Within the IT4Anxiety project, the World Health Organisation Collaborating Centre (WHOCC) for research and training in mental health of Lille, is the leader of the work package “identification of needs among the different actors in the mental health field”. The complexity of our object of study - the use of new technologies for people’s mental health - requires undertaking a multi-disciplinary approach, considering both the clinical and the socio-anthropological aspects. A mixed-methods research conducted with pepole people experiencing anxiety, carers and professionnals, aims to describe the use, acceptability and needs of the different categories of actors concerned by the use of new technologies. The quantitative part is a cross-sectional, descriptive, observational study. A anonymous self-administered questionnaire is distributed online and in hard copy in the 5 partner countries (Belgium, France, Germany, the Netherlands and the UK) to the three study populations. It consists of access to digital tools or technological solutions, experience related to these and the contribution and perceived effect of users to e-mental health related projects. The qualitative approach includes a detailed understanding of the potential therapeutic and socio-anthropological changes that these tools can bring. It explores : description of used technologies, the representations and emerging needs in relation to the management of anxiety and the improvement of mental health ; the clinical impact perceived by all stakeholders and the implementation of new ways of living with the tools. This international research will enable a comparative study to be carried out on the dynamics of appropriation of these e-(mental) health devices in different countries of the North-Western European region.

Technological innovations give new perspectives in many fields, including health. It was in this context that the IT4Anxiety project was born in 2019 bringing together mental health professionals and start-ups, but also universities, research centres, higher education establishments and public authorities from the North-West Region of Europe. The project is challenging our ability, as partners, to gather stakeholders from different background, medical and non-medical field, in order to support the implementation and co-conception of innovative solutions with the objective of reducing the anxiety of mental health service users. During the four years of project implementation (2019-2023), the stakeholders will have opportunities to work with the end-users, expecting to address the needs of around 3,000 mental health service users suffering from anxiety. The fifteen start-up involved in the project activities will be recruited through hackathons and calls based on identified needs. They will join the project in order to test and improve their solutions. This will create opportunities to connect the start-ups with the medical world, research codes and procedures and to give them a new perspective in the understanding of their targeted market segment. Furthermore, almost a thousand mental health professionals will be trained in e-mental health, benefiting from our training modules and an e-mental health job profile will be designed and implemented in our partner hospitals in Belgium and in Germany.

As the manager of a business incubator, I’m involved in the European project IT4Anxiety. It focuses on the creation and implementation of innovative solutions designed to reduce the anxiety of patients experiencing neurological disorders or PTSD. The IT4Anxiety project is a collaboration between mental health professionals, users and start-ups, but also universities, research centres and higher education establishments. There is growing evidence that technological solutions can expand and complement conventional medical protocols. Such “blended therapies” are central to the approach being developed through several work packages. In the framework of the IT4Anxiety project, I carry out actions to develop interactions between startups and mental health professionals.In this context, my speech will focus on 3 specific points: - Feedback on the process of testing and validation of innovative tools in hospitals, care homes… We developped a framework for testing and validating tools with patients and start-ups in order to guarantee the effective implementation of these innovative solutions, especially from an ethical point of view. Going before the ethics committee is often a new experience for start-up managers who have to answer complex questions - Feedback on co-creation processes, in particular through the organisation of hackathons bringing together start-ups, users and health professionals.The objective of the hackathons is to bring together stakeholders in the co-creation of innovative solutions and their integration thereafter into the mental health care sector - Examples of innovative tools in mental health developed by startups which have joined the IT4Anxiety project. These tools complement conventional medical protocols

