***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Guided self-help programs for depression ( with associated therapist contact ) have been successfully delivered over the Internet . However , previous trials of pure self-help Internet programs for depression ( without therapist contact ) , including an earlier trial conducted by us , have failed to yield positive results . We hypothesized that methods to increase participant usage of the intervention , such as postcard or telephone reminders , might result in significant effects on depression . Objectives This paper presents a second r and omized trial of a pure self-help Internet site , ODIN ( Overcoming Depression on the InterNet ) , for adults with self-reported depression . We hypothesized that frequently reminded participants receiving the Internet program would report greater reduction in depression symptoms and greater improvements in mental and physical health functioning than a comparison group with usual treatment and no access to ODIN . Methods This was a three-arm r and omized control trial with a usual treatment control group and two ODIN intervention groups receiving reminders through postcards or brief telephone calls . The setting was a nonprofit health maintenance organization ( HMO ) . We mailed recruitment brochures by US post to two groups : adults ( n = 6030 ) who received depression medication or psychotherapy in the previous 30 days , and an age- and gender-matched group of adults ( n = 6021 ) who did not receive such services . At enrollment and at 5- , 10- and 16-weeks follow-up , participants were reminded by email ( and telephone , if nonresponsive ) to complete online versions of the Center for Epidemiological Studies Depression Scale ( CES-D ) and the Short Form 12 ( SF-12 ) . We also recorded participant HMO health care services utilization in the 12 months following study enrollment . Results Out of a recruitment pool of 12051 approached subjects , 255 persons accessed the Internet enrollment site , completed the online consent form , and were r and omized to one of the three groups : ( 1 ) treatment as usual control group without access to the ODIN website ( n = 100 ) , ( 2 ) ODIN program group with postcard reminders ( n = 75 ) , and ( 3 ) ODIN program group with telephone reminders ( n = 80 ) . Across all groups , follow-up completion rates were 64 % ( n = 164 ) at 5 weeks , 68 % ( n = 173 ) at 10 weeks , and 66 % ( n = 169 ) at 16 weeks . In an intention-to-treat analysis , intervention participants reported greater reductions in depression compared to the control group ( P = .03 ; effect size = 0.277 st and ard deviation units ) . A more pronounced effect was detected among participants who were more severely depressed at baseline ( P = .02 ; effect size = 0.537 st and ard deviation units ) . By the end of the study , 20 % more intervention participants moved from the disordered to normal range on the CES-D. We found no difference between the two intervention groups with different reminders in outcomes measures or in frequency of log-ons . We also found no significant intervention effects on the SF-12 or health care services . Conclusions In contrast to our earlier trial , in which participants were not reminded to use ODIN , in this trial we found a positive effect of the ODIN intervention compared to the control group . Future studies should address limitations of this trial , including relatively low enrollment and follow-up completion rates , and a restricted number of outcome measures . However , the low incremental costs of delivering this Internet program makes it feasible to offer this type of program to large population s with widespread Internet access AIMS To assess suicide risk associated with alcohol use disorder in elderly men and women , and to examine the role of social stressors in elderly suicides with and without alcohol use disorders . METHODS This retrospective case-control study included 85 suicide cases aged 65 years and above ( 46 men , 39 women ) and 153 r and omly selected population controls ( 84 men , 69 women ) .  