La recherche en prévention du suicide fait face à des défis spécifiques liés aux caractéristiques des sujets à risque. La conception d’interventions de prévention efficaces est particulièrement difficile. Les sujets suicidants sont accueillis aux urgences qui assurent les soins immédiats et organisent la prise en charge au long cours. Un antécédent de passage à l’acte suicidaire est un puissant prédicteur de décès prématuré par au suicide. La prise en charge suivant un passage aux urgences pour un geste suicidaire constitue un défi critique pour les urgences et services de santé mentale. Compte tenu de ces enjeux, il y a eu un intérêt majeur à évaluer l’efficacité des interventions visant le maintien du contact des sujets à risque avec les services de soins. L’évaluation ponctuelle du risque suicidaire habituellement conduite aux urgences, après un geste suicidaire, ne rend pas compte son évolution après la sortie des soins, alors même que le risque de récidive reste important plusieurs mois après. Dans ces conditions, les possibilités d’identification, et donc de prise en charge, des patients à risque suicidaire sont limitées. Le développement de la santé connectée (eHealth) donne désormais accès en temps réel à des informations sur l’état de santé d’un patient entre deux séjours en centre de soins. Cette extension de l’évaluation clinique à l’environnement du patient permet de développer des outils d’aide à la décision face à la gestion du risque suicidaire. / Suicide prevention research faces specific challenges related to characteristics of suicide attempts and attempters. The design of powerful suicide prevention studies is especially challenging. Suicide attempters have been described as poorly adhering to long term treatment, and organizing such interventions from the emergency department can be difficult. While approximately one third of those who attempt suicide seek treatment for their injuries from hospital emergency department, a previous SA is a strong precursor of suicide-related premature death. The post-discharge period constitutes a critical challenge for emergency and mental health care services both in the short- and long-terms. Given these issues, there has been growing interest in assessing the efficacy of interventions that focus on maintaining post-discharge contact and offering re-engagement with health care services to suicide attempters. Suicide risk assessment usually rely on brief medical visit and does not report the evolution of this risk after the patient discharge. However, the reattempt risk is still high several months after the initial attempt. In these setting, long term suicide prevention of at risk subjects are challenging. Thanks to recent technological advances, electronic health (eHealth) data collection strategies now can provide access to real-time patient self-report data during the interval between visits. The extension of the clinical assessment to the patient environment and data processing using data mining will support medical decision making.

La schizophrénie est caractérisée par une importante variabilité symptomatique et fonctionnelle au cours du temps. Néanmoins, peu d’informations sont disponibles concernant la variabilité à court-terme des symptômes et des phénomènes associés (fonctionnement cognitif, expériences émotionnelles, perception du temps), dont la considération est pourtant fondamentale pour une description précise de cette pathologie complexe. Les approches d’évaluation traditionnelles conduites en laboratoire sont confrontées à un certain nombre de limites méthodologiques ne permettant pas d’apprécier cette variabilité. La problématique de cette thèse est d’apporter des informations manquantes concernant les liens à court terme entre cognition, expériences émotionnelles, perception du temps et symptômes de la schizophrénie, tels qu’ils se manifestent en vie quotidienne, et leurs corrélats cérébraux. Pour répondre à cette problématique, une approche novatrice combinant des méthodes d’évaluation écologique momentanée (EMA) via technologies mobiles et d’Imagerie par Résonance Magnétique (IRM) a été appliquée. La méthodologie EMA employée a permis de mettre en évidence l’implication des performances cognitives, des expériences émotionnelles et de la perception du temps dans l’expression des symptômes de la schizophrénie sur des périodes de temps brèves dans la vie quotidienne des patients. L’IRM a permis de révéler certains corrélats anatomiques et fonctionnels de ces relations, confirmant notamment le rôle central des régions fronto-temporo-cérébelleuses dans ce trouble. / Schizophrenia is characterized by significant variability over time in symptoms and functioning. However, little information is available concerning the short-term variability of symptoms and their associated phenomena (cognitive functioning, emotional experiences, perception of time), and despite their importance for providing precise descriptions of this complex mental disorder. Traditional laboratory-based assessments are confronted with a number of methodological limitations that make it impossible to assess such variability. This doctoral thesis therefore aims at providing missing information concerning the short-term temporal links between cognitive functioning, emotional experience, and time perception relative to the manifestation of symptoms of schizophrenia and examines the cerebral correlates of these associations. To address this issue, an innovative approach was applied that combined Ecological Momentary Assessment (EMA) using mobile technologies with Magnetic Resonance Imaging (MRI) of the brain. The EMA methodology identified the roles of cognitive performance, emotional experience and time perception in the expression of symptoms of schizophrenia over short time intervals in the patient’s daily life. MRI revealed the anatomical and functional correlates of these relationships, confirming in particular the central role of fronto-temporo-cerebellar regions in this disorder. Taken together, this dual approach provides novel insights into the underlying mechanisms of symptom expression in individuals with schizophrenia.

