Biopsychosocial factors associated with depression in the elderly: A systematic literature review

Yanti Harjono Hadiwiardjo; Rita Damayanti

doi:10.12688/f1000research.121710.2

Home Browse Biopsychosocial factors associated with depression in the elderly:...

ALL Metrics

Views

Downloads

Get PDF

Get XML

Export

▬

✚

Systematic Review

Revised

Biopsychosocial factors associated with depression in the elderly: A systematic literature review

[version 2; peer review: 1 approved, 1 approved with reservations]

Yanti Harjono Hadiwiardjo ^1,2, Rita Damayanti¹

PUBLISHED 14 Feb 2024

Author details Author details

¹ Medical Faculty, University Pembangunan Nasional Veteran Jakarta, Jakarta, 12450, Indonesia
² Faculty of Public Health, University of Indonesia, Depok, 10430, Indonesia

Yanti Harjono Hadiwiardjo
Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Writing – Original Draft Preparation

Rita Damayanti
Roles: Validation, Writing – Original Draft Preparation, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Research Synergy Foundation gateway.

This article is included in the Sociology of Health gateway.

Abstract

Background

One of the most common mental illnesses worldwide and that has significant negative effects on well-being and physical health, is depression. Many factors that affect the occurrence of depression are biopsychosocial. Elderly people have high risk factors for depression. This study aims to review and find a gap in current evidence of biopsychosocial factors affecting depression in the elderly.

Methods

We conducted an advanced search on PubMed database between October and November 2021. We screened the bibliographies of the articles from the database search using a set of inclusion criteria: studies with quantitative design; elderly population sample; exploration of at least one biopsychosocial factor; depression as the outcome or dependent variable; written in English; and published between 2011 and 2021.

Results

We found 54 studies that met the inclusion criteria. Of these, five papers discussed biopsychosocial factors, 18 discussed biological and psychological/social factors, five discussed psychosocial factors, and the rest of the studies discussed one component of biopsychosocial factors. Biological factors influencing elderly depression include being female, having health problems or low health status, older age, genetics, brain structure, and biomarkers, taking certain drugs, and lack of or inability to carry out daily activities. Psychosocial factors include lack of social support, low education level, financial problems, single/unmarried, lack of contact with family/friends, living alone, low self-perceived health, stressful life events, loneliness, and losing hobbies. From the literature search, it was also found that there are biopsychosocial factors that have not been studied and are expected to be able to make references for future research. From this literature review, we found gaps in the availability of evidence about biopsychosocial factors that require further research.

Conclusions

Knowing the biopsychosocial factors that affect them can help to prevent depression in the elderly.

Keywords

elderly, depression, biopsychosocial, systematic review

Corresponding author: Yanti Harjono Hadiwiardjo

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2024 Harjono Hadiwiardjo Y and Damayanti R. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Harjono Hadiwiardjo Y and Damayanti R. Biopsychosocial factors associated with depression in the elderly: A systematic literature review [version 2; peer review: 1 approved, 1 approved with reservations]. F1000Research 2024, 11:1068 (https://doi.org/10.12688/f1000research.121710.2) First published: 20 Sep 2022, 11:1068 (https://doi.org/10.12688/f1000research.121710.1) Latest published: 14 Feb 2024, 11:1068 (https://doi.org/10.12688/f1000research.121710.2)

Revised Amendments from Version 1

In this revised article, we have made notable improvements, primarily focusing on enhancing the level of synthesis and providing a more comprehensive understanding of the subject matter through the introduction of the JBI score.

See the authors' detailed response to the review by Rahul Shidhaye
See the authors' detailed response to the review by Acharaporn Seeherunwong

Introduction

Many developing countries are experiencing rapid growth in their older populations (Isdijoso et al., 2020). The elderly are predicted to become 25% of the global population, or 74 million people by 2050 (Isdijoso et al., 2020). “Demographic Profiles and Implications of the Top 10 Countries with the Highest Number of People Aged 65+ in 2020” delves into a significant global demographic shift observed in the year 2020 with calculations conducted by ESCAP based on the United Nations’ Department of Economic and Social Affairs, Population Division (2019). The data reveals the following key insights China emerged as the country with the largest elderly population, with a staggering 172,262 individuals aged 65 and above, representing 46.05% of its total population, India follows closely, with 90,720 seniors, constituting 24.25% of the population, Japan recorded 35,916 elderly citizens, making up 9.60% of its populace, The Russian Federation reported 22,633 seniors, accounting for 6.05% of its total population, Indonesia had 17,219 elderly individuals, representing 4.57% of the population, Pakistan's elderly population reached 9,606, making up 2.56% of its total, Thailand reported 9,044 seniors, equivalent to 2.41% of its population, Bangladesh recorded 8,608 elderly citizens, constituting 2.30% of its populace and Korea reported 8,096 elderly individuals, representing 2.16% of the total population.

The older population in the UK is projected to grow, with people aged 65 and over making up 24% of the population by 2043 (17.4 million people) (Lewis, 2021). The proportion of the population aged 75 and over is projected to rise from 8% in 2018 to 13% in 2043, while the proportion aged 85 and over is projected to rise from 2% to 4% (Lewis, 2021). This study aims to provide a comprehensive understanding of the demographic trends in these nations and their potential implications for various aspects of society.

The elderly can have specific physical and mental health issues, including decreased mobility and increased frailty, with some of them losing their independence due to such issues. In the USA, 20% of adults aged 55 and over suffered from a mental health disorder at the beginning of the millennium (World Federation for Mental Health, 2013).

In older people, mental health problems can affect their ability to carry out the basic activities of daily living, reducing their independence, autonomy, and quality of life. A common mental health problem that occurs in older people is depression (Carayanni, Stylianopoulou, Koulierakis, Babatsikou, & Koutis, 2012). Depression is related to distress and suffering and can cause impairment in mental, physical, and social functioning (World Federation for Mental Health, 2013).

Depression is one of the most common mental illnesses worldwide, with serious consequences for one’s well-being and physical health (Thipprakmas, 2021). The elderly may be particularly impacted by depression due to high levels of risk factors including illnesses, social isolation, and lack of emotional support. Depression is considered as a clinical syndrome. Low mood, anhedonia, and decreased energy levels are the three basic symptoms of depression, according to the International Classification of Diseases (ICD) diagnostic classification systems (Pocklington, 2017; Thipprakmas, 2021).

Other clinical findings which were listed include loss of confidence, impaired concentration, disturbances in sleep, suicidal ideation, and changes in appetite. If the above symptoms are present for at least in two weeks, then a diagnosis of depression can be established (Pocklington, 2017).

Major depression presents with all three core symptoms according to ICD criteria, and at least five other symptoms also present (Pocklington, 2017).

