A Community-based Depression Screening Intervention for Middle-aged Suicide

Aomori University of Health and Welfare89,700 enrolled

Overview

The purpose of this study is to examine the effectiveness of a community-based depression-screening program for suicide prevention among middle-aged adults, the investigators conducted a quasi-experimental intervention study, using a parallel cluster design with communities at municipal level as the unit of allocation and individuals as the unit of analysis.

Suicide is a major cause of premature death, particularly among middle-aged adults, in the majority of Western and Asian countries. A strong association of suicide and depression often indicates the necessity of a high-risk approach for suicide prevention. Improvements in identification and treatment can lead to better depression outcomes and suicide prevention. The investigators hypothesize that a 4-year community-based intervention, consisting of universal depression screening and subsequent care support in the target areas and health education programs, would result in reduced suicide rates among the middle-aged adult population in areas with a high suicide rate.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Enrollment

89,700

Conditions

Suicide

Interventions

Multi-level suicide prevention programsBEHAVIORAL

The intervention included both screening and educational components. The screening component invited residents aged 36-64 years to participate in a two-step screening program. In the initial screening, a self-report questionnaire were mailed to all of those residents in the priority districts with a past high suicide rate. The second stage was conducted for the participants who screened positive though a semi-structural interview. Based on the results, participants who were diagnosed with a major depressive episode were provided with a referral to a psychiatry and support for treatment adherence. Written feedback on the screening results was mailed to all respondents. The educational component was implemented through workshops open to the general public (3 times every year) and local public newsletters (twice every year) designed to improve access and adherence to treatment and to reduce stigma associated with suicide and depression.

Suicide prevention program as usualBEHAVIORAL

Usual mental health program (not including depression screening among middle-aged)

Eligibility

Sex: ALLMin age: 36 YearsMax age: 64 Years

Medical Language ↔ Plain English

Inclusion Criteria: * A municipal area located in the following 4 Aomori Second Medical Zones: Hachinohe, Kamitosan, Aomori, and Tsugaru. * A municipal area with the higher suicide rate than the prefectural average. * A municipal area having the sufficient and coverable size to serve the intervention (population 10,000-99,999). Exclusion Criteria: * A municipal area receiving further intervention including a depression screening for middle-aged adults.

Locations (11)

Control group

Fujisaki, Aomori, Japan

Intervention group

Gonohe, Aomori, Japan

Intervention group

Hashikami, Aomori, Japan

Intervention group

Hirakawa, Aomori, Japan

Outcomes

Primary Outcomes

Change in suicide rates among adults aged 40-64 years between the 4-year pre- and implementation periods.

Time frame: 4 years pre versus 4 years post

Secondary Outcomes

Invitation rate in the screening component

Time frame: 4 years post

Participation rate in the screening component

Time frame: 4 years post

Data from ClinicalTrials.gov

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