The Interreg IT4Anxiety Project gives birth to training modules in digital health. The European Interreg IT4Anxiety project, led by the CNP St-Martin, is launching a new range of training modules in digital health awareness at the Haute Ecole de la Province de Namur, the University of Applied Sciences (HEPN). Electronic medical records, teleconsultation, mobile applications, virtual reality… Digital tools are already part of the daily life of workers in the health sector. However, until now, no curriculum has included appropriate training to enable caregivers to acquire the fundamental knowledge needed to use digital tools effectively in their professional practice. Thanks to the expertise and support of its various partners in the IT4Anxiety project, the Haute Ecole de la Province de Namur will provide digital health awareness training starting in 2022. These training modules will be provided as part of the in-situ training of caregivers and are already being tested in the academic training of future nurses. In addition to discovering the potential of new technologies in the health field, health professionals and future professionals will learn to identify the appropriate use of these tools, to deploy them and to use them in their profession, in a respectful and caring relationship with a critical eye. The structure of the courses, the assessment and the feedback from the HEPN will form the basis for an international deployment of this training by the German, French, Dutch and English partners of the IT4Anxiety project.

Suicidal behavior is a complex human behavior expressed in a spectrum of various acts. From a suicidal gesture to a completed suicide, all reflect a cry for help and need clinical and scientific attention. The process ending up with suicidal act is shaped by multi-factors, including the socio-cultural ones. Suicide is indeed related to a deep feeling of hopelessness; not to have any control over their lives and circumstances except than deciding to stay alive or dead, and so related to serious psychopathologies, as depressive and substance use disorders. Hence, it is frequently seen as a personal act or as a question of individual decision. But since Durkheim‘s ground breaking work, which still inspires suicide researchers, the cultural factors behind this socially determined phenomenon have been widely discussed. Suicide is totally a personal act and a fully socio-cultural phenomenon. The cultural factors of suicidality are among the social determinants of health/ill health. Epidemiological evidence and cross-cultural comparisons show huge differences in suicide rates across countries and even between regions of same countries, and these are constant differences. Furthermore, even the definition of suicide is effected by the social circumstances. Certain socio-cultural patterns shape how and when people commit suicide; i.e., these patterns have decreasing or increasing effect on suicide rates, which provides basis for suicide prevention. Likewise, social solidarity, high group integration and collective sensitivity may have preventive effects. This brings us to the discussion of the effects of big social turmoil or wars or pandemics on suicidal behavior.

Crises such as the corona pandemic, but also climate change associated events such as extreme weather events are major stressors for people on an individual, but also on a population level. Such crises often lead to highly burdened individuals with reduced quality of life, decreased well-being, mental health problems and an accumulation of psychiatric illnesses, especially in vulnerable population groups. These create a high demand and need for low intensive (psychosocial) support and primary and clinical care that can often no longer be adequately met by the existing infrastructure. However, good mental health and mental health care is a necessary prerequisite for people to lead fulfilling and productive lives and for communities and their settings (such as families, schools and workplaces, etc.) to function well. Therefore efficient supporting (public mental health) approaches are urgently needed. This presentation will introduce and discuss public mental health approaches and their effectiveness with a focus on mental health promotion and prevention. The implementation and dissemination of these approaches may help to further strengthen psychological resilience in communities to be better prepared for coping with acute crises and long-term stressors.

Crises such as the corona pandemic, but also climate change associated events such as extreme weather events are major stressors for people on an individual, but also on a population level. Such crises often lead to highly burdened individuals with reduced quality of life, decreased well-being, mental health problems and an accumulation of psychiatric illnesses, especially in vulnerable population groups. These create a high demand and need for low intensive (psychosocial) support and primary and clinical care that can often no longer be adequately met by the existing infrastructure. However, good mental health and mental health care is a necessary prerequisite for people to lead fulfilling and productive lives and for communities and their settings (such as families, schools and workplaces, etc.) to function well. Therefore efficient supporting (public mental health) approaches are urgently needed. This presentation will introduce and discuss public mental health approaches and their effectiveness with a focus on mental health promotion and prevention. The implementation and dissemination of these approaches may help to further strengthen psychological resilience in communities to be better prepared for coping with acute crises and long-term stressors.

