Department of Social Welfare,Faculty of Heath Sciences,Aomori University of Health and Welfare,Aomori,Japan.
Psychol Med. 2017 Jun;47(8):1500-1509. doi: 10.1017/S0033291717000204. Epub 2017 Feb 14.
It has been suggested that screening interventions may be effective for suicide prevention. Few studies, however, have reported their effects on outcome measures, including death by suicide among middle-aged adults.
We used a quasi-experimental parallel cluster design with matched community-based intervention and control municipalities (total eligible population: 90 000) in Japan. At-risk residents within the intervention area were invited for universal depression screening and subsequent care/support. We compared changes in suicide incidence of adults aged 40-64 years for the 4-year pre- and post-implementation periods in the intervention group with the control group and the whole country. Incidence rate ratios (IRRs) of the outcomes were adjusted for age group, gender and interaction terms, using mixed-effects negative binomial regression models. Suicide rates among intervention and control subgroups were compared.
The screening procedure was offered to 52% of the intervention group, and 61% of those contacted responded over the implementation period. Suicide rates decreased more in the intervention group [IRR 0.57, 95% (CI) 0.41-0.78; F 1,36 = 12.52, p = 0.001] than the control group (IRR proportion 1.63, 95% CI 1.06-2.48; F 1,82 = 5.20, p = 0.025) or the whole country (IRR proportion 1.64, 95% CI 1.16-2.34; F 1,42 = 8.21, p = 0.006). Sensitivity analyses confirmed the results from the primary analysis. There were lower suicide rates among both respondents and non-respondents to the screening than in the control group during the implementation period.
Prevention efforts involved in the depression screening intervention were probably successful in reducing suicide rates.
有研究表明，筛查干预措施可能对预防自杀有效。然而，很少有研究报告其对包括中年成年人自杀死亡在内的结局指标的影响。
我们在日本使用了一种准实验平行群组设计，将基于社区的干预组和对照组（合格总人口：90000 人）进行匹配。邀请干预区域内的高危居民进行普遍的抑郁筛查，随后提供护理/支持。我们比较了干预组和对照组以及全国在实施前后 4 年期间 40-64 岁成年人自杀发生率的变化。使用混合效应负二项回归模型，根据年龄组、性别和交互项调整了结局的发病率比值比（IRR）。比较了干预组和对照组亚组的自杀率。
在实施期间，向干预组 52%的居民提供了筛查程序，而接触到的 61%的人做出了回应。干预组的自杀率下降更多[IRR 0.57，95%置信区间（CI）0.41-0.78；F 1,36 = 12.52，p = 0.001]，而对照组（IRR 比例 1.63，95% CI 1.06-2.48；F 1,82 = 5.20，p = 0.025）或全国（IRR 比例 1.64，95% CI 1.16-2.34；F 1,42 = 8.21，p = 0.006）。敏感性分析证实了主要分析的结果。在实施期间，与对照组相比，筛查的应答者和非应答者的自杀率都较低。
参与抑郁筛查干预的预防工作可能成功降低了自杀率。
