Tomoe Sakashita

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

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.

Effect of Community-based Intervention Using Depression Screening on Elderly Suicide Risk: A Meta-analysis of the Evidence from Japan

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.

Key considerations for preventing suicide in older adults: consensus opinions of an expert panel.

BACKGROUND The number of older adults is growing rapidly. This fact, combined with the high rates of suicide in later life, indicates that many more older adults will die by their own hands before rigorous trials can be conducted to fully understand the best approaches to prevent late life suicide. AIMS To disseminate key considerations for interventions addressing senior suicidal behavior. METHODS An international expert panel has reviewed and discussed key considerations for interventions against suicide in older adults based on existing evidence, where available, and expert opinion. RESULTS A set of new key considerations is divided into: universal, selective, and indicated prevention as well as a section on general considerations. CONCLUSIONS 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.

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

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.

Local community intervention through depression screening and group activity for elderly suicide prevention.

Abstract  This study aims to evaluate outcomes of a community‐based program to prevent suicide among the elderly (≥65 years old) using a quasi‐experimental design with two neighboring references. During 1999–2004, the program including depression screening and group activity was conducted by the public health nurses in the Minami district (population 1685) of Nagawa town, rural Japan. Pre‐post changes in the risk of completing suicide were estimated by the incidence rate ratios (IRR). The risk for Minamis elderly females was reduced by 74% (age‐adjusted IRR, 0.26; 90% CI, 0.07–0.98) more than the historical trend, while there was no change in the risk of Minamis males and nor in the male or female references. The local intervention using public health nursing would be effective against suicide for elderly females without diffusing to the surroundings.

A Community-Based Survey and Screening for Depression in the Elderly

BACKGROUND In addition to implementing a depression screening program, conducting a survey beforehand might contribute to suicide risk reduction for the elderly. AIMS This study evaluates outcomes of a community-based program to prevent suicide among individuals aged 60 and over, using a quasiexperimental design with an intervention region (41,337 residents, 35.1% aged 60 and over) and a neighboring reference region. METHODS Our 2-year intervention program included an anonymous survey by random sample in the entire intervention region and, in the second year, a depression screening with follow-up by a psychiatrist in the higher-risk districts. Changes in the risk of completed suicide were estimated by the incidence-rate ratio (IRR). RESULTS The risk for men in the intervention region was reduced by 61% (age-adjusted IRR = 0.39; 90% CI = 0.18-0.87), whereas there was a (statistically insignificant) 51% risk reduction for women in the intervention region, and no risk reduction for either men or women in the reference region. The ratio of the crude IRR for elderly men in the intervention region to that for all elderly men in Japan was estimated at 0.42 (90% CI = 0.18-0.92), showing that the risk reduction was greater than the national change. CONCLUSIONS The management of depression through a combination of an initial survey and subsequent screening holds clear promise for prompt effectiveness in the prevention of suicide for elderly men, and potentially for women.

Long-Term Effects of a Screening Intervention for Depression on Suicide Rates among Japanese Community-Dwelling Older Adults

OBJECTIVES To explore the long-term impact of a universal screening intervention for depression on suicide rates among older community-dwelling adults, with gender as an effect modifier. DESIGN Controlled cohort study reporting long-term follow-up of previous research. SETTING Two sets of three municipalities in Japan were assigned as intervention and control regions and compared with the surrounding zone and prefecture. PARTICIPANTS Intervention area residents aged 60 years and older (14,291) were invited to participate in a 2-year intervention (2005-2006). Four population-based dynamic cohorts of residents aged 65 years and older (1999-2010) were included as subjects, 6 years before and after the intervention started. INTERVENTION At-risk residents within the intervention region (4,918) were invited for a two-step screening program; 2,552 participated in the program linked with care/support services for 2 years. An education program open to the public was held. MEASUREMENTS Changes in suicide from a 6-year baseline to the 2-year intervention and a 4-year follow-up in the intervention region (11,700 adults ≥65 years) were compared with a matched control and two comparison areas using mixed-effects negative binomial regression models. Suicide rates among older adults exposed to screening were compared with those of the control region. RESULTS Suicide rates in the intervention region decreased by 48%, which was significantly greater than in the three comparison areas. The programs benefits lasted longer for women than men. Screening exposure may be associated with decreased suicide risk over the 4-year follow-up. CONCLUSIONS Universal screening may decrease suicide rates among older adults, with potential gender differences in treatment response.

