[Prevention of suicide in the elderly]

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 cross-sectional studies, impaired instrumental activities of daily living, lack of social support, and depressive symptoms were independently associated with suicidal ideation in elderly community residents. In addition, mental disorders, particularly depressive and alcohol-related disorders, were found to be strongly associated with recent suicidal ideation. In prospective cohort studies, low motor function or severe pain, alcohol problems, and depressive symptoms independently predicted male suicidal ideation, whereas only depressive symptoms predicted female suicidal ideation. 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. Screening for depressive symptoms followed by diagnostic evaluation of mental disorders may provide a practical and effective strategy for case identification. However, it should be noted that physical distress and alcohol problems might increase suicide risk irrespective of depression, especially among elderly males. The combination of population and high-risk strategies is recommended for a comprehensive community intervention program for preventing elderly suicide in urban residential districts.