Applicability of on-site disinfection of personal protective equipment by ozone gas.

On-site disinfection techniques are beneficial during a pandemic when there is a marked shortage of personal protective equipment (PPE), as experienced during the coronavirus disease 2019 outbreak. Ozone gas has been considered an alternative on-site disinfectant during a pandemic because it has antimicrobial activities, can be produced from air by electricity without the need for storage, and can be easily deactivated after use. However, ozone gas might become distributed at the lower layer because it has a larger molecular weight than air. This study aimed to reveal the applicability of ozone gas for the on-site disinfection of PPE. The lockers meant for changing dresses were used as ozone gas exposure boxes, and the distribution of ozone was assayed. Considering that the determined ozone levels were not consistent in the types of ozone analysers, we studied the chemical and biological activities of ozone, which were evenly detected in the locker. The gown in the locker was also uniformly exposed to ozone. Results showed that ozone gas could be used for the on-site disinfection of PPE in a closed box, such as a locker. This finding is valuable during a pandemic when PPE is in short supply.

Suicide Prevention Interventions and Their Linkages in Multilayered Approaches for Older Adults: A Review and Comparison.

Multilayered approaches to suicide prevention combine universal, selective, and indicated prevention interventions. These approaches may be more successful in reducing suicide rates among older adults if they link these layers more systematically: that is, if the programs are designed so that interventions at a lower level facilitate involvement at a higher level when appropriate. This study aimed to examine the effect on suicide rates of the structure of multilayered approaches, and in particular the types of interventions and the connections or linkages between them. We also wished to consider any different effects by sex. A literature search used PubMed and PsycINFO to identify systematic reviews of interventions in this age group. From the reference lists of these articles, we identified controlled studies assessing the impact of a multilayered program on suicide incidence among older adults. We were particularly interested in initiatives linking different kinds of prevention interventions. We found three relevant systematic reviews, and from these, we identified nine eligible studies. These included seven non-randomized controlled studies from rural areas in Japan (average eligible population: 3,087, 59% women, average duration: 8 years). We also found two cohort studies. The first was from a semi-urban area in Padua, Italy (18,600 service users, 84% women, duration: 11 years). The second was from urban Hong Kong, with 351 participants (57% women) over a 2-year follow-up period. We used a narrative synthesis of these studies to identify five different multilayered programs with different forms of connections or linkages between layers. Two studies/programs (Italy and Hong Kong) involved selective and indicated prevention interventions. One study/program (Yuri, Japan) included universal and selective prevention interventions, and the final six studies (two programs in northern Japan) involved linkages between all three layers. We also found that these linkages could be either formal or informal. Formal linkages were professional referrals between levels. Informal linkages included advice from professionals and self-referrals. Several of the studies noted that during the program, the service users developed relationships with services or providers, which may have facilitated movements between levels. All five programs were associated with reduced suicide incidence among women in the target groups or communities. Two programs were also associated with a reduction among men. The study authors speculated that women were more likely to accept services than men, and that the care provided in some studies did less to address issues that are more likely to affect men, such as suicidal impulsivity. We therefore suggest that it is important to build relationships between levels, especially between selective and indicated prevention interventions, but that these can be both formal and informal. Additionally, to reach older men, it may be important to create systematic methods to involve mental health professionals in the indicated prevention intervention. Universal interventions, especially in conjunction with systematically linked indicated and selective interventions, can help to disseminate the benefits across the community.

Developing a Hypothetical Model for Suicide Progression in Older Adults With Universal, Selective, and Indicated Prevention Strategies.