The effects of suicide prevention measures reported through a psychoeducational video: a practice in Japan.

Background: As the suicide rate in Japan has remained high since 1998, various suicide prevention measures have been implemented in Japanese local communities. Aims: To report our findings on the effect of a psychoeducational video as a suicide prevention measure in a Japanese rural town. Methods: Questionnaires were randomly mailed to 2,000 residents aged between 30 and 79 years. Within 4 weeks, volunteers in the town visited the residents individually and collected the questionnaires. The variables reported in this study are demographics, awareness of suicide prevention measures available in the town, whether the residents watched the video, help-seeking from advisers regarding suicidal ideation and financial problems and attitudes towards suicide. Results: We analysed data collected from 1,118 people who reported their demographics (i.e. sex, age, and job) and whether they had watched the video. By conducting a series of logistic regression and multiple regression analyses and controlling for demographic variables, we found that watching the video had substantial psychoeducational effects. Conclusion: Despite conducting a cross-sectional study, our new suicide prevention measures were considered effective for psychoeducation. However, further studies using a longitudinal design are needed.

Overview of community-based studies of depression screening interventions among the elderly population in Japan

Objectives: In most Western and Asian countries, a higher risk of suicide is found among elderly people than those in other age groups. However, the treatment needs of elderly people who are at risk of committing suicide are not well understood. We conducted an overview of studies that assessed the impact of suicide prevention interventions on suicide rates in elderly people in Japan. We interpreted the results of these studies, as well as prominent findings associated with other successful interventions, within a framework of the suicidal process and preventive strategies. Method: We assessed six quasi-experimental studies of community-based interventions providing universal depression screening, subsequent care, and education to elderly people in Japan, and performed a combined analysis of outcome data. Results: Screening interventions were associated with lower suicide rates. We also found a gender difference in the response to subsequent psychiatric or primary care. Two types of interventions decreased the rate of suicide among elderly people: crisis helplines and screening interventions. These interventions featured a close link between universal, selective, and indicated prevention strategies, which reflect different approaches tailored to the size and risk profile of the target individuals. Conclusion: Successful interventions appear to hinge on systematic links between multi-level prevention interventions. Multi-level interventions for depression screening may result in lower suicide rates among elderly individuals in communities, although primary care interventions alone appear to be insufficient in men. The benefit of linked multi-level prevention interventions may highlight the importance of the multiple steps and components of the suicidal process.

Effects of universal screening for depression among middle-aged adults in a community with a high suicide rate.

Abstract We examined the effect of a community-based screening program on depression in middle-aged individuals. Ten subdistricts constituting a rural township (2400 inhabitants aged 40–64 years) in northern Japan with a high suicide rate were randomly assigned to intervention (four) and control (six) groups. A 2-year depression-screening program entailing identification and subsequent care support was offered to adults aged 40 to 64 years in the intervention group, accompanied by 4-year ongoing dissemination of educational information in both groups. Change in depressive symptom prevalence was assessed through before-and-after cross-sectional surveys using the Center for Epidemiologic Studies–Depression Scale. Of the 900 targeted individuals, 49.2% participated in the screening. Comparison of data from these surveys after controlling for district-level clustering indicated a greater difference in prevalence between baseline and 5-year follow-up in the intervention group than that in the control. Universal screening and subsequent support seem effective to decrease depressive symptom prevalence among middle-aged individuals in a community setting.