Several observational studies investigated risk factors for suicide attempts/completed suicides in older age with contrasting evidence from ongoing population-based research. The risk factors most associated to suicide attempts than other variables were: depressive disorders, methods employed to self-harm (particularly poisoning), and psychotropic drug utilization followed by psychological factors and disability. Moreover, male sex, violent methods to self-harm, any psychiatric disorder (depression, anxiety and bipolar disorders), a poor medical condition, stressors/bereavement, and living alone appeared to be more significant for predicting completed suicides in late life. There is growing evidence of a role of environmental exposures in the pathogenesis and epigenetics of suicidal behavior in older age. Little is known about the possible relationship between suicidal ideation in older age and its biopsychosocial predictors, although psychiatric disorders (among which late-life depression, LLD), play a fundamental role. LLD, distinguished as late-onset depression (LOD) and early-onset depression (EOD). Suicidal ideators accounted for 2.32% of subjects, were female, smokers and obese affected by multimorbidity. After adjusting for age, gender, education and social dysfunction, suicidal ideation was associated to LLD (EOD>LOD:OR:21.71, 95% CI:9.22-51.14). In the full random forest model, asthma was the most important contributor to suicidal ideation. Among biomarkers, interleukin (IL)-6 followed by tumor necrosis factor (TNF)-a, Apolipoprotein E e4 allele-carriers, C-reactive protein contributed most to suicidal ideation. Although EOD is a strong determinant of suicidal ideation, other non-psychiatric factors, i.e., serum inflammation biomarkers, APOE e4 allele, and multimorbidity, should be taken into account when evaluating a suicidal ideation phenotype in older age.

E-Mental Health in older age Ulrich Hegerl, Caroline Oehler Department of Psychiatry, Psychosomatics, and Psychotherapy, Goethe Universität Frankfurt/M, Germany European Alliance against Depression e.V. (www.EAAD.net) The implementation and uptake of digital tools for self management or psychotherapy for people suffering from depression or other mental disorders has gained momentum during the Covid-19 pandemia. While studies using waiting list or treatment as usual control groups are of limited value, meta-analyses of RCTs with face-to-face psychotherapy as control condition have found a comparable antidepressant effect, especially when the interventions were provided together with professional guidance. The iFightDepression-tool offered by the European Alliance against Depression (EAAD) is available in 10 different languages and is broadly used in several European countries. Data will be presented concerning the attitude of older people concerning iCBT and also concerning effects of age, guidance, and gender on both adherence to the iFightDepression-tool and antidepressant effects.

Suicide in old age is frequently considered the result of a rational decision. Accumulation of physical illnesses, frailty, dependence on others, loss of partner and loneliness are often seen as reasons that might justify suicidal acts. Depression is an important risk factor for suicidal behaviour even at very advanced age. However, ageistic views tend to consider depression as a normal feature of the aging process; it is possible that its presence can be overestimated or perhaps generalized more than necessary by making it the scapegoat of any situation related to suicide. In fact, adopting an attitude that involves excessive simplification of problems, where everything is attributable to ‘depression’, can induce a rigid prescriptive approach, often limited to the indication of an antidepressant drug. In this way, the appreciation of the multifactorial nature of an individual’s crisis becomes too narrow and the chances of counteracting the complexities of a dangerous suicide progression too modest. From a prospect of suicide prevention, approaching a patient carefully and prudently is always to be preferred to the disposition that considers life events as inevitable as well as all reactions related to them, including the most extreme, such as suicide. This attitude can lead to a poor involvement of the treating physicians, who might become too acceptant of the ‘unavoidability’ of the unfavourable progression of their patient. Such a passive approach may especially characterise the relationship with patients of very advanced age, where stressors of physical and non-physical nature easily aggregate, multiplying their impacting power.

For more than 20 years, euthanasia in Belgium and The Netherlands is allowed for unbearable suffering caused by terminal or non-terminal illnesses, including psychiatric disorders. Although euthanasia numbers have been increasing over the years, the percentage of cases involving people with a primary psychiatric diagnosis has remained stable (between 1 and 2%). For these cases, the Belgian and Dutch Euthanasia Laws operate similar due care criteria: a well-considered, repeated, and voluntary request from a legally competent adult; a medical condition without prospect of improvement; constant and unbearable suffering that cannot be alleviated; consultation of two independent physicians, including a psychiatrist; and a posteriori evaluation and control [1–3].