Depression consists of two types: early-onset and late-onset depression. In individuals over the age of 65, there is a new diagnosis for depression, namely late-onset depression in which more than half of cases of depression in older adults are newly emerged i.e., the person has never experienced depression. Late-type depression is related to structural changes in the brain, cognitive deficits, and vascular risk factors (Pocklington, 2017).

There are two principal points of view commonly used to explain depression, the bio-medical perspective, and the psychosocial perspective. These perspectives oftentimes conflict with each other. The biomedical perspective asserts that disturbances in the functioning of the brain manifest as psychopathological symptoms, whereas the psychosocial perspective maintains that mental issues are caused by disruptive life experiences (Garcia-Toro & Aguirre, 2007).

Frequently, this twofold viewpoint influences certainly the different affirmations that are made about mental problems, albeit expressly it is progressively perceived that organic and psychosocial angles are generally involved, interfacing in a complex way. Indeed, this is the explanation for why the term “biopsychosocial model” has flourished (Garcia-Toro & Aguirre, 2007).

Depression in older adults is related to cognitive, physical, and social functional impairment (Pocklington, 2017). It is also related to a variety of psychological, biological, and social factors causing it (Alexopoulos & Kelly, 2009; Blazer, 2003). It has a variety of biopsychosocial risk variables that interact to predict the onset of depressive symptoms in a single person. However, it is unclear how much each risk factor contributes to the onset of depressive symptoms. A greater understanding of the individual contributions of biological, psychological, and social risk factors can have a big impact on the adoption of preventive actions to lower the population's risk of depression (Diniz, 2020). Several studies have investigated several biological, psychological, and social factors associated with depression in the elderly, so this systematic review aims to review and synthesize current evidence of biopsychosocial factors affecting depression in the elderly and can also contribute to future research on factors that affect depression which can eventually contribute to the decrease in the incidence of depression in the elderly.

Objectives

This systematic review aims to examine and find gaps or current evidence regarding biopsychosocial factors that influence depression in the elderly. The review is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. See Reporting guidelines (Hadiwiardjo and Damayanti, 2022c) for the completed checklist.

Methods

We conducted an advanced search on PubMed database using a set of keywords which consisted of population sample keywords (elderly OR geriatric OR late life OR older) combined with independent variable keywords (psychological factors OR social factors OR biological factors OR biopsychosocial), and the outcome (depression). After obtaining these search results, we downloaded the records into our reference manager software Mendeley and removed any duplication. From those search results, we gathered 728 records of studies. The data search on PubMed was conducted in October - November 2021. The last data search was carried out on November 18, 2021.

We applied a two-step screening process that involved two reviewers. Both reviewers worked independently, and any disagreements were resolved through discussion. First, we screened the title and abstract of the bibliography using a set of eligibility criteria. The inclusion criteria were original studies with a quantitative design, that were peer-reviewed, with elderly people (over 60 years) as the population sample, and that explored at least one biopsychosocial factor, with depression as the outcome or dependent variable. Articles also needed to be written in English and published between 2011 and 2021 to be included.

Articles also needed to be written in English and published between 2011 and 2021 to be included. The selection of the last 10 years for research is driven by the need to focus on recent and relevant information. This time frame allows us to capture the most up-to-date developments, trends, and insights in the field. The requirement for articles to be written in English and published between 2011 and 2021 further ensures that the sources are contemporary and provide valuable insights within a reasonable time span. This approach enhances the accuracy and relevance of the information gathered for the study.

Studies published as review articles, qualitative studies, brief reports, letters to the editor or editorial comments, and working papers published in a language other than English were all excluded. In the first stage of screening, we removed studies before 2011 and collected 470 records to be screened. After further screening, 99 studies are eligible for the next screening process.

Further screening of 99 eligible studies was conducted with Population, Intervention, Comparison Outcome and Study (PICOS) criteria where if not appropriate it would be excluded. We retrieved the full text of the potentially relevant studies and conducted a second screening process. The selection process can be seen in the flowchart presented in Figure 1, also available in Extended data (Hadiwiardjo and Damayanti, 2022b). The eligible studies were extracted for the design of the study, country of origin, number of samples, the instrument used to measure depression, and factors associated with depression. That information was extracted from each included study into a standardized spreadsheet and checked by two reviewers. The two reviewers worked independently and if there were any disagreements, these were resolved by discussion between the two reviewers. Any ambiguous material from an included paper was clarified after contacting the respective authors, or else only the available data was analyzed. Microsoft Excel was used to organize the identified papers. The results were described narratively and helped to identify the gaps in the literature that can be filled by future studies.

These studies included quantitative synthesis. After the two-step screening process was conducted, 54 papers were reviewed and extracted. We first described the number of articles based on the country of origin of the article, the type of research design, and the year. Next, we extracted the data based on the research design, the number of samples, the measuring instruments used to measure depression and factors related to depression. After that, the purpose of the content analysis was to identify and assess the primary research streams, reporting in an objective manner on the various domains while also addressing future research prospects and problems.

The 54 papers were then reassessed using the Joanna Briggs Institute (JBI) checklist which is a tool for critical appraisal of a paper and from the Critical Appraisal results it was obtained that 53 papers were high quality paper and JBI 1 paper was low quality paper as seen at Table 2. The last articles obtained are all used in this systematic review. We access this JBI checklist at https://jbi.global/critical-appraisal-tools.

The risk of bias can occur if the quality of the data from the reviewed papers is mostly of low quality. To determine the quality of the data, the JBI critical appraisal tool is used. This critical appraisal is carried out by two reviewers and if there is a disagreement, it will be discussed.

Results

A total of 54 studies met the inclusion criteria after the full-text screening. Previously there were papers that were eventually excluded because there were discrepancies in terms of population and outcome (Pollock & Berge, 2018). The full list of the 54 studies are available in Underlying data (Hadiwiardjo and Damayanti, 2022a). The process using the PRISMA flowchart is shown in Figure 1. The majority of the 54 studies came from the United States, followed by China, as seen in Figure 2.

Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.

Figure 2. Origin of included studies.

Twenty-two papers used a cohort study design, two studies used a combination of cohort and a cross-sectional design, and 24 studies used cross-sectional design. We also included experimental and case-control studies. An illustration of the number of types of study designs used in all studies can be seen in Figure 3. Figure 3 shows that most studies use cross-sectional research designs which are then followed by cohort research designs.

Figure 3. Design of included studies.

The graph of publication shows the number of studies during the last eleven years from 2011 to 2021 as shown in Figure 4. The total number of publications collected from PubMed database are shown in Figure 4. In 2012 there were nine studies related to biopsychosocial factors related to depression in the elderly but from 2013 to 2020 there were less. In 2021 there was an increase in the number of studies related to depression in the elderly. This can be attributed to an increase in the elderly population globally which was also followed by an increase in the incidence of depression, so it was necessary to conduct more research.