Understanding human behaviour is key to understanding the spread of epidemics, habit dispersion, and the efficacy of health interventions. Investigation into the patterns of and drivers for human behaviour has often been facilitated by paper tools such as surveys, journals, and diaries. These tools have drawbacks in that they can be forgotten, go unfilled, and depend on often unreliable human memories. Researcher-driven data collection mechanisms, such as interviews and direct observation, alleviate some of these problems while introducing others, such as bias and observer effects. In response to this, technological means such as special-purpose data collection hardware, wireless sensor networks, and apps for smart devices have been built to collect behavioural data. These technologies further reduce the problems experienced by more traditional behavioural research tools, but often experience problems of reliability, generality, extensibility, and ease of configuration. This document details the construction of a smartphone-based app designed to collect data on human behaviour such that the difficulties of traditional tools are alleviated while still addressing the problems faced by modern supplemental technology. I describe the app's main data collection engine and its construction, architecture, reliability, generality, and extensibility, as well as the programming language developed to configure it and its feature set. To demonstrate the utility of the tool and its configuration language, I describe how they have been used to collect data in the field. Specifically, eleven case studies are presented in which the tool's architecture, flexibility, generality, extensibility, modularity, and ease of configuration have been exploited to facilitate a variety of behavioural monitoring endeavours. I further explain how the engine performs data collection, the major abstractions it employs, how its design and the development techniques used ensure ongoing reliability, and how the engine and its configuration language could be extended in the future to facilitate a greater range of experiments that require behavioural data to be collected. Finally, features and modules of the engine's encompassing system, iEpi, are presented that have not otherwise been documented to give the reader an understanding of where the work fits into the larger data collection and processing endeavour that spawned it.

Les Pensées Répétitives Négatives (PRN) font référence à des pensées récurrentes, prolongées et relativement incontrôlables au sujet de nos expériences négatives passées, actuelles ou anticipées. Ce processus transdiagnostique serait impliqué dans de nombreux troubles psychologiques, dont les troubles de l’usage de l’alcool (TUA). Cette thèse s’inscrit dans une démarche processuelle afin d’étudier l’impact des PRN sur la consommation d’alcool chez des patients souffrant d’un TUA. La recension systématique des travaux concernant la relation entre PRN et consommation d’alcool a souligné des interrogations concernant l’influence du sexe et de la symptomatologie anxio-dépressive sur ce lien. Afin de répondre à ces questions laissées sans réponses par la littérature, nous avons menées une étude écologique en temps réel via l’utilisation d’une application électronique qui enregistraient les PRN, les émotions et la consommation d’alcool chez des patients souffrant d’un TUA, suivis en ambulatoire. Pour mener à bien cette étude, deux outils transdiagnostiques d’évaluation des PRN ont d’abord été validés. Le Perseverative Thinking Questionnaire a permis l’évaluation transdiagnostique des PRN-traits, soit la tendance habituelle à utiliser des PRN et le Momentary Ruminative Self-Focus Inventory, a permis d’examiner les PRN-états, soient le recours aux PRN au moment de la passation. Les résultats de la thèse démontrent que les PRN expliquent la consommation d’alcool. Ils sont discutés en lien avec la formulation métacognitive triphasique des problèmes d’alcool. L’intérêt de valider la prise en charge transdiagnostique des PRN dans le cadre des TUA est également développée. / Repetitive Negative Thinking (RNT) refers to a style of recurring, relatively uncontrollable and prolonged thoughts about one’s current, past or anticipated negative experiences. This transdiagnostic mental process is shared across a wide range of psychological disorders, including alcohol use disorders (AUD). The current thesis examined the link between RNT and alcohol use among patients suffering from an AUD in a processual perspective. The systematic review of the literature