The lack of social support is the most common risk factor for late-life suicide. Few previous community-based interventions against the lack of social relationships reduced suicide. This study aims to evaluate outcomes of a community-based prevention program against suicide amongst the elderly in rural Japan. During 1995During -2002, the program based on population strategy including group activity, psychoeducation and self-assessment of depression but no screening for depression, was implemented for elderly residents in Yuri town, Japan (5-year average population 6817; 5-year average suicide rate [ ≥ 65 years old] 291.4/10 5 ). Changes in the relative risk of suicide for individuals ( ≥ 65 years old) before and after the 8-year implementation were estimated by the incidence rate ratio (IRR), using a quasi-experimental design with a neighboring reference, Chokai town, Japan (5-year average population 8136; 5-year average suicide rate [ ≥ 65 years old] 216.5/10 5 ). The risk of elderly females in Yuri completing suicide was reduced by 76% (age-adjusted IRR, 0.24; 95% CI, 0.10-0.58), while there was no change in the risks for Yuri's elderly males and both Chokai's elderly males and females. General loglinear analysis estimated a ratio of the female IRR in Yuri to that in its Akita prefecture of 0.35 (95% CI, 0.14-0.84), showing that the reduction of the risk in the intervention area was greater than a historical trend. A community-based suicide prevention through a group intervention designed to increase knowledge and to cultivate social relationships would be effective for elderly females but not males.

The aim of the study was to evaluate the outcome of a community-based prevention program against suicides among the elderly aged 65 and over in the Japanese rural town of Joboji (population 7,010), using a quasi-experimental design with two neighboring control areas. During the 10-year implementation of the program based on strategies including screening for depression, follow up with mental health care or psychiatric treatment and health education on depression, the relative risks estimated by the age-adjusted odds ratios for both males and females were reduced to almost one quarter more than a regional historical trend, with a better response to education for females than for males. A community-based management for later-life depression with mental health care supported by the psychiatric treatment can be effective against suicide among the elderly for both males and females.

A systematic review was undertaken to quantify the effect of community-based depression screening (CDS) with follow-up on the completed suicide risk for residents aged 65 and over. Five quasi-experimental studies in Japanese regions with high suicide rates were included in the meta-analysis. Combined incidence rate ratios (95% confidence intervals) by the Mantel-Haenszel method and by the DerSimonian-Laird method in two homogenous studies implementing the follow-up conducted by psychiatrists were 0.30 (0.13-0.68) and 0.33 (0.14-0.80) in men, and 0.33 (0.19-0.58) and 0.33 (0.19-0.60) in women, respectively; and those in three homogenous studies implementing the follow-up conducted by general practitioners were 0.73 (0.45-1.18) and 0.74 (0.45-1.23) in men, and 0.36 (0.21-0.60) and 0.39 (0.22-0.66) in women, respectively. There are very few studies included, however, to demonstrate an association between CDS and the reduced risk, suggesting gender difference in the effectiveness.

The suggestions span a wide range and are offered for consideration by local groups preparing new interventions, as well as large scale public health care planning.

Depression is a major cause of suicide among the elderly. Few previous community-based interventions against depression have reduced the suicide rate. This study aims to evaluate outcomes of a community-based program to prevent suicide among the elderly using a quasi-experimental design with a neighboring reference group. The program, including depression screening with follow-up and health education through primary care and public health nursing, was implemented for 10 years in Matsudai town, a rural area of Japan (population 6,015; suicide rate per 10(5) [65-year-olds] for males 290.6, and for females 361.3). Changes in the suicide risk were estimated by the incidence rate ratio (IRR). The female risk of completing suicide in the intervention area was reduced by 70% (age-adjusted IRR: 0.30; 95% CI: 0.14-0.67), while there was no change in the risk for males in the intervention area nor for males or females in the reference area (Kawanishi town: population 9,425; elderly suicide rate for males 212.2, females 151.9). A ratio of the female IRR in the intervention area to that in its prefecture was also estimated at 0.45 (95% CI: 0.19-0.97), showing that the reduction of suicide risk in the intervention area was greater than the historical trend. A community intervention against suicide using management of depression with nonpsychiatric, primary health care would be effective for elderly females, but not males.