Figure 4. Year of publication for included studies.

An overview of critical appraisal using JBI Checklist shows that there are 53 papers with high quality paper and one paper with low quality as illustrated in Figure 5.

Figure 5. Critical appraisal based on Joanna Briggs Institute (JBI) checklist.

The data extraction of each study can be seen in Table 1. Five papers discussed biopsychosocial factors, 18 papers discussed biological and psychological/social factors, five papers discussed psychosocial factors, and the rest of the studies discussed one component of biopsychosocial factors associated with depression. Now we outline the results for the biological, psychological, and social factors of depression (examples of determinants and consequences are shown below).

Table 1. Data extracted from eligible studies.

No.	Author	Method	Country	Sample size	Instrument	Tools for Quality Assessment	Biological	Psychological	Social
1	(Nicolosi et al., 2011)	Cross-sectional	Brazil	303	Geriatric Depression Scale (GDS)	JBI for Cross-sectional Study	Health problems	Poor self-perceived health	Lower education level
2	(Gureje et al., 2011)	Cohort	Nigeria	1408	Major Depressive Disorder based on DSM-IV Axis I Disorders	JBI for Cohort Study	Female	-	Rural residence and poor social network
3	(Piboon et al., 2012)	Cross-Sectional	Thailand	317	Thai Geriatric Depression Scale	JBI for Cross-sectional Study	Female, functional ability	Stressful life events, loneliness, problem-focused and emotional focused coping strategy	Lack of social support, income
4	(Arve et al., 2012)	Cohort	Finland	276	Zung depression scale	JBI for Cohort Study	Negative health status	Feeling sick, Loneliness	-
5	(Leggett et al., 2012)	Cross-Sectional	Vietnam	600	Center for Epidemiologic Studies- Depression Scale	JBI for Cross-sectional Study	Female, Pain, ADL assistance need	-	Low education level, low economic status. and lack of emotional support
6	(Petkus, Gum, & Wetherell, 2012)	Cross-Sectional	US	142	Brief Symptom Inventory-18 (BSI-18), Structured Clinical Interview for DSM-IV Diagnosis (SCID)	JBI for Cross-sectional Study	-	Thought suppression	-
7	(Popescu et al., 2012)	Cross-Sectional	Canada	315	Geriatric Depression Scale Short Form (GDS-15)	JBI for Cross-sectional Study	Age-related macular degeneration (AMD), glaucoma, or Fuchs corneal dystrophy	-	-
8	(Carayanni et al., 2012)	Cross-Sectional	Greece	360	15-item geriatric depression scale (GDS)	JBI for Cross-sectional Study	Female, multimorbidity	-	Unmarried, not meeting friends, childless, economic problems, not caring for a grandchild, lack of social participation
9	(Davison et al., 2012)	Case-Control	Australia	100	Major Depressive Disorder based on DSM-IV Axis I Disorders, 15-item version of the Geriatric Depression Scale	JBI for Case- Control Study	Lower physical health and higher disability levels	Purpose in life, and autonomy	Time spent in the facility, environmental mastery
10	(Chan et al., 2012)	Cohort	China	2630	15-item version of the Geriatric Depression Scale	JBI for Cohort Study	-	Losing hobby, stressful events	Losing pets, economic problems
11	(Pusswald et al., 2012)	Case-Control	Vienna	110	Geriatric Depression Scale	JBI for Case- Control Study	Parkinson disease	-	-
12	(Glei et al., 2013)	Cohort	Taiwan	4049	Center for Epidemiologic Studies Depression scale (CES-D)	JBI for Cohort Study	Female	-	Live far from family, widow, losing a child
13	(Sjöberg et al., 2013)	Cohort	Sweden	891	DSM-IV-TR	JBI for Cohort Study	-	Loneliness, losing hobby	Lack of contact with family, unmarried/widowed, low education level
14	(Sadler et al., 2013)	Cross-sectional	Australia	171	Centre for Epidemiologic Studies Depression Scale (CESD)	JBI for Cross-sectional Study	Insomnia	Dysfunctional beliefs about sleep and hopelessness	-
15	(Horita et al., 2013)	Cross-sectional	Japan	84	Geriatric Depression Scale Short Form (GDS-15)	JBI for Cross-sectional Study	Low BMI, dyspnea, exercise capacity, Oxygen level	-	-
16	(Lewin, Jöbges, & Werheid, 2013)	Cross-sectional	Germany	105	Geriatric Depression Scale Short Form (GDS-15)	JBI for Cross-sectional Study	-	Self-efficacy, history of pre-stroke depression	Lack of social support
17	(Meesters et al., 2014)	Cross-sectional	Dutch	99	Centre for Epidemiologic Studies Depression Scale (CESD)	JBI for Cross-sectional Study	Higher functional limitation, more chronic physical disorder	-	Lack of social support
18	(Choi et al., 2014)	Cross-sectional and Cohort	United States	5414	Patient Health Questionnaire-2 (PHQ-2)	JBI for Cross-sectional and Cohort study	Cardiovascular disease	-	-
19	(Wild et al., 2014)	Cohort	Germany	3124	Patient Health Questionnaire (PHQ-8) depression scale	JBI for Cohort Study	-	-	Health care needs
20	(Nadimpalli, James, Yu, Cothran, & Barnes, 2015)	Cross-sectional and Cohort	United States	487	Centre for Epidemiologic Studies Depression Scale (CESD)	JBI for Cross-sectional and Cohort Study	-	-	Discrimination
21	(Rzewuska et al., 2015)	Cohort	UK	501	Hospital Anxiety and Depression Scale (HADS)	JBI for Cohort Study	Female, older age, pain, low activity level	-	Lack of support, routine work
22	(Park & Yu, 2015)	Experimental	South Korea	24	Beck Depression Inventory (BDI)	JBI for Experimental Study	Nordic walking (negative)	-	-
23	(Sanders et al., 2015)	Cohort	Netherland	1528	Centre for Epidemiologic Studies Depression Scale (CESD)	JBI for Cohort Study	Pain	-	-
24	(Klinedinst et al., 2015)	Cross-sectional	US	114	Useful Depression Screening Tool (UDST)	JBI for Cross-sectional Study	Single nucleotide polymorphisms (SNPs) in the NTRK3 gene, pain, physical activity	Fear of falling	-