on the relationship between RNT and alcohol use highlighted some questions about the impact of sex and anxious or depressed symptoms. To address these unanswered questions, we conducted an ecological study in real time through the use of an electronical application assessing RNT, mood and alcohol consumption among AUD patients. To accomplish this aim, two transdiagnostic scales evaluating RNT were validated. The Perseverative Thinking Questionnaire assessed RNT-traits which is the habitual tendency to have RNT, and the Momentary Ruminative Self-Focus Inventory examined RNT-state which is the use of RNT at the time of the assessment. Results of this thesis demonstrated that the link between RNT and alcohol use was direct. They are discussed according to the triphasic metacognitive formulation of problem drinking. The interest of validating the Rumination-focused Cognitive and Behavioural Therapy for AUD patients is developed.Repetitive Negative Thinking (RNT) refers to a style of recurring, relatively uncontrollable and prolonged thoughts about one’s current, past or anticipated negative experiences. This transdiagnostic mental process is shared across a wide range of psychological disorders, including alcohol use disorders (AUD). The current thesis examined the link between RNT and alcohol use among patients suffering from an AUD in a processual perspective. The systematic review of the literature on the relationship between RNT and alcohol use highlighted some questions about the impact of sex and anxious or depressed symptoms. To address these unanswered questions, we conducted an ecological study in real time through the use of an electronical application assessing RNT, mood and alcohol consumption among AUD patients. To accomplish this aim, two transdiagnostic scales evaluating RNT were validated. The Perseverative Thinking Questionnaire assessed RNT-traits which is the habitual tendency to have RNT, and the Momentary Ruminative Self-Focus Inventory examined RNT-state which is the use of RNT at the time of the assessment. Results of this thesis demonstrated that the link between RNT and alcohol use was direct. They are discussed according to the triphasic metacognitive formulation of problem drinking. The interest of validating the Rumination-focused Cognitive and Behavioural Therapy for AUD patients is developed.

Chaque année en France, 150 000 personnes sont hospitalisées suite à un Accident Vasculaire Cérébral (AVC). Il est estimé qu'environ la moitié des survivants récupéreront complètement sur le plan neurologique, et ne souffriront d'aucun déficit quant à leurs capacités fonctionnelles (motrices et cognitives notamment). On parle dans ce cas d'AVC mineurs. Le parcours de soin après un AVC mineur est caractérisé par un retour au domicile précoce et un suivi médical intermittent, et nous n'avons actuellement que très peu d'informations quant à l'impact de l'accident sur l'évolution de la qualité de vie de ces patients. La littérature spécifique à cette population est encore très peu fournie à l'heure actuelle. Cependant, il a récemment était montré que des symptômes anxio-dépressifs surviennent fréquemment après un AVC mineur, et ce en dépit de l'absence de séquelles fonctionnelles visibles. Ces symptômes pourraient donc venir dégrader la qualité de vie des patients malgré leur bon état de santé apparent. Deux enjeux majeurs de santé publique s'articulent autour de la question de l'impact subjectif d'un AVC mineur : celui du dépistage et celui de la prise en charge des facteurs associés à la dégradation de la qualité de vie. Ce travail de thèse vise à étudier l'évolution de la qualité de vie après un AVC mineur et à explorer l'implication des symptômes anxio-dépressifs, d'une part, et celle des stratégies d'adaptation (coping), d'autre part, dans cette évolution. Nous avons mis en place une étude au cours de laquelle nous avons évalué les dimensions de la qualité de vie, auprès d'un échantillon composé de 68 personnes, à différents moments après un AVC mineur : durant l'hospitalisation initiale, après le retour au domicile, et quatre mois après l'accident. En parallèle, nous avons également évalué la symptomatologie anxio-dépressive et les stratégies de coping en associant deux modalités de mesures : des évaluations ponctuelles grâce à des échelles et questionnaires standardisés et validés d'une part, et, d'autres part, des évaluations écologiques instantanées et répétées grâce à une application smartphone. Les résultats révèlent que nombre de personnes décrivent une dégradation de leur qualité de vie au cours