Objective: To estimate the frequencies of suicidal ideation, depressive symptoms and depressive disorder and the effects of depressive symptoms and disorder on suicidal ideation in an elderly Japanese population. Design: Population-based study. Materials and Methods: Two-step surveys were conducted in a residential district in Sendai city in northeastern Japan. All residents over 70 years of age (2,730) were informed for the Comprehensive Geriatric Assessment. Of these, 1,198 participated, and 1,179 who gave informed consent were interviewed between July and August 2002 using questionnaires concerning various sociodemographic and health risk variables. Depressive symptoms were assessed with the Geriatric Depression Scale (GDS). Recurring thoughts of death and thoughts of suicide were evaluated with the following two questions: "Do you think a lot about death?" and "Do you feel so low that you think about committing suicide?" Subsequently, all subjects having a score of 14 and more on the GDS (GDS14+) were requested to undergo further examination and, if responding positively, were evaluated using the DSM-IV criteria for major depressive episode and anxiety symptoms. Statistical analyses were performed using the chi-squared test and a multiple logistic regression model. P-values below 0.05 were considered significant. Results: Within the population of subjects who provided sufficient data (1,170), the frequencies of recurring thoughts of death and thoughts of suicide were estimated at 38.3% (95%CI=35.6-41.1) and 4.4% (95%CI=3.3-5.6), respectively. The frequencies of depressive symptoms (GDS11+ and GDS14+) and major depression were estimated at 32.9% (95%CI=30.2-35.6), 19.6% (95%CI=17.3-21.8) and 1.8% (95%CI=1.0-2.5). Multiple sociodemographic and health risk variables were significantly related to both suicidal ideations in univariate analyses, but only depressive symptoms (GDS14+, OR=4.2), insomnia (OR=1.6), history of hypertension (OR=1.4) and history of cataracta (OR=1.4) were significantly related to recurring thoughts of death and only depressive symptoms (OR=34.5) were significantly related to thoughts of suicide. Major depression (OR=8.2) and anxiety symptoms (OR=2.9) were significantly related to suicidal ideation in the elderly with GDS 14+. Conclusion: Thoughts of suicide and major depression may be relatively rare, while recurring thoughts of death and depressive symptoms may be relatively frequent in an elderly Japanese population. Depressive symptoms have a strong predictive value for suicidal ideation in an elderly general population, and major depression and anxiety symptoms have a significant predictive value in the elderly with depressive symptoms.
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