25	(Ylli et al., 2016)	Cross-sectional	Canada, Albania, Colombia, Brazil	1995	Centre for Epidemiologic Studies Depression Scale (CESD)	JBI for Cross-sectional Study	Multiple chronic conditions, and poor physical performance	-	Low education and insufficient income
26	(Jovanova et al., 2016)	Cohort	Netherland	1823	Centre for Epidemiologic Studies Depression Scale (CESD)	JBI for Cohort Study	Recognized myocardial infarction (RMI)	-	-
27	(Wang et al., 2016)	Cohort	China	608	Post stroke depression based on ICD-10 criteria	JBI for Cohort Study	Insomnia, neurological deficit, low Barthel Index	-	-
28	(Manaf et al., 2016)	Cross Sectional	Malaysia	230	Depression, Anxiety, and Stress Scale (DASS-21)	JBI for Cross-sectional Study	Poor health status	-	Single, living with family
29	(Kato, Zweig, Schechter, Barzilai, & Atzmon, 2016)	Cross Sectional	US	357	Geriatric Depression Scale Short Form (GDS-15)	JBI for Cross-sectional Study	-	Attitudes toward life, self-rated health	High level of care
30	(Brinda et al., 2016)	cross-sectional	China, Ghana, India, Mexico, South Africa, Russia	34159	International Classification of Diseases-10th revision Diagnostic Criteria for Research (ICD-10 DCR)	JBI for Cross-sectional Study	Female, angina, stroke	Bereavement	Illiteracy, poverty, indebtedness, past informal-sector occupation, pension support and health insurance
31	(Kuroda et al., 2017)	Cohort	Japan	438	Basic Checklist	JBI for Cohort Study	Female, gender, age, diabetes, cognitive disorder	-	-
32	(Matthieu, Lawrence, & Robertson-Blackmore, 2017)	Cohort	US	346	Patient Health Questionnaire-2 (PHQ-2)	JBI for Cohort Study	-	-	Social activities
33	(Ferrand et al., 2018)	Cross Sectional	French	402	30-items Geriatric Depression Scale	JBI for Cross-sectional Study	High fish-fruit- vegetable compared to ready meals	-	-
34	(Rippon & Steptoe, 2018)	Cohort	England	9886	Centre for Epidemiologic Studies Depression Scale (CESD)	JBI for Cohort Study	Older age	-	-
35	(Olsen et al., 2018)	Cohort	Norway	7068	Hospital Anxiety and Depression Scale (HADS)	JBI for Cohort Study	Age, cardiovascular morbidity	-	Low education level
36	(Odlum et al., 2018)	Cross Sectional	US	3377	Centre for Epidemiologic Studies Depression Scale (CESD)	JBI for Cross-sectional Study	Female, incontinence	-	Demanding spouse, lack of time with spouse
37	(Wang et al., 2018)	Cross Sectional	China	47	Depression based on ICD-10 criteria	JBI for Cross-sectional Study	White matter hyperintensity	-	Religious beliefs, family harmony
38	(Kobylańska et al., 2018)	Quasi-experimental	Poland	120	30-items Geriatric Depression Scale	JBI for Quasi-experimental Study	Mobility and independence	-	Education level
39	(Akila et al., 2019)	Cross Sectional	India	510	Geriatric Depression Scale Short Form (GDS-15)	JBI for Cross-sectional Study	-	Perceived mental health	Rural area, illiteracy, social support, financial problems
40	(Sakurai et al., 2019)	Cohort	Japan	400	Zung Self-Rating Depression Scale	JBI for Cohort Study	-	-	Living alone, social support
41	(Laird et al., 2019)	Cross Sectional	US	113	Montgomery-Åsberg Depression Rating Scale (MADRS)	JBI for Cross-sectional Study	Lower Grey Matter Volume (GMV) bilaterally in the insula, lower Total Intracranial Volume (TIV)	-	-
42	(Misawa & Kondo, 2019)	Cohort	Japan	3464	Geriatric Depression Scale Short Form (GDS-15)	JBI for Cohort Study	Female	Life events, sense of coherence, hobby, self-rated health	Meeting with friends
43	(Bui, 2020)	Cohort	US	2200	Centre for Epidemiologic Studies Depression Scale (CESD)	JBI for Cohort Study	-	-	Social support, density
44	(Stringa et al., 2020)	Cohort	Netherland	2276	Centre for Epidemiologic Studies Depression Scale (CESD)	JBI for Cohort Study	Higher PRS-D (genetic)	-	Single, network
45	(Bond et al., 2020)	Cohort	Ireland	291	Glasgow Depression Scale for people with a Learning Disability (GDS-LD)	JBI for Cohort Study	Mood stabilisers, anxiolytic medications, hypnotic/sedative medications	Had trouble sleeping, difficulties in carrying out ADLs. difficulties in keeping up enthusiasm to get things done, feeling lonely, aggression	-
46	(Hong et al., 2021)	Cohort	US	12998	Health and Retirement Study (HRS) Psychosocial and Lifestyle Questionnaire	JBI for Cohort Study	-	Sense of control	-
47	(Woods et al., 2021)	Experimental	US	189	Hamilton Depression Rating Scale (HAM-D)	JBI for Experimental Study	-	-	Unmarried, lack of social support, interpersonal problems
48	(Rhee et al., 2021)	Cross Sectional	South Korea	8522	Geriatric Depression Scale Short Form (GDS-15)	JBI for Cross-sectional Study	Incident of fall	-	Unmarried, living alone, lack of network
49	(Cordes, Zwingmann, Rudisch, Voelcker-Rehage, & Wollesen, 2021)	Experimental	Germany	52	Centre for Epidemiologic Studies Depression Scale (CESD)	JBI for Experimental Study	Exercise	-	-
50	(Chen et al., 2021)	Cross Sectional Cohort	China	1764	Geriatric Depression Scale Short Form (GDS-15)	JBI for Cross-sectional Study	-	-	Social frailty
51	(Koo et al., 2021)	Cohort	South Korea	3011	Centre for Epidemiologic Studies Depression Scale (CESD)	JBI for Cohort Study	-	-	Live alone and the periods of living alone
52	(Derry et al., 2021)	Cross Sectional	US	161	Centre for Epidemiologic Studies Depression Scale (CESD)	JBI for Cross-sectional Study	Higher composite cytokine levels	-	-
53	(Paralikas et al., 2021)	Cross Sectional	Greece	230	General Health Questionnaire 28 (GHQ-28)	JBI for Cross-sectional Study	-	-	Unmarried, single, divorced, widowed
54	(Karczewska & Młynarska, 2021)	Cohort	Poland	158	Hospital Anxiety and Depression Scale (HADS)	JBI for Cohort Study	ICD discharged	-	-

Table 2. JBI Score.

