Community-Based Prevention for Suicide in Elderly by Depression Screening and Follow-Up

Abstract

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.

Screening for depression: a systematic review and meta-analysis

“…Two of the 5 identified papers 17,18 included 2 control groups; the remaining 3 studies each had 1 control group. [19][20][21] Four out of the 5 papers presented data using adjusted incidence rate ratios (IRR) and one reported adjusted odds ratios.…”

“…[17][18][19][20][21] These studies were conducted in rural regions of Japan, where suicide rates among older people ranged from 50 to 418 per 100 000 among women and from 113 to 326 per 100 000 among men. [17][18][19][20][21] Oyama and associates [17][18][19][20][21] developed a universal suicide prevention program, which included a screening component adapted from the WHO World Mental Health Survey. 24 The program involved screening for depression, follow-up with mental health care or psychiatric treatment, and psychoeducation in the community setting.…”

“…In the first step, older residents within the selected communities were called with an invitation to participate in an educational health workshop on the signs of and possible treatments for depression and suicide risk and also on how to use mental health services. Following the workshop, those who agreed to participate in the program completed the Japanese version of the Zung Self-rating Depression Scale, 23 a 20-item scale that measures affective, psychologic and somatic symptoms associated with depression (used in all 5 of the included studies [17][18][19][20][21] ), or the 5-item Geriatric Depression Scale 22 (used in 1 of the included studies 21 ). Those who did not attend the workshop were contacted the following day and asked to participate in the program.…”

“…Oyama et al 17 Oyama et al 19 Oyama et al 20 Oyama et al 18 Oyama et al Figure 2: Meta-analysis of the effect of community-based suicide prevention programs, including screening for depression, on suicide rates reported in cohort studies. A rate ratio (RR) less than 1.0 indicates a benefit of suicide prevention programs.…”

“…The pooled data from the 5 studies [17][18][19][20][21] showed a statistically significant reduction in the number of completed suicides after implementation of the community-based depression screening program (RRR 0.50, 95% CI 0.3-0.78) (Figure 2). RRRs also indicated a significant reduction in the suicide rate among women (RRR 0.37, 95% CI 0.21-0.66) but no significant effect among men (RRR 0.67, 95% CI 0.35-1.27) (Figure 3).…”