des quatre mois. Cette dégradation est liée, d'une part, à l'apparition de symptômes anxio-dépressifs consécutifs à l'AVC. Les analyses en réseau suggèrent que l'apparition, dès l'hospitalisation initiale, de manifestations somatiques précède la survenue de symptômes psychiques. Ces résultats soulignent la nécessité de ne pas négliger l'importance de la prise en charge, dès la phase aiguë, des symptômes somatiques, indépendamment du pronostic de récupération neurophysiologique. D'autre part, nos résultats suggèrent le rôle de certaines stratégies de coping dans l'évolution de la qualité de vie. Des études complémentaires devront permettre de confirmer nos résultats. Ces études sont nécessaires afin de préciser, notamment, les caractéristiques des situations problématiques vécues par les patients en fonction du temps après un AVC mineur. Ainsi, les stratégies de coping fonctionnelles pourraient constituer, à terme, des objectifs thérapeutiques tangibles qui contribueront à préciser les recommandations de prise en charge des AVC mineurs. Notre travail apporte également des éléments qui contribuent à la réflexion théorique et méthodologique de la recherche en psychopathologie et en psychologie de la santé. Sur le plan théorique, notre étude souligne l'intérêt et l'apport de l'approche en réseau, notamment pour l'étude des processus psychopathologiques dans le cadre de la maladie somatique. Au niveau méthodologique, nos résultats encouragent à l'utilisation et au développement des méthodes d'évaluation écologiques instantanées et répétées en psychologie. Malgré les limites actuelles sur le plan technologique, les perspectives de recherches futures sont nombreuses et prometteuses. / About 150 000 individuals are hospitalized after a stroke every year in France. Half of stroke survivors are expected to have complete neurological recovery and thus they will not suffer from any motor or cognitive impairment. Those cases are called minor strokes. Patients with minor stroke frequently experience an early hospital discharge and fitful neurological follow-ups. To date, we have few information regarding minor stroke's effect on the evolution of those patients' quality of life. Even though scientific literature is still insufficient, recent studies showed that anxiety and depression symptoms frequently occur after a minor stroke despite there being no functional impairment. Anxiety and depressive symptoms could impact patients' quality of life. Two main concerns of public health emerge from this hypothesis: screening and caring the determinants of the deterioration of minor stroke patients' quality of life. The present dissertation aims to study the evolution of quality of life after a minor stroke and to explore the role of anxiety and depression symptoms and the role of coping strategies. For this purpose, we have measured the quality of life of 68 patients at three times after the stroke: during initial hospitalization, after discharge and at four-month. We also assessed their anxiety and depression symptoms and coping strategies by combining two methods: standard ponctual assessment using classical scales and questionnaires on the one hand; and ecological momentary assessment using a smartphone application, on the other hand. Our results show a deterioration of the quality of life in numerous participants during the study. On the one hand, this deterioration is associated with the appearance of anxiety and depression symptoms after stroke. Network analysis suggests that somatic disturbance precedes the occurrence of psychological symptoms. Those results highlight the importance of paying attention and caring somatic symptoms despite the pronostic of neurophysiological recovery. On the other hand, our results suggest that coping could influence the evolution of quality of life after a minor stroke. Further studies are needed to confirm those results. Indeed, we have to understand the specificities of stress situations that individuals are facing after a minor stroke. According to this information, efficient coping could represent concrete therapeutic objectives which will be helpful to specify practice guidelines. Our work also contributes to a theoretical and methodological reflexion of psychopathology and health psychology science. On the theoretical hand, our study emphasizes the benefits of the network approach to psychopathology in somatic diseases. On the methodological hand, our study argues for the use of ecological momentary assessment methods in regard of the promising perspectives they could bring in psychological science.