No	Title	Author	Year	Score	Status
1	A psychological pathway from insomnia to depression among older adults	Paul Sadler, Suzanne McLaren dan Megan Jenkins	2013	81.82%	High quality paper
2	The role of biopsychosocial factors in the rehabilitation process of individuals with a stroke	Marzena Kobylańska, Joanna Kowalskab, Jolanta Neusteina, Justyna Mazurekc, Bartosz Wójcika, Małgorzata Bełzaa, MichałCichosza and Joanna Szczepańska-Gierachab	2018	81.82%	High quality paper
3	A Causal Model of Depression Among Older Adults in Chon Buri Province, Thailand	Kanchana Piboon, RN, MNS, Rarcharneeporn Subgranon, PhD, Pornpat Hegudomsub, PhD, Pairatana Wongnam, PhD, Bonnie Louise Callen, PhD	2020	75.00%	High quality paper
4	Anxiety Symptoms are Associated with Smaller Insular and Orbitofrontal Cortex Volumes in Late-life Depression	Kelsey T. Laird, Ph.D., Prabha Siddarth, Ph.D., Beatrix Krause, Ph.D., Lisa Kilpatrick, Ph.D., Michaela Milillo,B.S., Yesenia Aguilar, B.A., Katherine L. Narr, Ph.D. .D., Helen Lavretsky, MD	2020	100.00%	High quality paper
5	Association of post stroke depression with social factors, insomnia, and neurological status in Chinese elderly population	Lingru Wang, Yong Tao, Yang Chen, Hua Wang, Huadong Zhou, Xiaoyan Fu	2016	100.00%	High quality paper
6	Biopsychosocial factors associated with depression and anxiety in older adults with intellectual disability: results of the wave 3 Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing	L. Bond, R. Carroll, N. Mulryan, M. O’Dwyer, J. O’Connell, R. Monaghan, F. Sheerin, P. McCallion, M. McCarron	2020	75.00%	High quality paper
7	Biopsychosocial factors related to depression in aged care residents	Tanya E. Davison n, MaritaP.McCabe, Tess Knight, David Mellor	2012	62.50%	High quality paper
8	Clinically relevant depression in old age: an international study with populations from Canada, Latin America and Eastern Europe	Alban Ylli, Malgorzata Miszkurka, Susan P. Phillips, Jack Guralnik, Nandini Deshpande, Maria Victoria Zunzunegui	2016	87.50%	High quality paper
9	Comparative assessment of psychosocial status of elderly in urban and rural areas, Karnataka, India	Govindarajan Venguidesvarane Akila, Banavaram Anniappan Arvind, Arjunan Isaac	2019	75.00%	High quality paper
10	Depression in Japanese Patients With Chronic Obstructive Pulmonary Disease	Nobuyuki Horita MD, Takeshi Kaneko MD PhD, Masaharu Shinkai MD PhD, Makiko Yomota MD, Satoshi Morita MD PhD, Bruce K Rubin MEngr MD MBA PhD FAARC, and Yoshiaki Ishigatsubo MD PhD	2013	75.00%	High quality paper
11	Dietary patterns in French home-living older adults	C. Ferrand, C. Féart, G. Martinent, C. Albinet, N. André, M. Audiffrene	2017	75.00%	High quality paper
12	Factors Influencing the Prevalence of Mental Health Problems among Malay Elderly Residing in a Rural Community	M. Rizal Abdul Manaf, Madihah Mustafa, Mohd Rizam Abdul Rahman, Khairul Hazdi Yusof, Noor Azah Abd Aziz	2016	62.50%	High quality paper
13	Links Between Inflammation, Mood, and Physical Function Among Older Adults With HIV	Heather M. Derry, PhD, Carrie D. Johnston, MD, Chelsie O. Burchett, MA, Mark Brennan-Ing, PhD, Stephen Karpiak, PhD, Yuan-Shan Zhu, MB, PhD, Eugenia L. Siegler, MD, and Marshall J. Glesby, MD, PhD	2021	100.00%	High quality paper
14	Physical and Mental Health Level of the Elderly Living in Central Greece	Theodosios Paralikas, Malliarou Maria, Theofanidis Dimitrios, Barmpouta Christina, Chachamidis Nikolaos, Fountouki Antigoni, Tsioumanis Georgios, Kotrotsiou Stiliani	2021	75.00%	High quality paper
15	Positive attitude toward life, emotional expression, self-rated health, and depressive symptoms among centenarians and near-centenarians	Kaori Katoa, Richard Zweigb, Clyde B. Schechterc, Nir Barzilaid & Gil Atzmon	2015	75.00%	High quality paper
16	Prevalence and correlates of depressive symptoms in a catchment-area based cohort of older community-living schizophrenia patients	Paul D. Meesters, Hannie C. Comijs, Caroline M. Sonnenberg, Adriaan W. Hoogendoorn, Lieuwe de Haan, Piet Eikelenboom, Aartjan T.F. Beekman, Max L. Stek	2014	75.00%	High quality paper
17	Sex differences in depression among older adults: are older women more vulnerable than men in social risk factors? The case of open care centers for older people in Greece	Vilelmine Carayanni, Christina Stylianopoulou, George Koulierakis, Fotoula Babatsikou, Charilaos Koutis	2012	100.00%	High quality paper
18	Social frailty and longitudinal risk of depressive symptoms in a Chinese population: the Rugao Longevity and Aging Study	ZeKun CHEN, XiaoYan JIANG, GuoPing SHI, Yong WANG, XueFeng CHU, ZhengDong WANG, JiangHong GUO, YinSheng ZHU, Jie CHEN, XiaoFeng WANG and ZhiJun BAO	2021	75.00%	High quality paper
19	The “Sense of Coherence” and the coping capacity of patients with Parkinson disease	Gisela Pusswald, Martina Fleck, Johann Lehrner, Dietrich Haubenberger, Germain Weber and Eduard Auff	2012	75.00%	High quality paper
20	The association between discrimination and depressive symptoms among older african americans: the role of psychological and social factors	Sarah B. Nadimpalli, Bryan D. James, Lei Yu, Fawn Cothran, Lisa L. Barnes	2013	75.00%	High quality paper
21	The influence of social factors and health on depressive symptoms and worry: A study of older Vietnamese adults	Amanda Leggett, Steven H. Zarit, Ngoc H. Nguyen, Chuong N. Hoang, Ha T. Nguyen	2014	75.00%	High quality paper
22	The Interplay of Genetics, Behavior, and Pain with Depressive Symptoms in the Elderly	N. Jennifer Klinedinst, PhD, MPH, RN, Barbara Resnick, PhD, CRNP, FAAN, FAANP, Laura M. Yerges-Armstrong, PhD, and Susan G. Dorsey, PhD, RN, FAAN	2015	75.00%	High quality paper
23	The moderating role of social factors in the relationship between an incident of fall and depressive symptoms: a study with a national sample of older adults in South Korea	Min-Kyoung Rhee, Yuri Jang, Soo Young Kim & Sujie Chang	2020	75.00%	High quality paper
24	The Study of White Matter Hyperintensity (WMH) and Factors Related to Geriatric Late-Onset Depression	Jinghua WANG, Wei LI, Ling YUE, Bo HONG, Na AN, Guanjun LI, Shifu XIAO	2018	75.00%	High quality paper
25	The relationship between social network characteristics and depressive symptoms among older adults in the United States: differentiating between network structure and network function	Bonnie Khanh Ha BUI	2021	75.00%	High quality paper
26	Thought suppression is associated with psychological distress in homebound older adults	Andrew J. Petkus, M.A., Amber Gum, Ph.D., and Julie Loebach Wetherell, Ph.D.	2011	75.00%	High quality paper
27	Depressive symptoms in old age: relations among sociodemographic and self-reported health variables	Gloria Teixeira Nicolosi, Deusivania Vieira da Silva Falcão, Samila Satler Tavares Batistoni, Andrea Lopes, Meire Cachioni, Anita Liberalesso Neri and Monica Sanches Yassuda	2011	75.00%	High quality paper
