality of life, and social support in AASs and a control group. AASs (58) were recruited from Emergency or Pediatric departments and matched to school pupil controls (86); all the adolescents were volunteers. The 58 AASs had a mean age of 14.7 +/- 1.5; 84% were girls. Both the control group (86) and the AASs use their cell phones for more than seven hours per day (p = 0.08), preferentially for texting or social networking but in different proportions (p = 0.03). Both social support and health-related quality of life are significantly worse for AASs than for the control group (p < .0001 to .03). Like the control group, adolescents attempting suicide use their cell phone for longer when they feel better. In conclusion, MEDIADO highlights the particular relevance of using text messaging to reach AASs, data that could be used for intervention following attempted suicide. The manner in which cell phones are used also seems to be affected by quality of life. It would be interesting to assess social support and quality of life in further research, as indicators of clinical changes following suicide attempts.

Background: Suicide is a major public health concern. In 2017, the suicide rate in Canada was 11 per 100,000 inhabitants. According to literature, 1 in 5 people have experienced a death by suicide during their lifetime. The aim of this study was to describe the met and unmet needs of suicide-bereaved survivors and to provide postvention recommendations.Methods: Further to an exploratory mixed-method audit of 39 suicides that occurred in Montreal (Canada) in 2016, suicide-bereaved survivors (n = 29) participated in semi-structured interviews and completed instruments to discuss and assess potential pathological grief, depression (PHQ-9), and anxiety (GAD-7), as well as health and social services utilization. A panel then reviewed each case and provided recommendations. The mean age of participants was 57.7 years and 23 were women.Results: Although help was offered initially, in most cases by a health professional or service provider (16/29), 22 survivors would have liked to be contacted by telephone in the first 2 months post suicide. Four categories of individual unmet needs (medical/pharmacological, information, support, and outreach) and one collective unmet need (suicide pre/postvention training and delivery) emerged.Conclusions: Although Quebec provincial services have been developed and offered to suicide-bereaved survivors in the past decade, many dwindled over time and none has been applied systematically. Recommendations for different stakeholders (Ministry of Health and Social Services, coroners, NGOs, and representatives of suicide-bereaved survivors) outlined in this study could be an interesting first step to help develop a suicide pre/postvention strategy.