Suicide prevention is an increasingly important issue, especially among older people. Recent work on improving its effectiveness has focused on developing a framework aligning interventions with key risk factors and stages of the suicide process. We have developed this further, by integrating psycho-behavioral components associated with suicide, existing guidelines for identifying critical points of intervention, and the previous preventive strategies framework. Our schematic diagram shows the relationship between the suicide process and prevention strategies, combined with initiatives for linking different types of strategies, from universal strategies at population level, through selective strategies focusing on groups at risk, to indicated strategies, aimed at specific high-risk individuals. We tested our framework using previous studies assessing the impact of suicide prevention interventions on suicide rates in older adults. It was possible to place all identified interventions within the framework. Examining effectiveness within the framework suggests that some interventions may be more successful in reducing suicide rates because they developed systematic linkages between universal, selective, and indicated prevention interventions. Other studies, however, show that interventions can be successful without these linkages, so other factors may also be important. The main weakness of our framework is a lack of evidence about critical intervention points within the suicide process, which may limit its practical application. However, the framework may help to improve the linkages between types of interventions, and support practitioners in developing a wide range of strategies across different areas and stages of the suicide process.

Long-Term Effects of a Screening Intervention for Depression on Suicide Rates among Japanese Community-Dwelling Older Adults.

OBJECTIVES: 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. DESIGN: Controlled cohort study reporting long-term follow-up of previous research. SETTING: Two sets of three municipalities in Japan were assigned as intervention and control regions and compared with the surrounding zone and prefecture. PARTICIPANTS: 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. INTERVENTION: 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. MEASUREMENTS: 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.

Overview of community-based studies of depression screening interventions among the elderly population in Japan.

OBJECTIVES: In most Western and Asian countries, a higher risk of suicide is found among elderly people than those in other age groups. However, the treatment needs of elderly people who are at risk of committing suicide are not well understood. We conducted an overview of studies that assessed the impact of suicide prevention interventions on suicide rates in elderly people in Japan. We interpreted the results of these studies, as well as prominent findings associated with other successful interventions, within a framework of the suicidal process and preventive strategies. METHOD: We assessed six quasi-experimental studies of community-based interventions providing universal depression screening, subsequent care, and education to elderly people in Japan, and performed a combined analysis of outcome data. RESULTS: Screening interventions were associated with lower suicide rates. We also found a gender difference in the response to subsequent psychiatric or primary care. Two types of interventions decreased the rate of suicide among elderly people: crisis helplines and screening interventions. These interventions featured a close link between universal, selective, and indicated prevention strategies, which reflect different approaches tailored to the size and risk profile of the target individuals. CONCLUSION: Successful interventions appear to hinge on systematic links between multi-level prevention interventions. Multi-level interventions for depression screening may result in lower suicide rates among elderly individuals in communities, although primary care interventions alone appear to be insufficient in men. The benefit of linked multi-level prevention interventions may highlight the importance of the multiple steps and components of the suicidal process.

Effects of universal screening for depression among middle-aged adults in a community with a high suicide rate.

We examined the effect of a community-based screening program on depression in middle-aged individuals. Ten subdistricts constituting a rural township (2400 inhabitants aged 40-64 years) in northern Japan with a high suicide rate were randomly assigned to intervention (four) and control (six) groups. A 2-year depression-screening program entailing identification and subsequent care support was offered to adults aged 40 to 64 years in the intervention group, accompanied by 4-year ongoing dissemination of educational information in both groups. Change in depressive symptom prevalence was assessed through before-and-after cross-sectional surveys using the Center for Epidemiologic Studies-Depression Scale. Of the 900 targeted individuals, 49.2% participated in the screening. Comparison of data from these surveys after controlling for district-level clustering indicated a greater difference in prevalence between baseline and 5-year follow-up in the intervention group than that in the control. Universal screening and subsequent support seem effective to decrease depressive symptom prevalence among middle-aged individuals in a community setting.

The effects of suicide prevention measures reported through a psychoeducational video: a practice in Japan.

BACKGROUND: As the suicide rate in Japan has remained high since 1998, various suicide prevention measures have been implemented in Japanese local communities. AIMS: To report our findings on the effect of a psychoeducational video as a suicide prevention measure in a Japanese rural town. METHODS: Questionnaires were randomly mailed to 2,000 residents aged between 30 and 79 years. Within 4 weeks, volunteers in the town visited the residents individually and collected the questionnaires. The variables reported in this study are demographics, awareness of suicide prevention measures available in the town, whether the residents watched the video, help-seeking from advisers regarding suicidal ideation and financial problems and attitudes towards suicide. RESULTS: We analysed data collected from 1,118 people who reported their demographics (i.e. sex, age, and job) and whether they had watched the video. By conducting a series of logistic regression and multiple regression analyses and controlling for demographic variables, we found that watching the video had substantial psychoeducational effects. CONCLUSION: Despite conducting a cross-sectional study, our new suicide prevention measures were considered effective for psychoeducation. However, further studies using a longitudinal design are needed.