We examine the relationships among employees’ use of energy management strategies and two occupational well-being outcomes: job satisfaction and emotional exhaustion. Based on conservation of resources theory, it was hypothesized that employees with high job demands would benefit more from using energy management strategies (i.e., including prosocial, organizing, and meaning-related strategies), compared to employees with low job demands. We tested this proposition using a quantitative diary study. Fifty-four employees provided data twice daily across one work week (on average, 7 daily entries). Supporting the hypotheses, prosocial energy management was positively related to job satisfaction. Moreover, employees with high job demands were less emotionally exhausted when using prosocial strategies. Contrary to predictions, when using organizing strategies, employees with low job demands had higher job satisfaction and lower emotional exhaustion. Under high job demands, greater use of organizing strategies was associated with lower job satisfaction and higher emotional exhaustion. Finally, use of meaning-related strategies was associated with higher emotional exhaustion when job demands were low. With this research, we position energy management as part of a resource investment process aimed at maintaining and improving occupational well-being. Our findings show that this resource investment will be more or less effective depending on the type of strategy used and the existing drain on resources (i.e., job demands). This is the first study to examine momentary effects of distinct types of work-related energy management strategies on occupational well-being.

(1) Background. Defeat and entrapment have been highlighted as major risk factors of suicidal ideation and behavior. Nevertheless, little is known about their short-term variability and their longitudinal association in real-time. Therefore, this study aims to investigate whether defeat and entrapment change over time and whether defeat predicts entrapment as stated by the integrated motivational–volitional model of suicidal behavior. (2) Methods. Healthy participants (n = 61) underwent a 7-day smartphone-based ecological momentary assessment (EMA) on suicidal ideation/behavior and relevant risk factors, including defeat and entrapment and a comprehensive baseline (T0) and post (T2) assessment. (3) Results. Mean squared successive differences (MSSD) and intraclass correlations (ICC) support the temporal instability as well as within-person variability of defeat and entrapment. Multilevel analyses revealed that during EMA, defeat was positively associated with entrapment at the same measurement. However, defeat could not predict entrapment to the next measurement (approximately two hours later). (4) Conclusion. This study provides evidence on the short-term variability of defeat and entrapment highlighting that repeated measurement of defeat and entrapment—preferably in real time—is necessary in order to adequately capture the actual empirical relations of these variables and not to overlook significant within-person variability. Further research—especially within clinical samples—seems warranted.

Background. Individuals with anorexia nervosa (AN) are often thought to show heightened selfcontrol and increased ability to inhibit desires. In addition to inhibitory self-control, antecedentfocused strategies (e.g., cognitive reconstrual—the re-evaluation of tempting situations) might contribute to disorder maintenance and enable disorder-typical, maladaptive behaviors. - Methods. Over a period of 14 days, 40 acutely underweight young female patients with anorexia nervosa (AN) and 40 healthy control (HC) participants reported their affect and behavior in selfcontrol situations via ecological momentary assessment during inpatient treatment (AN) and everyday life (HC). Data were analyzed via hierarchical analyses (linear and logistic modeling). - Results. Conflict strength had a significantly lower impact on self-control success in AN compared to HC. While AN and HC did not generally differ in the number or strength of self-control conflicts or in the percentage of self-control success, AN reported self-controlled behavior to be less dependent on conflict strength. - Conclusions. While patients with AN were not generally more successful at self-control, they appeared to resolve self-control conflicts more effectively. These findings suggest that the magnitude of self-control conflicts has comparatively little impact on individuals with AN, possibly due to the use of antecedent-focused strategies. If confirmed, cognitive-behavioral therapy might focus on and help patients to exploit these alternative self-control strategies in the battle against their illness.