Interviews were carried out with control persons and with informants for the suicide cases . Mental disorders were diagnosed in accordance to DSM-IV . RESULTS A history of alcohol dependence or misuse was observed in 35 % of the elderly men who died by suicide and in 18 % of the women . This disorder was uncommon among persons in the control group ( 2 % of the men and 1 % of the women ) . Alcohol use disorder remained an independent predictor of suicide risk in the regression models for both sexes . Among suicide cases , those with alcohol use disorders were younger and less likely to be suffering from severe physical illness ( 35 vs 63 % ) than those without this disorder . CONCLUSION Alcohol use disorder is associated with suicide in elderly men and women . Prevention programmes need to target this important subgroup OBJECTIVE The authors ' goal was to study the importance of different psychiatric disorders in relation to suicide in individuals 65 years old or older . METHOD The psychological autopsy approach was used to study 85 cases of suicide among subjects who were 65 years old or older ; 153 living comparison subjects from the same age group who were r and omly selected from the tax register were interviewed face-to-face . Retrospective axis I diagnoses were made according to DSM-IV on the basis of interview data and medical records . RESULTS Ninety-seven percent of the suicide victims fulfilled criteria for at least one DSM-IV axis I diagnosis , compared with 18 % of the living comparison subjects . Recurrent major depressive disorder was a very strong risk factor for suicide , as was substance use disorder . An elevated risk was also associated with minor depressive disorder , dysthymic disorder , psychotic disorder , single-episode major depressive disorder , and anxiety disorder . Comorbid axis I disorders were observed in 15 ( 38 % ) of the 39 elderly subjects with major depressive disorder who had committed suicide . CONCLUSIONS Although recurrent major depressive disorder was the mental disorder most strongly associated with suicide , the findings of this study suggest that elderly individuals who commit suicide represent a heterogeneous group with regard to mental disorders , implying a need for differentiated prevention strategies BACKGROUND Elderly persons ( > or = 65 years ) have the highest rate of suicide ; still , little is known about the occurrence , course , and responsivity of suicidal ideation during treatment of depression in late life and how suicidality affects treatment response . METHODS This study was undertaken to determine ( 1 ) how suicidal ideation changes during short-term depression treatment and ( 2 ) whether treatment response differs among 3 groups of patients based on their levels of suicidality at baseline and during treatment ( those with a recent suicide attempt or current suicidal ideation [ high-risk group ; n = 46 ] , those with recurrent thoughts of death [ moderate-risk group ; n = 143 ] , or those with no suicide attempt , suicidal ideation , or thoughts of death [ low-risk group ; n = 206 ] ) . This is a secondary analysis of pooled data from 3 treatment studies of late-life major depression . Participants were 395 elderly persons with a current major depressive episode , treated as in patients or out patients under protocol ized conditions with paroxetine hydrochloride or nortriptyline hydrochloride , with or without interpersonal psychotherapy . Changes in suicidal ideation over time , rate of responses , and time to response in each group were compared . RESULTS Suicidal ideation decreased rapidly early in the course of treatment , with more gradual change thereafter . At the beginning of treatment , 77.5 % of the patients reported suicidal ideation , thoughts of death , or feelings that life is empty . After 12 weeks of treatment , suicidal ideation had resolved in all treated patients ; 4.6 % still reported thoughts of death . However , 6-week ( P = .001 ) and 12-week ( P = .02 ) rates of response were significantly lower in high-risk patients than in low- and moderate-risk patients . High- and moderate-risk patients needed a significantly ( P<.001 ) longer time to respond than low-risk patients ( median time to response , 6 and 5 vs 3 weeks ) . CONCLUSIONS While suicidal ideation resolves rapidly , the resolution of thoughts about death is more gradual . Suicidal elderly persons with depression require special attention during depression treatment because they have a lower response rate and need a longer time to respond CONTEXT Few depressed older adults receive effective treatment in primary care setting s. OBJECTIVE To determine the effectiveness of the Improving Mood-Promoting Access to Collaborative Treatment ( IMPACT ) collaborative care management program for late-life depression .  DESIGN R and omized controlled trial with recruitment from July 1999 to August 2001 . SETTING Eighteen primary care clinics from 8 health care organizations in 5 states . PARTICIPANTS A total of 1801 patients aged 60 years or older with major depression ( 17 % ) , dysthymic disorder ( 30 % ) , or both ( 53 % ) . INTERVENTION Patients were r and omly assigned to the IMPACT intervention ( n = 906 ) or to usual care ( n = 895 ) . Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care expert and who offered education , care management , and support of antidepressant management by the patient 's primary care physician or a brief psychotherapy for depression , Problem Solving Treatment in Primary Care . MAIN OUTCOME MEASURES Assessment s at baseline and at 3 , 6 , and 12 months for depression , depression treatments , satisfaction with care , functional impairment , and quality of life . RESULTS At 12 months , 45 % of intervention patients had a 50 % or greater reduction in depressive symptoms from baseline compared with 19 % of usual care participants ( odds ratio [ OR ] , 3.45 ; 95 % confidence interval [ CI ] , 2.71 - 4.38 ; P<.001 ) . Intervention patients also experienced greater rates of depression treatment ( OR , 2.98 ; 95 % CI , 2.34 - 3.79 ; P<.001 ) , more satisfaction with depression care ( OR , 3.38 ; 95 % CI , 2.66 - 4.30 ; P<.001 ) , lower depression severity ( range , 0 - 4 ; between-group difference , -0.4 ; 95 % CI , -0.46 to -0.33 ; P<.001 ) , less functional impairment ( range , 0 - 10 ; between-group difference , -0.91 ; 95 % CI , -1.19 to -0.64 ; P<.001 ) , and greater quality of life ( range , 0 - 10 ; between-group difference , 0.56 ; 95 % CI , 0.32 - 0.79 ; P<.001 ) than participants assigned to the usual care group . CONCLUSION The IMPACT collaborative care model appears to be feasible and significantly more effective than usual care for depression in a wide range of primary care practice Background : Seniors aged 75 and above have the highest suicide rates of all age groups in most industrialized countries . However , research concerning risk factors for suicide in the old elderly is sparse . Objective : The purpose was to determine predictors for suicide among the old elderly ( 75 + ) . Data concerning the young elderly ( 65–74 years ) are shown for comparison . Methods : 85 consecutive cases of suicide that occurred in western Sweden and 153 control persons with the same sex , birth year , and zip code as the suicide cases were r and omly selected from the tax register . The old elderly group included 38 cases and 71 controls ; the young elderly group included 47 cases and 82 controls . Data concerning the suicide cases were collected through interviews with close informants ; controls were interviewed in person . The interview included questions on past-year life events and mental and physical health . Medical records were review ed for cases and controls . The Cumulative Illness Rating Scale – Geriatrics was used to rate illness burden . Results : Family conflict , serious physical illness , loneliness , and both major and minor depressions were associated with suicide in the 75 + group . Economic problems predicted suicide in the younger but not in the older elderly . Old elderly suicide victims with depression ( major or minor ) were less likely to have received depression treatment than their younger counterparts . Conclusions : Better recognition and treatment of both major and minor depression should constitute an important target for the prevention of suicide in the old elderly . Intervention studies with large numbers of senior participants are sorely needed BACKGROUND The World Health Organisation SUicide PREvention-Multisite Intervention Study on Suicide ( WHO/SUPRE-MISS ) investigates suicidal behaviours in a number of nations . The feasibility of the different branches of the study was piloted in Queensl and , Australia . This paper reports on the community survey component . METHOD  R and omised telephone interviews ( n=11,572 ) were conducted to determine the lifetime prevalence of suicidal ideation and attempts , and corresponding socio-demographic and cultural characteristics . A subsequent postal survey sent to consenting individuals reporting lifetime suicide ideation/attempt ( n=1311 ) was meant to ascertain the possible development of that behaviour along a continuum , psychiatric and psychological factors , suicidal transmission , help-seeking , and service utilisation . RESULTS Suicide ideation and attempts prevailed in individuals aged 25 - 44 years , and declined with increasing age . In most cases , suicidal experience/s did not develop over time with progressively increasing severity . Knowledge of someone else 's suicidal behaviour significantly increased the risk of similar acts . Almost half of the subjects contended with their suicidal crisis by over-drinking alcohol , and 1/3 through other forms of reckless behaviour . The ratio completed/attempted suicide was 1 to 23 . 
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RESULTS Most studies were centered on the reduction of risk factors ( depression screening  and treatment  , and decreasing  isolation ) , but when gender was considered , programs were mostly efficient for women .
CONCLUSIONS Innovative strategies should improve resilience and positive aging , engage family and community gatekeepers , use telecommunications to reach vulnerable older adult , and evaluate the effects of means restriction and physicians education on elderly suicide