Preventing Elderly Suicide Through Primary Care by Community-Based Screening for Depression in Rural Japan

Abstract

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.

Community-Based Care of the Elderly in Rural Japan: A Review of Nurse-Led Interventions and Experiences

“…To analyse whether certain home care patients have needs not met by visiting nurse services (especially after leaving hospital) Oyama et al (2006a) Niigata (center of Honshu, facing the Sea of Japan)…”

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. This variation in data presentation necessitated calculation of the ratio of rate ratios (RRR) for each group (i.e., ratio of postimplementation rate to preimplementation rate in the geographic area where the intervention was applied divided by the corresponding ratio of postimplementation rate to preimplementation rate in the control area).…”

“…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.…”

“…[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.…”