28	Explaining the Relationship between Three Eye Diseases and Depressive Symptoms in Older Adults	Mihaela L. Popescu, Hélène Boisjoly, Heidi Schmaltz, Marie-Jeanne Kergoat,Jacqueline Rousseau, Solmaz Moghadaszadeh, Fawzia Djafari, and Ellen E. Freeman	2012	75.00%	High quality paper
29	Health, Social, and Economic Variables Associated with Depression among Older People in Low and Middle Income Countries: WHO Study on Global AGEing and Adult Health	Ethel M. Brinda, Anto P. Rajkumar, Jǿrn Attermann, Ulf G. Gerdtham, Ulrika Enemark, Kuruthukulangara S. Jacob	2016	75.00%	High quality paper
30	Late-Life Depression and Cardiovascular Disease Burden: Examination of Reciprocal Relationship	Namkee G. Choi, Ph.D., Jinseok Kim, Ph.D., C. Nathan Marti, Ph.D., and G. John Chen, M.D., Ph.D.	2015	75.00%	High quality paper
31	Association between life events and change in depressive symptoms in HongKong Chinese elderly	Dicken Chan, Anthony Kwok, Jason Leung, Kay Yuen, Dicky Choy, Ping Chung Leung	2011	100.00%	High quality paper
32	Cardiac rehabilitation and symptoms of anxiety and depression after percutaneous coronary intervention	Siv JS Olsen, Henrik Schirmer, Tom Wilsgaard, Kaare H Bønaa and Tove A Hanssen	2018	54.55%	High quality paper
33	Significance and Costs of Complex Biopsychosocial Health Care Needs in Elderly People: Results of a Population-Based Study	Beate Wild, Ph.D., Dirk Heider, Ph.D., Imad Maatouk, M.D., Joris Slaets, M.D., Hans-Helmut König, M.D., Dorothea Niehoff, M.D., Kai-Uwe Saum, M.D., Hermann Brenner, M.D., Wolfgang Söllner, M.D., and Wolfgang Herzog, M.D.	2014	45.45%	low quality paper
34	Depressive symptoms among older people: a 15-year follow-up	Seija Arve, Sini Eloranta, Suvi Rovio, Hannu Isoaho, Matti Viitanen and Aapo Lehtonen	2012	54.55%	High quality paper
35	Incidence and risk factors for latelife depression in the Ibadan Study of Ageing	O. Gureje, B. Oladeji and T. Abiona	2011	72.73%	High quality paper
36	Occurrence of depressive tendency and associated social factors among elderly persons forced by the Great East Japan Earthquake and nuclear disaster to live as long-term evacuees	Yujiro Kuroda, Hajime Iwasa, Aya Goto, Kazuki Yoshida, Kumiko Matsuda, Yumi Iwamitsu, Seiji Yasumura	2017	72.73%	High quality paper
37	One-year trajectories of depression and anxiety symptoms in older patients presenting in general practice with musculoskeletal pain: A latent class growth analysis	Magdalena Rzewuska, Christian D Mallen, Victoria Y Strauss, John Belcher, George Peat	2015	54.55%	High quality paper
38	Poor Social Network, Not Living Alone, Is Associated With Incidence of Adverse Health Outcomes in Older Adults	Ryota Sakurai PT, PhD, Hisashi Kawai PhD, Hiroyuki Suzuki, Hunkyung Kim PhD, Yutaka Watanabe DDS, PhD, Hirohiko Hirano DDS, PhD, Kazushige Ihara MD, PhD,Shuichi Obuchi PT, PhD, Yoshinori Fujiwara MD, PhD	2019	81.82%	High quality paper
39	Sex differences in trajectories of depressive symptoms among older Taiwanese: the contribution of selected stressors and social factors	Dana A. Glei, Noreen Goldman, I-Wen Liu, Maxine Weinstein	2014	72.73%	High quality paper
40	Social factors relating to depression among older people in Japan: analysis of longitudinal panel data from the AGES project	Jimpei Misawa & Katsunori Kondo	2018	72.73%	High quality paper
41	A 13-year prospective cohort study on the effects of aging and frailty on the depression–pain relationship in older adults	Joost B. Sanders, Hannie C. Comijs, Marijke A. Bremmer, Dorly J. H. Deeg and Aartjan T. F. Beekman	2014	81.82%	High quality paper
42	The effects of Nordic and general walking on depression disorder patients’ depression, sleep, and body composition	Seong Doo Park, PhD, PT, Seong Hun Yu, PhD, PT	2015	63.64%	High quality paper
43	The impact of a civic service program on biopsychosocial outcomes of post 9/11 U.S. military veterans	Monica M. Matthieu, Karen A. Lawrence, Emma Robertson-Blackmore	2017	54.55%	High quality paper
44	The Influence of Antiarrhythmic Device Intervention on Biopsychosocial Functioning and Anxiety in Patients with an Implanted Cardioverter Defibrillator	Olimpia Karczewska and Agnieszka Młynarska	2021	54.55%	High quality paper
45	The long-term risk of recognized and unrecognized myocardial infarction for depression in older men	O. Jovanova, A. I. Luik, M. J. G. Leening, R. Noordam, N. Aarts, A. Hofman, O. H. Franco,A. Dehghan and H. Tiemeier	2017	81.82%	High quality paper
46	Secular changes in the relation between social factors and depression: A study of two birth cohorts of Swedish septuagenarians followed for 5 years	Linnea Sjöberg, SvanteÖstling, HannaFalk, ValterSundh, MargdaWaern,Ingmar Skoog	2013	81.82%	High quality paper
47	Genetic Liability for Depression, Social Factors and Their Interaction Effect in Depressive Symptoms and Depression Over Time in Older Adults	Najada Stringa, M.Sc., Yuri Milaneschi, Ph.D., Natasja M. van Schoor, Ph.D., Bianca Suanet, Ph.D., Sven van der Lee, Ph.D., Henne Holstege, Ph.D., Marcel J.T. Reinders, Ph.D., Aartjan T.F. Beekman, Ph.D., Martijn Huisman, Ph.D.	2020	72.73%	High quality paper
48	Is the relationship between subjective age, depressive symptoms and activities of daily living bidirectional?	Isla Rippon, Andrew Steptoe	2018	81.82%	High quality paper
49	Multicomponent exercise to improve motor functions, cognition and well-being for nursing home residents who are unable to walk – A randomized controlled trial	Thomas Cordes, Katharina Zwingmann, Julian Rudisch, Claudia Voelcker-Rehage, Bettina Wollesen	2021	72.73%	High quality paper
50	Perceived Social Support and Interpersonal Functioning as Predictors of Treatment Response Among Depressed Older Adults	Alexandra Woods, Ph.D., Nili Solomonov, Ph.D., Brian Liles, M.S., Arielle Guillod, B.S., Helen C. Kales, M.D., Jo Anne Sirey, Ph.D.	2020	72.73%	High quality paper
51	Relationship between the living-alone period and depressive symptoms among the elderly	Jun Hyuk Koo, Noorhee Son, Ki-Bong Yoo	2021	54.55%	High quality paper
52	The influence of self-efficacy, pre-stroke depression and perceived social support on selfreported depressive symptoms during stroke rehabilitation	A. Lewin, M. Jöbges, K. Werheid	2013	63.64%	High quality paper
53	The positive influence of sense of control on physical, behavioral, and psychosocial health in older adults: An outcome-wide approach	Joanna H. Hong, Margie E. Lachman, Susan T. Charles, Ying Chen, Caitlyn L. Wilson, Julia S. Nakamura, Tyler J. VanderWeele, Eric S. Kim	2021	81.82%	High quality paper
54	Correlates and aetiological factors associated with hedonic well-being among an ageing population of US men and women: secondary data analysis of a national survey	Michelle Odlum, Nicole Davis, Otis Owens, Michael Preston, Russell Brewer, Danielle Black	2018	87.50%	High quality paper

