Community-Based Participatory Social Support Intervention in Preventing Suicide of Rural Older Adults: A Clustered Randomized Trial

Suicide in rural older adults is a serious social and medical problem. Due to older adults' concrete difficulties and lack of mental health resources in rural areas, many proven late-life suicide prevention approaches are not feasible in rural areas. Social support intervention via various methods has been proven to be effective in preventing suicide.  Enhancing social support could be potentially feasible in rural areas. But the effectiveness of group social support intervention still lacks evidence. There is a need to evaluate social support intervention with a rigorous study design. Moreover, most interventions are derived from research in developed countries. Culturally sensitive preventive strategies are in pressing need outside of high-income settings.

Thus, we proposed to conduct a community-based participatory social support intervention following the community-based participatory research (CBPR) framework to prevent suicide among Chinese rural elderly and use a clustered randomized trial to examine the effectiveness. In this trial, suicide ideation is the primary outcome. Secondary outcomes include suicide attempt and suicide death. We hypothesize that the proposed intervention can effectively decrease 12-month incidence rates of suicidal ideation compared to the health education control group. The effect of the intervention on preventing suicide ideation is partially mediated by enhancing social support and reducing loneliness.

We plan to recruit all eligible older adults from enrolled villages of three provinces from Central, East, and West China (12 villages and 2700 subjects). The villages will be randomly assigned to either intervention (CPSS + health education) or control (health education only) groups. 1350 older adults in the six intervention villages will be provided with CPSS intervention and health education for one year. CPSS intervention is a combination of universal and selected preventive strategies. For all older residents, group activities will be provided. For those who live alone or are left-behind, one-to-one home visits will be arranged. One CBPR team for each intervention village. CBPR teams will be engaged in all aspects of research, especially the development and implementation of the intervention. Subjects in villages of the control group will only receive four health education sessions. Individual information will be collected by face-to-face interview at baseline and follow-ups scheduled at 4-month, 8-month, and 12-month after the initiation of intervention.

With the rigorous study design, we can directly evaluate the efficacy of widely used social support interventions in preventing suicide in rural areas and explore the potential mechanisms. The proposed CPSS intervention under the CBPR framework would be more cooperative, feasible, and acceptable for rural older adults. If the proposed intervention is proven effective, the next steps are to summarize the intervention strategies and further seek opportunities for continuous support to conduct a large-scale study.