De Leo et al's study (Reference De Leo, Buono and Dwyer2002) confirmed that a TeleHelp—TeleCheck service reduced suicides among elderly service users in northern Italy. The authors comment that the highest suicide rates in almost every country (including Hong Kong and China) are among those aged more than 75 years. The literature suggests that considerable numbers of suicides among the elderly are due to depression. Conwell (Reference Conwell, Schneider, Reynolds and Lebowitz1996) reported that 60-75% of those who committed suicide had a diagnosis of depression among patients aged ≥ 75 years. This is particularly relevant in elderly people with chronic physical conditions such as stroke and Parkinson's disease. My colleagues and I (Reference Tsang, Cheung and LakTsang et al, 2002) recently hypothesised, after a comprehensive literature review, that depression in elderly people with chronic physical illnesses results from disability and a reduction in psychosocial resources. If depression is left untreated, suicide may be a consequence.

In view of the high prevalence rates and seriousness of the consequences of the co-occurrence of depression and physical illnesses in later life, various approaches have been developed to counteract the effect of depressed mood. De Leo et al's study reports one such approach, using a telephone helpline and emergency response service. We (Reference Tsang, Cheung and LakTsang et al, 2002) proposed qigong as a psychosocial intervention to help elderly people with depression and chronic physical illnesses. Qigong has a long history with diverse schools in China. It can be seen as a method to regulate the body, breathing and mind. In China, health and longevity are believed to be determined by strength, balance and cultivation of the three treasures: jing (essence), qi (energy) and shen (spirit). Qigong focuses on these three treasures to represent a holistic view of the human being. ‘Eight-section brocades’ is one of the many forms of health-promoting Chinese qigong.

A pilot study (Reference Tsang, Cheung and LakTsang et al, 2002) using a group of eight out-patients (two males and six females) suffering from chronic physical illnesses was conducted in Hong Kong. The mean age of the participants was 68 years (s.d.=10.7). Rating on the Geriatric Depression Scale showed that the participants had a certain degree of depressed mood, even though they did not carry a clinical diagnosis of depression. The participants received 1 h practice of qigong, twice a week, under the supervision of a qualified practitioner. As all participants had satisfactory standing balance, the standing-style eight-section brocades were used as the intervention protocol. The participants were asked to practise it daily (under the supervision of their relatives, who were also trained by the practitioner) for at least 30 min (in addition to the twice-weekly supervised practice in the hospital). The feedback from the participants showed that six of them (75%) felt better in terms of their psychosocial functioning after the 12-week programme. Before 6 weeks of practice, only three (37.5%), however, reported improvement. At an early stage, the feedback centred around physical function such as movement of the limbs and activities of daily living. At a later stage, the feedback then shifted more to psychological aspects. The improvement included feeling more relaxed, more comfortable, better sleep and being more optimistic. All of these reported improvements in psychosocial functioning are indicative of less depressed mood and improved quality of life. This preliminary report showed that qigong is promising as an alternative intervention for elderly people with depression and with chronic physical illness to improve their biopsycho-social health and possibly reduce their suicide rate. More systematic evaluation with larger samples and a longer period of intervention is now underway in Hong Kong.