title: Long-Term Effects of a Screening Intervention for Depression on Suicide Rates among Japanese Community-Dwelling Older Adults.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Controlled cohort study reporting long-term follow-up of previous research.
  
  
  METHODS
  Two sets of three municipalities in Japan were assigned as intervention and control regions and compared with the surrounding zone and prefecture.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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 program's 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.
authors.affiliation: Department of Social Welfare, Faculty of Health Sciences, Aomori University of Health and Welfare, Aomori, Japan. Electronic address: h_oyama@auhw.ac.jp.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Oyama
authors.affiliation: Department of Social Welfare, Faculty of Health Sciences, Aomori University of Health and Welfare, Aomori, Japan.
authors.forename: Tomoe
authors.initials: T
authors.lastname: Sakashita
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000175:diagnosis* / Q000628:therapy; D003866:Depressive Disorder / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D013405:Suicide / Q000706:statistics & numerical data; D000092864:Suicide Prevention
keywords: Suicide; community; depression screening; intervention; older adults