Differences in specific depressive symptoms among community-dwelling middle-aged Japanese adults before and after a universal screening intervention.

PURPOSE: This study investigated changes in depressive symptoms after the implementation of a universal screening for depression and subsequent care support. METHODS: A cluster-randomized study design used 10 subdistricts (2,400 inhabitants aged 40-64 years) in northern Japan randomly assigned in a 2:3 ratio to intervention and control conditions. All 900 residents aged 40-64 in the intervention districts were invited to participate in a 2-year depressive screening program, with a participation rate of 49.2%. A 4-year ongoing education program occurred in both intervention and control districts. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depressive symptomatology. Repeated cross-sectional samples were surveyed before (n = 1,516, response rate 63.6%) and after (n = 1,596, 66.4%) intervention, and the data, clustered according to district, were analyzed at the individual level using a mixed-effects model. RESULTS: Significant changes in mean scores between baseline and 5-year follow-up in the intervention group were observed in the Depressive Affect, Somatic Symptoms, and Interpersonal Problems subscales. The difference between the changes over time in the two groups was significant for the three subscales and marginally for the CES-D total scale, but not for the Positive Affect subscale. CONCLUSIONS: Universal depression screening and subsequent support can be effective in preventing general depressive symptoms, but may not influence psychological well-being, among middle-aged adults in a community setting.

Key considerations for preventing suicide in older adults: consensus opinions of an expert panel.

BACKGROUND: The number of older adults is growing rapidly. This fact, combined with the high rates of suicide in later life, indicates that many more older adults will die by their own hands before rigorous trials can be conducted to fully understand the best approaches to prevent late life suicide. AIMS: To disseminate key considerations for interventions addressing senior suicidal behavior. METHODS: An international expert panel has reviewed and discussed key considerations for interventions against suicide in older adults based on existing evidence, where available, and expert opinion. RESULTS: A set of new key considerations is divided into: universal, selective, and indicated prevention as well as a section on general considerations. CONCLUSIONS: The suggestions span a wide range and are offered for consideration by local groups preparing new interventions, as well as large scale public health care planning.

A community-based survey and screening for depression in the elderly: the short-term effect on suicide risk in Japan.

BACKGROUND: In addition to implementing a depression screening program, conducting a survey beforehand might contribute to suicide risk reduction for the elderly. AIMS: This study evaluates outcomes of a community-based program to prevent suicide among individuals aged 60 and over, using a quasiexperimental design with an intervention region (41,337 residents, 35.1% aged 60 and over) and a neighboring reference region. METHODS: Our 2-year intervention program included an anonymous survey by random sample in the entire intervention region and, in the second year, a depression screening with follow-up by a psychiatrist in the higher-risk districts. Changes in the risk of completed suicide were estimated by the incidence-rate ratio (IRR). RESULTS: The risk for men in the intervention region was reduced by 61% (age-adjusted IRR = 0.39; 90% CI = 0.18-0.87), whereas there was a (statistically insignificant) 51% risk reduction for women in the intervention region, and no risk reduction for either men or women in the reference region. The ratio of the crude IRR for elderly men in the intervention region to that for all elderly men in Japan was estimated at 0.42 (90% CI = 0.18-0.92), showing that the risk reduction was greater than the national change. CONCLUSIONS: The management of depression through a combination of an initial survey and subsequent screening holds clear promise for prompt effectiveness in the prevention of suicide for elderly men, and potentially for women.

Effect of community-based intervention using depression screening on elderly suicide risk: a meta-analysis of the evidence from Japan.

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.

Outcomes of community-based screening for depression and suicide prevention among Japanese elders.

