• Wen Jie Sun, Lin Xu, Wai Man Chan, Tai Hing Lam, and C Mary Schooling.
• Department of Community Medicine, School of Public Health, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
• Soc Psychiatry Psychiatr Epidemiol. 2012 Apr 1; 47 (4): 505-14.

ObjectiveTo examine dose-response associations between depressive symptoms and suicide and modification effects of sex, age and health status in older Chinese.MethodsWe used the Chinese version of the 15-item Geriatric Depression Scale (GDS) to measure depressive symptoms (GDS score ≥ 8) and Cox regression to examine association with suicide mortality in a population-based cohort of 55,946 individuals, aged 65 years or above, enrolled from July 1998 to December 2000 at one of 18 Elderly Health Centres of Hong Kong Department of Health. The cohort was followed up for suicide mortality till 31 March 2009 (mean follow-up 8.7 years).ResultsDepressive symptoms were associated with suicide in men [hazard ratio (HR) 2.03, 95% confidence interval (CI) 0.96-4.29] and women (HR = 2.36, 95% CI 1.31-4.24) after adjusting for age, education, monthly expenditure, smoking, alcohol drinking, physical activity, body mass index, health status, and self-rated health. There was no threshold for GDS score and suicide in either sex. Age, sex and health status did not modify the association.ConclusionsDepressive symptoms predict higher suicide risk in older Chinese in a dose-response pattern. These associations were not attenuated by adjustment for health status, suggesting that depressive symptoms in older people are likely to be an independent causal factor for suicide. The GDS score showed no threshold in predicting suicide risk, suggesting that older people with low GDS scores deserve further attention and those with very high scores need urgent intervention.

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