Suicidal behaviors in migrant youths: Male experiences

Objectives. - Suicide is the second leading cause of death among adolescents. Boys are more affectedthan girls, although they report fewer suicide attempts and rely less on care. Few studies have examinedthe experience of suicidal thoughts and behavior among young boys. In order to improve their healthcare, it is necessary to consider the socio-cultural aspects and the construction of the meaning given byadolescent boys to suicidal behaviors in France. Method. - This is a qualitative, complementary and inductive study. All teens included have presentedsuicidal thoughts in the months preceding the inclusion. The existence of self-mutilation and/or suicidalact is sought but is not included within the criteria of inclusion, the various contexts will enrich thedata. Semi-structured interviews are transcribed and analyzed by the Interpretative PhenomenologicalAnalysis. Vivier). Results. - Ten adolescents between 14 and 20 years old were included in the study. Three axes of experienceemerge: the relationship to oneself, the relationship to the other, the relationship to death. Some themesare common to experiences of both boys and girls, others are more specific to the boys' experience. The inner struggle, testing one's limits and an isolating unspeakable are thus common, highlighting thedifficulty for adolescents to mentalize and verbalize emotions and feelings. Difficulties in connecting withothers, and feelings of loneliness and isolation, are at the core of the participants' experience. However, theexperience of boys appears specific in the difficulty to represent the irreversibility of death which can leadto suicidal behavior without direct intentionality. The narrative of suicidal acts, in its formulation, is quitedifferent from that of young girls. One can assume that the difficulty of expressing suffering could leadyoung boys to develop a discourse that overshadows the question of their death, or in contrast magnifies itin a rewarding stage from which they pride themselves. The fear of being isolated or rejected seems almostinsurmountable for the boys interviewed. The fear of the judgment of peers or the family is mixed with theimperative to face the problem by oneself and reinforces the feeling of isolation in a retroactive loop. Thestory of the suicidal act can take a positive and enriching tone in the participant's stories. This only appliesto adolescents with a history of suicidal gesture. The experience of acting out and its consequences seemsto be integrated by the adolescent as elements which participate to a certain extent to the construction oftheir identity. This ameliorative feature can be compared to the hegemonic social models of masculinity. The sociological notion of gender identity makes it possible to think of this construction in a dynamicway and to propose adaptations of the caregivers' attitude during the first interviews with a suicidalteenager. During the first meetings, the caregiver should explore the adolescent's representations ofthe suicidal crisis in a neutral, self-interested, and unbiased way, including when the representationsare disturbing or shocking for the caregiver. For example, when the patient values or glorifies suicidalbehavior or when care is experienced as a sign of weakness and vulnerability. Respect of these proposalscan indeed support weakened narcissistic foundations and favor encounter and alliance. This can onlybe done with the conviction that these representations are not frozen, but in construction, and that theycan be secondarily mobilized in the therapeutic relationship. For that purpose, a work of elaboration onthe representations of the masculinity will be able to lead the young person to reconsider his perceptionof care and suicidal behaviors. Reflexivity on the part of the caregiver about his own representations ofmasculinity seems necessary. Conclusion. - Therapeutic management must explore and respect the adolescent's representations ofmasculinity and then mobilize them to bring the young person to reconsider his perception of care andsuicidal behavior. (C) 2020 L'Encephale, Paris.