title: High and low suicidality in Europe: a fine-grained comparison of France and Spain within the ESEMeD surveys.
abstract: BACKGROUND
  Suicidality risk-factors between countries with similar economic and religious background have been rarely compared, especially within genders.
  
  
  METHODS
  Lifetime prevalence of suicide ideation, plans, and attempts in the ESEMeD surveys were stratified on four separate groups: French women, Spanish women, French men, and Spanish men. Outcome odds-ratios (OR) were modelled within each group using logistic regression including demographic characteristics, lifetime mood/anxiety disorders, parental bonding, marital status, and health service-use.
  
  
  RESULTS
  Lifetime prevalence of suicide attempts was 3.4% in France (1.1% men, 5.4% women) and 1.5% in Spain (1.2% men, 1.7% women), with a significantly greater gender difference in France (p=0.001). Regarding risk-factors, French women reported suicide attempt more commonly with authoritarian mothers (OR=1.51; 95%CI=1.04-2.18), unlike Spanish women (OR=0.77; 95%CI=0.51-1.15) (p<0.001). Spanish men showed more than eight-times higher odds of suicide attempt with overprotecting mothers than French men (p=0.03). General practitioner-(GP)-use was significantly protective of suicide attempt among Spanish women (OR=0.08; 95%CI=0.02-0.35) with no effect in French women (OR=1.03; 95%CI=0.54-2.00) (p=0.01). No significant differences in the effect of marital status, any lifetime antidepressant use, mental disorders, or religiosity on suicide attempt were observed between France and Spain within gender-stratum.
  
  
  CONCLUSIONS
  Parental bonding is retrospective and potentially influenced by mental state. Response rate was considerably lower in France than in Spain.
  
  
  CONCLUSIONS
  Suicidality risk-factors play different roles across genders between France and Spain. Parental bonding dimensions may be interpreted differently according to country, underlining cultural importance. As recommended by WHO, mental health decisions must involve GPs in conjunction with psychiatrists or psychologists.
authors.affiliation: Paris Descartes University and Department of Epidemiology, EHESP, Paris, France. viviane.kovess@ehesp.fr
authors.forename: V
authors.initials: V
authors.lastname: Kovess-Masfety
authors.forename: A
authors.initials: A
authors.lastname: Boyd
authors.forename: J M
authors.initials: JM
authors.lastname: Haro
authors.forename: R
authors.initials: R
authors.lastname: Bruffaerts
authors.forename: G
authors.initials: G
authors.lastname: Villagut
authors.forename: J P
authors.initials: JP
authors.lastname: Lépine
authors.forename: I
authors.initials: I
authors.lastname: Gasquet
authors.forename: J
authors.initials: J
authors.lastname: Alonso
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology; D005060:Europe; D005260:Female; D005602:France / Q000453:epidemiology; D058005:General Practitioners; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000208:ethnology; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data; D013406:Suicide, Attempted / Q000208:ethnology* / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult