| Study population | Outcomes | ||||
|---|---|---|---|---|---|
| Study | Description | Definition | Evaluation | Definition | Results |
| Oyama et al. (19) (5-yr quasi-experimental study in Matsudai, Japan [rural]) | Total person-years: 11 567 for intervention, 15 055 for control Age, mean: NR Age, range: ≥□65 yr Age, median: NR Sex, female: 57.6% Ethnicity: Japanese Education: NR Dx: major and minor depression | Older (≥ 65 yr) residents in 6 rural municipalities of southwest and central Japan Intervention: mental health workshop, referral to general practitioner or follow-up interview with PHN Exclusions: severely disabled or hospitalized cases were excluded from the study | Screening instrument: SDS Other rating: RDC Confirmatory exam: ICD-9 No. of follow-ups: 10 No. of stages: two 10-yr | Main outcome: Change in risk of completed suicide Age-adjusted IRRs of completed suicide before and after intervention or control | Main outcome: Risk of completed suicide in intervention area reduced by 70% among women, no significant change among men Intervention: IRR 1.02 (95% CI 0.49–2.13) for men and 0.30 (95% CI 0.14–0.67) for women Control: No significant change |
| Oyama et al. (20) (10-yr quasi-experimental study in Yasuzuka, Japan [rural]) | Total person- years: 9791 for intervention, 16 032 for control Age, mean: NR Age, range: ≥□65 yr Age, median: NR Sex, female: NR Ethnicity: Japanese Education: NR Dx: major and minor depression | Older (≥ 65 yr) residents of agricultural rural area in Japan with high suicide rate Intervention: (a) public health education from 1991 to 2000 and (b) screening for depression with follow-up from 1991 to 1997 Exclusions: NR | Screening instrument: SDS Other rating: RDC Confirmatory exam: ICD-9 No. of follow-ups: 7 No. of stages: two 10-yr | Main outcome: Change in risk of completed suicide Age-adjusted IRRs of completed suicide before and after intervention or control | Main outcome: Risk of completed suicide in intervention area reduced by 64% among women, no significant change among men Intervention: IRR 0.51 (95% CI 0.22–1.19) for men and 0.36 (95% CI 0.14–0.93) for women Control: No significant change |
| Oyama et al. (17) (10-yr quasi-experimental study in Joboji town, Japan [rural]) | Total person- years: 9721 for intervention, 17 166 for control Age, mean: NR Age, range: ≥□65 yr Age, median: NR Sex, female: 50.8% Ethnicity: Japanese Education: NR Dx: depression (unspecified) | Older (≥ 65 yr) residents of agricultural rural area in Japan with high suicide rate Intervention: 2-step depression screening performed by PHN and psychiatrist with follow-up by psychiatrist every 3 yr in targeted district of intervention municipality, health education and emphasis on suicide taboo every year in 10-yr period from 1990 Exclusions: Older people receiving social welfare | Screening instrument: SDS Other rating: SADD Confirmatory exam: ICD-9 No of follow-ups: 10 No. of stages: three 5-yr | Main outcome: Change in suicide rates Age-adjusted IRRs of completed suicide before and after intervention or control | Main outcome: Risk of suicide in intervention area reduced by 73% among men and by 76% among women during implementation decade (relative to pre-implementation decade) Intervention: IRR 0.27 (95% CI 0.08–0.88) for men and 0.24 (95% CI 0.11–0.52) for women Control: No significant change |
| Oyama et al. (18) (5-yr quasi-experimental study in Nagawa town, Japan [rural]) | Total person- years: 1982 for intervention, 16 754 for control Age, mean: NR Age, range: ≥□65 yr Age, median: NR Sex, female: 59%–60.8% Ethnicity: Japanese Education: NR Dx: depression (unspecified) | Older (≥ 65 yr) residents of agricultural rural area in Japan with high suicide rate Intervention: 2-step screening for depression and follow-up by PHN, mental health workshop 3 or 4 times a year, group activity program once a month Exclusions: NR | Screening instrument: SDS Other rating: RDC Confirmatory exam: ICD-9 No. of follow-ups: 6 No. of stages: two 6-yr | Main outcome: Change in risk of completed suicide Age-adjusted IRRs of completed suicide before and after intervention or control | Main outcome: Risk of suicide in intervention area reduced by 74% among women, no significant change among men Intervention: IRR 0.48 (90% CI 0.10–2.31) for men and 0.26 (90% CI 0.07–0.98) for women Control: No significant change |
| Oyama et al. (21) (5-yr quasi-experimental study in 6 rural municipalities of the Sanpachi Second Medical Zone, Japan [rural]) | Total person-years: 28 838 for intervention, 27 633 for control Age, mean: NR Age, range: ≥□60 yr Age, median: NR Sex, female: 57.5% Ethnicity: Japanese Education: NR Dx: depression (unspecified) | Older (≥ 60 yr) residents living in 6 rural municipalities of Sanpachi Second Medical Zone of Japan (mostly agricultural region with high suicide rate) Intervention: (a) health education and (b) screening for depression with follow-up, using community resources of primary care and public health nursing Exclusions: NR | Screening instrument: CES-D, DSS, SDS, GDS-5 Other rating: CIDI Confirmatory exam: ICD-10 No. of follow-ups: 2 No. of stages: two 2-yr | Main outcome: Change in risk of completed suicide Age-adjusted IRRs of completed suicide before and after intervention or control | Main outcome: Risk of suicide in intervention region reduced by 61% among men; no significant change among women Intervention: IRR 0.39 (90% CI 0.18–0.87) for men and 0.49 (90% CI 0.19–1.22) for women Control: No significant change |
Note: CES-D = Center for Epidemiologic Studies Depression Scale, CI = confidence interval, CIDI = Composite International Diagnostic Interview, DSS = Depression and Suicide Screen, Dx = diagnosis, GDS-5 = 5-item Geriatric Depression Scale, (22) ICD = International Statistical Classification of Diseases, IRR = incidence rate ratio, NR = not reported, PHN = public health nurse, RDC = Research Diagnostic Criteria, SADD = schedules of Standardized Assessment of Patient with Depressive Disorders, SDS = Self-rating Depression Scale. (23)