Background: Although exposure-based cognitive-behavioral therapy for anxiety disorders has frequently been proven effective, only few studies examined whether it improves everyday behavioral outcomes such as social and physical activity. Methods: 126 participants (85 patients with panic disorder, agoraphobia, social anxiety disorder, or specific phobias, and 41 controls without mental disorders) completed smartphone-based ambulatory ratings (activities, social interactions, mood, physical symptoms) and motion sensor-based indices of physical activity (steps, time spent moving, metabolic activity) at baseline, during, and after exposure-based treatment. Results: Prior to treatment, patients showed reduced mood and physical activity relative to healthy controls. Over the course of therapy, mood ratings, interactions with strangers and indices of physical activity improved, while reported physical symptoms decreased. Overall results did not differ between patients with primary panic disorder/agoraphobia and social anxiety disorder. Higher depression scores at baseline were associated with larger changes in reported symptoms and mood ratings, but smaller changes in physical activity Conclusions: Exposure-based treatment initiates increased physical activity, more frequent interaction with strangers, and improvements in everyday mood. The current approach provides objective and fine-graded pro cess and outcome measures that may help to further improve treatments and possibly reduce relapse.

Cette thèse vise à expliquer les fluctuations du bien-être momentané tout au long de la journée et de la semaine, en tenant compte de l'influence de l'environnement construit et social sur ces variations. Cette étude a évalué l'impact du moment de la journée, des interactions sociales, de la météo et des environnements bâtis et sociaux, sur le bien-être momentané à l’aide d’un devis longitudinal par évaluation écologique momentanée géographique (GEMA). Un total de 899 participants résident dans le Grand Montréal, âgés de 18 à 80 ans (Âge : M = 41,71, md = 39 ; femmes = 55,7%) ont rempli une échelle brève de l'humeur trois fois par jour pendant sept jours consécutifs sur leurs téléphones intelligents (application EthicaData). Lors des réponses, la coordonnée GPS de leur localisation a également été captée, et a servi à mesurer diverses expositions environnementales dans un système d’information géographique. Un modèle à effets mixtes à trois niveaux avec des effets aléatoires a montré une corrélation positive entre le bien-être et l'âge, les après-midis, les week-ends et les interactions sociales impliquant la famille et les amis. En revanche, le bien-être était négativement associé aux soirées. Quelques variables de l’environnement bâti et social étaient significativement associées au bien-être. Ces liens ont persisté après contrôle des facteurs de confusion potentiels. De plus, un effet d'interaction a révélé que l'influence des interactions sociales momentanées différait entre les hommes et les femmes. Cette étude met en lumière le rôle des facteurs environnementaux et sociaux dans la compréhension du bien-être momentané. L'intégration de la technologie géospatiale et des évaluations écologiques momentanées offre des perspectives précieuses pour l'urbanisme et la santé publique dans l’exploration des liens entre contexte et santé. / This thesis aims to explain the fluctuations of momentary well-being throughout the day and week, taking into consideration how the built and social environment affects these variations. In this seven-day longitudinal study using GPS-enabled smartphones and EthicaData software with a geographic ecological momentary assessment (GEMA) approach, the real-time impact of built and social environments on self-reported momentary well-being of residents of Greater Montreal between 2018 and 2021 was investigated. A total of 889 participants aged 18–80 years (Age: M=41.71, md=39; females = 55.7%) completed the Short Mood Scale three times daily for seven consecutive days. A three-level mixed-effects model with random effects showed a positive correlation between well-being and age, afternoons, weekends, and social interactions involving family and friends. On the other hand, well-being was negatively associated with evenings. Only a few built and social environmental variables were found to be significantly associated with well-being. These links remained after controlling for potential confounding factors. Moreover, an interaction effect revealed that the influence of momentary social interactions differed for men and women. This study highlights the significance of environmental and social factors in comprehending momentary well-being, which has important implications for urban planning and public health initiatives. Integrating geospatial technology and EMA provides valuable insights into this intricate relationship.