Development of community intervention program to detect depression and to prevent suicide in elders residing urban cities

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1. In order to establish a comprehensive community intervention program for preventing suicide in late life, a series of observation and intervention studies was conducted in an urban residential district where the elderly population was rapidly increased. In intervention studies, education, consultation, increased community activity, and screening programs decreased the proportion of residents who indicated a lack of social support, and reduced depressive symptoms (GDS). Additionally, outreach and case management programs improved mental-health wellbeing (WHO-5), and reduced suicidal ideation among elderly with depressive disorders. The combination of population and high-risk strategies is recommended for a comprehensive community intervention program for preventing elderly suicide in urban residential districts.2. To evaluate the validity and the utility of the Japanese version of the WHO-Five Well-Being Index (WHO-5-J) in the context of detecting suicidal ideation in elderly community residents, a sample of 696 subjects aged 70 years or over who completed a set of questionnaires was examined. Chronbach's coefficient alpha was 0.87 and Loevinger's coefficient was 0.64. The total score was significantly correlated with the number of cohabitants, the number of physical illnesses, physical functioning, instrumental activities of daily living, and depressive symptoms. Subjects with suicidal ideation had significantly lower scores on the WHO-5-J. The receiver-operating characteristic curve analysis indicated that the scale significantly discriminated the subjects with suicidal ideation. When combined with the assessment of a lack of perceived social support (PSS), a standard cut-off criterion of 'a total score < 12 or answering 0 or 1 to any of the five items' more appropriately identified elderly subjects with suicidal ideation : sensitivity = 87%, specificity = 75%, negative predictive value = 99%, and positive predictive value = 10%.