PURPOSE: In this study we evaluate outcomes of a community-based program to prevent suicide among elderly individuals aged 65 and older. DESIGN AND METHODS: We 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). We estimated changes in the risk of completing suicide before and after the 10-year implementation by the incidence-rate ratio (IRR). RESULTS: The risk for women in the intervention area was reduced by 64% (age-adjusted IRR=0.36; 95% confidence interval=0.14-0.93), 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 (90% confidence interval=0.05-0.99), showing that the risk reduction was greater than the secular trend. IMPLICATIONS: 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.

Preventing elderly suicide through primary care by community-based screening for depression in rural Japan.

Depression is a major cause of suicide among the elderly. Few previous community-based interventions against depression have reduced the suicide rate. This study aims to evaluate outcomes of a community-based program to prevent suicide among the elderly using a quasi-experimental design with a neighboring reference group. The program, including depression screening with follow-up and health education through primary care and public health nursing, was implemented for 10 years in Matsudai town, a rural area of Japan (population 6,015; suicide rate per 10(5) [65-year-olds] for males 290.6, and for females 361.3). Changes in the suicide risk were estimated by the incidence rate ratio (IRR). The female risk of completing suicide in the intervention area was reduced by 70% (age-adjusted IRR: 0.30; 95% CI: 0.14-0.67), while there was no change in the risk for males in the intervention area nor for males or females in the reference area (Kawanishi town: population 9,425; elderly suicide rate for males 212.2, females 151.9). A ratio of the female IRR in the intervention area to that in its prefecture was also estimated at 0.45 (95% CI: 0.19-0.97), showing that the reduction of suicide risk in the intervention area was greater than the historical trend. A community intervention against suicide using management of depression with nonpsychiatric, primary health care would be effective for elderly females, but not males.

Local community intervention through depression screening and group activity for elderly suicide prevention.

This study aims to evaluate outcomes of a community-based program to prevent suicide among the elderly (>or=65 years old) using a quasi-experimental design with two neighboring references. During 1999-2004, the program including depression screening and group activity was conducted by the public health nurses in the Minami district (population 1685) of Nagawa town, rural Japan. Pre-post changes in the risk of completing suicide were estimated by the incidence rate ratios (IRR). The risk for Minami's elderly females was reduced by 74% (age-adjusted IRR, 0.26; 90% CI, 0.07-0.98) more than the historical trend, while there was no change in the risk of Minami's males and nor in the male or female references. The local intervention using public health nursing would be effective against suicide for elderly females without diffusing to the surroundings.

Community-based suicide prevention through group activity for the elderly successfully reduced the high suicide rate for females.

The lack of social support is the most common risk factor for late-life suicide. Few previous community-based interventions against the lack of social relationships reduced suicide. This study aims to evaluate outcomes of a community-based prevention program against suicide amongst the elderly in rural Japan. During 1995-2002, the program based on population strategy including group activity, psychoeducation and self-assessment of depression but no screening for depression, was implemented for elderly residents in Yuri town, Japan (5-year average population 6817; 5-year average suicide rate [> or =65 years old] 291.4/10(5)). Changes in the relative risk of suicide for individuals (> or =65 years old) before and after the 8-year implementation were estimated by the incidence rate ratio (IRR), using a quasi-experimental design with a neighboring reference, Chokai town, Japan (5-year average population 8136; 5-year average suicide rate [> or =65 years old] 216.5/10(5)). The risk of elderly females in Yuri completing suicide was reduced by 76% (age-adjusted IRR, 0.24; 95% CI, 0.10-0.58), while there was no change in the risks for Yuri's elderly males and both Chokai's elderly males and females. General loglinear analysis estimated a ratio of the female IRR in Yuri to that in its Akita prefecture of 0.35 (95% CI, 0.14-0.84), showing that the reduction of the risk in the intervention area was greater than a historical trend. A community-based suicide prevention through a group intervention designed to increase knowledge and to cultivate social relationships would be effective for elderly females but not males.

Community-based prevention for suicide in elderly by depression screening and follow-up.

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.