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Sylvie Lapierre,
Annette Erlangsen,
Margda Waern,
Diego De Leo, Hirofumi Oyama,
Paolo Scocco,
Joseph Gallo,
Katalin Szanto,
Yeates Conwell,
Brian Draper,
Paul Quinnett
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ABSTRACT: Suicide rates are highest among the elderly, yet research on suicide prevention in old age remains a much-neglected area.
We carried out a systematic review to examine the results of interventions aimed at suicidal elderly persons and to identify successful strategies and areas needing further exploration.
Searches through various electronic databases yielded 19 studies with an empirical evaluation of a suicide prevention or intervention program designed especially for adults aged 60 years and older.
Most studies were centered on the reduction of risk factors (depression screening and treatment, and decreasing isolation), but when gender was considered, programs were mostly efficient for women. The empirical evaluations of programs attending to the needs of high-risk older adults seemed positive; most studies showed a reduction in the level of suicidal ideation of patients or in the suicide rate of the participating communities. However, not all studies used measures of suicidality to evaluate the outcome of the intervention, and rarely did they aim at improving protective factors.
Innovative strategies should improve resilience and positive aging, engage family and community gatekeepers, use telecommunications to reach vulnerable older adult, and evaluate the effects of means restriction and physicians education on elderly suicide.
Crisis The Journal of Crisis Intervention and Suicide Prevention 01/2011; 32(2):88-98. · 1.09 Impact Factor
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Annette Erlangsen,
Merete Nordentoft,
Yeates Conwell,
Margda Waern,
Diego De Leo,
Reinhard Lindner, Hirofumi Oyama,
Tomoe Sakashita,
Karen Andersen-Ranberg,
Paul Quinnett,
Brian Draper,
Sylvie Lapierre
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ABSTRACT: 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.
To disseminate key considerations for interventions addressing senior suicidal behavior.
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.
A set of new key considerations is divided into: universal, selective, and indicated prevention as well as a section on general considerations.
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.
Crisis The Journal of Crisis Intervention and Suicide Prevention 01/2011; 32(2):106-9. · 1.09 Impact Factor
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ABSTRACT: In addition to implementing a depression screening program, conducting a survey beforehand might contribute to suicide risk reduction for the elderly.
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.
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).
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.
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.
Crisis The Journal of Crisis Intervention and Suicide Prevention 01/2010; 31(2):100-8. · 1.09 Impact Factor
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Yutaka Ono,
Shuichi Awata,
Hideharu Iida,
Yasushi Ishida,
Naoki Ishizuka,
Hiroto Iwasa,
Yuichi Kamei,
Yutaka Motohashi,
Atsuo Nakagawa,
Jun Nakamura, [......], Hirofumi Oyama,
Akio Sakai,
Hironori Sakai,
Yuriko Suzuki,
Miyuki Tajima,
Eriko Tanaka,
Hidenori Uda,
Naohiro Yonemoto,
Toshihiko Yotsumoto,
Naoki Watanabe
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ABSTRACT: To respond to the rapid surge in the incidence of suicide in Japan, which appears to be an ongoing trend, the Japanese Multimodal Intervention Trials for Suicide Prevention (J-MISP) have launched a multimodal community-based suicide prevention program, NOCOMIT-J. The primary aim of this study is to examine whether NOCOMIT-J is effective in reducing suicidal behavior in the community.
This study is a community intervention trial involving seven intervention regions with accompanying control regions, all with populations of statistically sufficient size. The program focuses on building social support networks in the public health system for suicide prevention and mental health promotion, intending to reinforce human relationships in the community. The intervention program components includes a primary prevention measures of awareness campaign for the public and key personnel, secondary prevention measures for screening of, and assisting, high-risk individuals, after-care for individuals bereaved by suicide, and other measures. The intervention started in July 2006, and will continue for 3.5 years. Participants are Japanese and foreign residents living in the intervention and control regions (a total of population of 2,120,000 individuals).
