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Effect of community-based intervention using depression screening on elderly suicide risk: a meta-analysis of the evidence from Japan
- Authors:
- OYAMA Hirofumi, et al
- Journal article citation:
- Community Mental Health Journal, 44(5), October 2008, pp.311-320.
- Publisher:
- Springer
A systematic review was undertaken to quantify the effect of community-based depression screening (CDS) with follow-up on the completed suicide risk for residents aged 65 and over. Five quasi-experimental studies in Japanese regions with high suicide rates were included in the meta-analysis. Combined incidence rate ratios (95% confidence intervals) by the Mantel–Haenszel method and by the DerSimonian–Laird method in two homogenous studies implementing the follow-up conducted by psychiatrists were 0.30 (0.13–0.68) and 0.33 (0.14–0.80) in men, and 0.33 (0.19–0.58) and 0.33 (0.19–0.60) in women, respectively; and those in three homogenous studies implementing the follow-up conducted by general practitioners were 0.73 (0.45–1.18) and 0.74 (0.45–1.23) in men, and 0.36 (0.21–0.60) and 0.39 (0.22–0.66) in women, respectively. There are very few studies included, however, to demonstrate an association between CDS and the reduced risk, suggesting gender difference in the effectiveness.
A longitudinal study regarding conversion from mild memory impairment to dementia in a Japanese community
- Authors:
- ISHIKAWA Tomohisa, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(2), February 2006, pp.134-139.
- Publisher:
- Wiley
The aim was to estimate the rate that subjects with Mild Memory Impairment /Not Dementia (MMI/ND) shifted to dementia in a population-based cohort and to establish simple diagnostic methods for identification of high-risk persons for dementia. Subjects in a community-based elderly cohort of MMI/ND were followed longitudinally. Subjects were selected from the participants in the first Nakayama study. MMI/ND was defined as memory deficit with objective memory assessment, without dementia, impairment of general cognitive function, or disability in activities of daily living. The conversion rate was calculated using the person-year method. At baseline, the sample consisted of 104 subjects (59 female; 45 male) selected from 1162 community dwellers aged over 65 year. During the five-year follow-up, 14 subjects died, 13 moved to other communities, and six refused to participate further. Eleven (10.6%) subjects were diagnosed with Alzheimer's disease (AD), five (4.8%) were diagnosed with vascular dementia (VaD), and six (5.8%) were diagnosed with dementia of other etiology. The annual conversion rate that MMI/ND shifted to AD is calculated on 8.5% per 100 person-year, and shifted to dementia on 16.1% per 100 person-year in this survey. The rate at which subjects with MMI/ND whose conditions shifted to dementia was the same as the rate that subjects with mild cognitive impairment (MCI) shifted to dementia in a previous report. It would be useful to identify groups of high-risk individuals for dementia by simple diagnostic methods.
Screening for late life depression: cut-off scores for the Geriatric Depression Scale and the Cornell Scale for Depression in Dementia among Japanese subjects
- Authors:
- SCHREINER Andrea S., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(6), June 2003, pp.498-505.
- Publisher:
- Wiley
Proper screening of depression among older adults depends on accurate cut-off scores. Recent articles have recommended the Geriatric Depression Scale (GDS) and the Cornell Scale for Depression in Dementia (CSDD) for this screening. However, there has been no investigation of the sensitivity and specificity of either scale using Japanese subjects. The purpose of the present study was to identify appropriate GDS and CSDD cut-offs for Japanese older adults. The GDS and the CSDD were interview-administered to nondepressed Japanese older adults (n = 74) and to Japanese older adults with a SCID-IV diagnosis of major or minor depression (n = 37). Depressed subjects were also administered the Hamilton Depression Rating Scale (HDRS). Data were also collected on demographic variables, mental status, health status, and medication use. ROC curve analysis identified a cut-off score of 6 for the GDS which had a sensitivity of 0.973, a specificity of 0.959, a False Positive Rate (FPR) of 0.894, and a False Negative Rate (FNR) of 0. A cutoff score of 5 for the CSDD yielded a sensitivity of 1, a specificity of 0.919, a FPR of 0.942, and a FNR of 0. Comparisons indicate current HDRS cut-offs may overlook subthreshold depression. The GDS cut-off score identified among Japanese subjects was the same as that reported for Western subjects. Due to the substantial prevalence of psychiatric disorders found in false-negative subjects, the above cut-off scores were chosen to optimize the potential for true positives. These scores are recommended for alerting physicians and other caregivers as to when more intensive depression evaluation is needed.
Development and evaluation of a health-related quality of life questionnaire for the elderly with dementia in Japan
- Authors:
- TERADA Seishi, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 17(9), September 2002, pp.851-858.
- Publisher:
- Wiley
The purpose of this research was the development of the quality of life (QOL) questionnaire for dementia (QOL-D) in Japan. Researchers performed a questionnaire survey of QOL assessment in elderly patients with dementia in Japan, and developed QOL-D. The final version consists of only 31 items grouped into six response sets, each with its own scale. Reliability is good to excellent, and validity is, to some extent, established. The six domains of health-related QOL are divided into two groups. One is the positive and the other is the negative aspects of health-related QOL. The positive aspects have been shown to correlate positively with cognitive function and activities of daily living (ADL) score, whereas the negative aspects have not. The concept of QOL for elderly patients with dementia in Japan is similar to that in Western countries.
Outcomes of community-based screening for depression and suicide prevention among Japanese elders
- Authors:
- OYAMA Hirofumi, et al
- Journal article citation:
- Gerontologist, 46(6), December 2006, pp.821-826.
- Publisher:
- Oxford University Press
This study evaluates outcomes of a community-based program to prevent suicide among elderly individuals aged 65 and older. The study used a quasi-experimental design with intervention and referent municipalities. The program included a 7-year implementation of depression screening with follow-up by general practitioners and a 10-year implementation of public education conducted in Yasuzuka (population 4,940; elderly suicide rate for women, 275/100,000; for men, 323/100,000). Changes in the risk of completing suicide before and after the 10-year implementation by the incidence-rate ratio (IRR) were estimated. The results found risk for women in the intervention area was reduced by 64%, whereas there was no significant change in the risk for men in the intervention area and either men or women in the referent municipalities. A ratio of the IRR for women aged 65 to 74 in the intervention area to that in its prefecture was estimated at 0.23, showing that the risk reduction was greater than the secular trend. It is concluded that the management of depression by use of community resources involving public health and primary care physicians is effective in the prevention of suicide for elderly women but uncertain for men.
Community-based prevention for suicide in elderly by depression screening and follow-up
- Authors:
- OYAMA Hirofumi, et al
- Journal article citation:
- Community Mental Health Journal, 40(3), June 2004, pp.249-263.
- Publisher:
- Springer
The aim of the study was to evaluate the outcome of a community-based prevention program against suicides among the elderly aged 65 and over in the Japanese rural town of Joboji (population 7,010), using a quasi-experimental design with two neighboring control areas. During the 10-year implementation of the program based on strategies including screening for depression, follow up with mental health care or psychiatric treatment and health education on depression, the relative risks estimated by the age-adjusted odds ratios for both males and females were reduced to almost one quarter more than a regional historical trend, with a better response to education for females than for males. A community-based management for later-life depression with mental health care supported by the psychiatric treatment can be effective against suicide among the elderly for both males and females.