Biological factor

Biological factors were frequently found to influence geriatric depression. Such factors mentioned included gender (Brinda et al., 2016; Carayanni et al., 2012; Glei, Goldman, Liu, & Weinstein, 2013; Gureje, Oladeji, & Abiona, 2011; Kuroda et al., 2017; Leggett, Zarit, Nguyen, Hoang, & Nguyen, 2012; Misawa & Kondo, 2019; Odlum et al., 2018; Piboon, Subgranon, Hengudomsub, Wongnam, & Louise Callen, 2012; Rzewuska, Mallen, Strauss, Belcher, & Peat, 2015), health problems (Arve et al., 2012; Carayanni et al., 2012; Choi, Kim, Marti, & Chen, 2014; Horita et al., 2013; Jovanova et al., 2016; Karczewska & Młynarska, 2021; Leggett et al., 2012; Meesters et al., 2014; Nicolosi et al., 2011; Olsen, Schirmer, Wilsgaard, Bønaa, & Hanssen, 2018; Popescu et al., 2012; Pusswald et al., 2012; Rhee, Jang, Kim, & Chang, 2021; Rzewuska et al., 2015; Sadler, McLaren, & Jenkins, 2013; Sanders, Comijs, Bremmer, Deeg, & Beekman, 2015; Wang et al., 2016; Ylli et al., 2016), older age (Olsen et al., 2018; Rippon & Steptoe, 2018; Rzewuska et al., 2015), genetics (Klinedinst, Resnick, Yerges-Armstrong, & Dorsey, 2015; Stringa et al., 2020), brain anatomical structure (Laird et al., 2019; Wang et al., 2018), cytokine level (Derry et al., 2021), taking drugs (Bond et al., 2020), low activity (Davison, McCabe, Knight, & Mellor, 2012; Kobylańska et al., 2019; Leggett et al., 2012; Meesters et al., 2014; Piboon et al., 2012; Rzewuska et al., 2015), diet (Ferrand et al., 2018) and BMI (body mass index) status (Horita et al., 2013). One study has found that women showed a significant positive association with geriatric depression (Brinda et al., 2016). Other literature found that the prevalence of depression is higher in women than in men (Piboon et al., 2012; Ylli et al., 2016). In total, ten different kinds of studies have shown that women were more likely to have depression or higher depressive symptoms than men, indicating a relationship between gender and older age depression.

Eighteen studies in this review have found that the presence of depression is associated with health problems including pain, degenerative diseases, multimorbidity, poor respiratory indicators, cardiovascular morbidity, insomnia, and a falling incident. One of the literature obtained a p<0.001, showing the significant relationship between health problems and depression (Nicolosi et al., 2011).

There were three studies in this review that have found that older age is associated with depression (Olsen et al., 2018; Rippon & Steptoe, 2018; Rzewuska et al., 2015). One of the literature showed that age of ≥70 year associated with depression disorder (Rzewuska et al., 2015). Another study showed with increase in the subject age, greater depressive symptoms were present (Rippon & Steptoe, 2018). Other factors mentioned concerning older age depression were genetic, brain anatomical structure, and cytokine levels (Derry et al., 2021; Klinedinst et al., 2015; Laird et al., 2019; Stringa et al., 2020; Wang et al., 2018).

One study, namely research conducted by Bond, revealed that taking drugs such as mood stabilizers, anxiolytics, and hypnotic or sedatives were associated with depression (Bond et al., 2020). They obtained a p=0.001 for mood stabilizers, p<0.001 for anxiolytic, and p=0.009 for hypnotic or sedatives, suggesting a significant relationship for this drug-taking factor.

Low activity or low activity tolerance and disability were also found to have a positive relationship with older age depression (Davison et al., 2012; Kobylańska et al., 2018; Leggett et al., 2012; Meesters et al., 2014; Piboon et al., 2012; Rzewuska et al., 2015). Lastly, diet and BMI status were explored as possible biological factors (Ferrand et al., 2018; Horita et al., 2013).

Psychological factors

The results of this research showed that seventeen studies discussed psychological factors that influence the occurrence of depression in the elderly. These factors were low self-perceived health, stressful life events, loneliness, and losing hobby/interest/purpose in life.

According to research conducted by Nicolosi et al. (2011), poorer self-perceived health leads to more depressive symptoms (Nicolosi et al., 2011).