The present study is designed to evaluate the effectiveness of the community-based suicide prevention program in the seven participating areas.
UMIN Clinical Trials Registry (UMIN-CTR) UMIN000000460.
BMC Public Health 10/2008; 8:315. · 2.00 Impact Factor
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ABSTRACT: 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.
Community Mental Health Journal 04/2008; 44(5):311-20. · 1.03 Impact Factor
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Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica 02/2008; 110(9):731-8.
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ABSTRACT: In this study we evaluate outcomes of a community-based program to prevent suicide among elderly individuals aged 65 and older.
We used a quasi-experimental design with intervention and referent municipalities. The program included a 7-year implementation of depression screening with follow-up by general practitioners and a 10-year implementation of public education conducted in Yasuzuka (population 4,940; elderly suicide rate for women, 275/100,000; for men, 323/100,000). We estimated changes in the risk of completing suicide before and after the 10-year implementation by the incidence-rate ratio (IRR).
The risk for women in the intervention area was reduced by 64% (age-adjusted IRR=0.36; 95% confidence interval=0.14-0.93), whereas there was no significant change in the risk for men in the intervention area and either men or women in the referent municipalities. A ratio of the IRR for women aged 65 to 74 in the intervention area to that in its prefecture was estimated at 0.23 (90% confidence interval=0.05-0.99), showing that the risk reduction was greater than the secular trend.
The management of depression by use of community resources involving public health and primary care physicians is effective in the prevention of suicide for elderly women but uncertain for men.
The Gerontologist 01/2007; 46(6):821-6. · 2.48 Impact Factor
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ABSTRACT: Little is known about the association between depression and the buffering effects of social support in mid-life crisis. The aim of this study is to determine the buffering effects of social support on depression concerning middle-aged individuals, while also taking reciprocity and gender differences into careful consideration. A cross-sectional survey of all middle-aged individuals (40-69 years of age) using a large sample (n = 4558) from a community-living population, who resided in Rokunohe town, Aomori prefecture in northern Japan (response rate = 69.8%), was undertaken. This town recently had a lot of suicides. Two-way anova was used to analyze the effects of stressor and social support on the Center for Epidemiologic Studies Depression scale scores. The authors found a stress buffering effect of social support on the depressive symptoms occurring in middle age, however, a significant difference in the stress buffer effect was only observed in male subjects. Moreover, when the authors take reciprocity into account, the effect of the buffer on depression was found not only in males receiving support but in males providing support as well. In conclusion, pertaining to males, social support reduces depressive symptoms under stressful circumstances in middle age, not only when they receive such support but also when they provide it. Therefore, these findings suggest that reciprocal social support is important for males in relation to community mental health.
Psychiatry and Clinical Neurosciences 01/2007; 60(6):652-61. · 2.13 Impact Factor
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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.
Crisis The Journal of Crisis Intervention and Suicide Prevention 02/2006; 27(2):58-65. · 1.09 Impact Factor
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Hirofumi Oyama,
Yutaka Ono,
Naoki Watanabe,
Eriko Tanaka,
Seijiro Kudoh,
Tomoe Sakashita,
Shinji Sakamoto,
Keiko Neichi,
Kyoko Satoh,
Kenji Nakamura,
Kimio Yoshimura
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ABSTRACT: This study aims to evaluate outcomes of a community-based program to prevent suicide among the elderly (>or=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 Minami's 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 Minami's 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.
Psychiatry and Clinical Neurosciences 02/2006; 60(1):110-4. · 2.13 Impact Factor
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ABSTRACT: 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 1995-2002, 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 [> or =65 years old] 291.4/10(5)). Changes in the relative risk of suicide for individuals (> or =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 [> or =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.
Psychiatry and Clinical Neurosciences 07/2005; 59(3):337-44. · 2.13 Impact Factor
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Geriatrics & Gerontology International 09/2004; 4(s1):S235 - S236.
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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.
Community Mental Health Journal 07/2004; 40(3):249-63. · 1.03 Impact Factor
