Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan.
Department of Neuropsychiatry, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
Psychogeriatrics. 2023 Sep;23(5):831-837. doi: 10.1111/psyg.13006. Epub 2023 Jul 13.
Suicidal ideation is closely related to severe suicidal behaviour and is an important predictor of suicide attempt and completion, including in older people. Older people tend to have many opportunities to be conscious of death, and may have vague suicidal ideation because of various loss experiences, even if they are not depressed. We hypothesised that suicidal ideation among older people might be a risk factor for later transition to depression. The present study aimed to clarify risk factors that predict the incidence of depression in older people 3 years post-baseline in a rural area of Japan, and to examine the subsequent course of depression among non-depressed older people with suicidal ideation.
In 2015 and 2018, survey questionnaires were mailed to residents aged 65 years and over living in a rural area in Japan. Participants were divided into a depression group and a non-depression group using 15-item Geriatric Depression Scale scores 3 years post-baseline. Logistic regression analysis was used to identify predictive factors of late-life depression 3 years post-baseline.
We received 597 valid responses, with a 3-year follow-up rate of 78.8%. Regarding suicidal ideation, 6.7% of non-depressed older people exhibited suicidal ideation at baseline. Of these, 9.8% exhibited depression after 3 years post-baseline. Logistic regression analysis indicated that development of late-life depression is significantly associated with suicidal ideation, being female, and poor health-related quality of life (HRQOL).
The results revealed that suicidal ideation, being female, and poor HRQOL were predictive factors of the development of late-life depression 3 years post-baseline in a rural area of Japan. These findings provide novel information regarding the transition to depression among community-dwelling older people who are not depressed but have suicidal ideation. Whereas suicidal ideation is considered to be a symptom of depression, the current results suggest that suicidal ideation may precede depression in some older people.
自杀意念与严重自杀行为密切相关，是自杀企图和完成的重要预测因素，包括老年人。老年人往往有很多机会意识到死亡，并且可能会因为各种失落的经历而产生模糊的自杀意念，即使他们没有抑郁。我们假设老年人的自杀意念可能是以后发展为抑郁的一个危险因素。本研究旨在阐明日本农村地区老年人在基线后 3 年内发生抑郁的预测因素，并研究有自杀意念但无抑郁的老年人随后的抑郁病程。
2015 年和 2018 年，向日本农村地区 65 岁及以上的居民邮寄了调查问卷。基线后 3 年，根据 15 项老年抑郁量表评分将参与者分为抑郁组和非抑郁组。采用逻辑回归分析识别基线后 3 年内发生迟发性老年抑郁的预测因素。
我们收到了 597 份有效回复，随访率为 78.8%。在基线时，6.7%的无抑郁老年人存在自杀意念。其中，9.8%的人在基线后 3 年内出现抑郁。逻辑回归分析表明，自杀意念、女性和较差的健康相关生活质量（HRQOL）与迟发性老年抑郁的发展显著相关。
研究结果表明，自杀意念、女性和较差的 HRQOL 是日本农村地区老年人在基线后 3 年内发生迟发性老年抑郁的预测因素。这些发现为社区居住的无抑郁但有自杀意念的老年人向抑郁的转变提供了新的信息。虽然自杀意念被认为是抑郁的症状，但目前的结果表明，在一些老年人中，自杀意念可能先于抑郁出现。
