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

1.为了建立预防老年自杀的综合性社区干预方案，在城市老年人口迅速增加的一个社区进行了一系列的观察和干预研究。在干预研究中，教育、咨询、增加社区活动和筛查计划降低了缺乏社会支持的居民比例，并减少了抑郁症状（GDS）。此外，外展和病例管理计划改善了心理健康状况（WHO-5），并减少了老年抑郁症患者的自杀意念。建议在城市居民区开展预防老年人自杀的社区综合干预，应将人群与高危策略相结合.为了评价日本版的WHO-5幸福感指数（WHO-5-J）的有效性和实用性，在检测老年社区居民的自杀意念的背景下，696名年龄在70岁或以上的受试者完成了一组问卷调查。Chronbach系数α为0.87，Loevinger系数为0.64。总分与同居人数、躯体疾病数量、躯体功能、工具性日常生活活动和抑郁症状显著相关。有自杀意念的受试者在WHO-5-J量表上的得分显著降低。受试者工作特征曲线分析表明，该量表对有自杀意念的受试者有显著的区分作用。当结合缺乏社会支持（PSS）的评估时，“总分< 12或对五项中的任何一项回答0或1”的标准截止标准更适合识别有自杀意念的老年受试者：敏感性= 87%，特异性= 75%，阴性预测值= 99%，阳性预测值= 10%。

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%.