One of three studies on stress in life, namely the study conducted by Chan (2012), found that there is a relationship between the number of stressful events in life and the incidence of depression (p=0.0020), with the number of stressful events associated with an increased risk of having depression (Chan et al., 2012). In both men and women, life events predicted the odds of depression among older people (Misawa & Kondo, 2019).

Social factor

In this literature study, there were 20 studies that discussed social factors that affect the occurrence of depression in the elderly. The social factors were social/emotional support, education level, financial problem, marital status, lack of contact with family/friends, living alone, dependency, environmental and religious beliefs. According to three from 12 that examined social support, social support was associated with depression. Research conducted by Bui (2020) found that there was a reciprocal relationship between social support and depressive symptoms, with p<0.001 (Bui, 2020). Meanwhile, research by Piboon (2012) found that there was a positive relationship between social support and depression (Piboon et al., 2012). Chen et al. found in their research that social frailty may be a predictor of depression among community-dwelling older adults (Chen et al., 2021).

This study found seven papers that discussed the relationship between education levels and the incidence of depression. In research conducted by Brinda (2016), it was found that low education correlated with geriatric depression (Brinda et al., 2016). Other studies have also found that less educated people have higher depressive symptoms (Akila, Arvind, & Isaac, 2019; Kobylańska et al., 2018; Leggett et al., 2012; Nicolosi et al., 2011; Olsen et al., 2018; Sjöberg et al., 2013).

Discussion

Biological factors

From one study, it was found that female gender was significantly associated with depression where p<0.001 was found (Piboon et al., 2012). Gender differences in depression can potentially be explained genetically, where genetic studies have found that female twins with a history of depression in the family were more likely to develop depression, and according to the psychological perspective, men and women have different personality features, which could explain the gender variations in depression. A study showed that females are more nurturing, non-aggressive, modest, and reliant than males, and they are more likely to have a relationship-oriented disposition (Piboon et al., 2012).

Individuals who had a chronic disease or health problems, particularly related to the musculoskeletal system such as arthritis and osteoporosis, are likely to had a weakened sense of self-efficacy, which can cause functional impairment and their presence has been associated with depression (Nicolosi et al., 2011). Health problems like pain were a predictive of depressive symptoms (Leggett et al., 2012). Some other studies showed that once pain and depression occurred, they will remain associated (Sanders et al., 2015). People with comorbidities are more likely to suffer from depression, indicating that it is another risk factor (Carayanni et al., 2012).

Psychological factors

According to research conducted by Bond et al. (2020), there is a significant relationship between loneliness and the occurrence of depression, where p<0.05 (Bond et al., 2020). Piboon (2012) found that loneliness had a significantly positive impact on depression, with an obtained p<0.001. Chan et al. also found that loss of hobbies is related to an increased incidence of depression (Chan et al., 2012).

Loneliness had a significantly positive relationship and was a predictor of depression among older adults because they are more likely to experience losses and changes in later life, so those that may feel lonely are more likely to suffer from depression than younger adults who do not feel lonely (Piboon et al., 2012).

Social factors

Education was the key indicator of social risk for depression. Individuals with lower education tend to feel more uncertain about the future and on a higher poverty level which makes greater prevalence of depression (Nicolosi et al., 2011). Individuals with lower education and income may have less access to health services, putting them at higher risk of getting depressive symptoms (Nicolosi et al., 2011).

Financial problems or poverty were also found to be factors that influence the incidence of depression. In this study we found seven papers that discusses financial problems or poverty as factors that influence the occurrence of depression. Brinda (2016) showed that poverty had a positive association with depression in the elderly (Brinda et al., 2016). Other literature studies have suggested that a significant lack of income is associated with the prevalence of depression (Ylli et al., 2016), furthermore showing that income has a negative effect on depression (Piboon et al., 2012). Income also had an indirect effect on depression in older adults. Some studies reported that elderly people living alone are single, divorced or lost a partner where they then unknowingly suffer from financial burdens and look at their health status negatively (Koo, Son, & Yoo, 2021). It is also reported that elderly people who are reluctant to live alone are prone to depression (Koo et al., 2021).

Eight literature studies discussed the relationship between marital status and (Koo et al., 2021) depression. According to Manaf (2016), marital status was a factor that was significantly associated with depression where they obtained a p=0.00l. Single elderly people experienced depression three times more often compared to elderly who are married (Manaf, Mustafa, Rahman, Yusof, & Aziz, 2016). Other literature showed that single/divorced/widowed people had more depressive symptoms than those who are married (Paralikas et al., 2021; Sjöberg et al., 2013).

In this study, we found that people with poor social networks, especially those lacking contact with friends, had an elevated risk of an incident of depression (Gureje et al., 2011). The frequency of meetings with friends predicted reduced odds of depression in older men (Misawa & Kondo, 2019).

It was also found that living alone is a risk factor associated with depression, where p<0.001 was obtained (Carayanni et al., 2012). Additionally, Living with an unmarried son was linked to a higher risk of depression than living with a married son and daughter-in-law (Glei et al., 2013). A study conducted by Koo (2021) also stated that those living alone are at higher risk of suffering from depression compared to those living with others (Koo et al., 2021). Lastly we found one study that stated that religious beliefs were associated with depression (Wang et al., 2018).

The risk of bias in this systematic review is that depression is assessed as all depression that occurs in the elderly, whether they have a chronic disease and not. In this literature review, based on the JBI checklist, high-quality papers were obtained.

Limitations

The limitation of the results of this systematic literature review is that most papers do not clearly identify the confounding factor. Therefore, we discuss the results narratively in order to provide the big picture of the topic.

Conclusions

The results confirmed that biopsychosocial factors were correlated with depression within a population of older individuals. Depression is a clinical condition that requires a holistic approach with biopsychosocial factors. From the results of this literature search, it was also found that there are biopsychosocial factors that have not been studied and are expected to be able to make references for future research. As for the variables that have not been discussed before such as in biological factors are the weakening that occurs in the elderly and psychological factors are a history of previous mental status and coping style. Understanding the biopsychosocial factors influencing them is paramount in developing the management programs to tackle depression in the elderly.

Data availability

Underlying data

Figshare: Data Extraction_Depression in Elderly from 54 research papers.csv. https://doi.org/10.6084/m9.figshare.19661373.v1 (Hadiwiardjo and Damayanti, 2022a).

This project contains the following underlying data:

- Data Extraction_Depression in Elderly from 54 research papers.csv.

Extended data

Figshare: Prisma flowchart depression in Elderly. https://doi.org/10.6084/m9.figshare.19991789.v1 (Hadiwiardjo and Damayanti, 2022b).

This project contains the following extended data:

- Prisma search figure_Depression in Elderly.jpg (PRISMA flowchart).

Reporting guidelines

Figshare: PRISMA checklist for ‘Biopsychosocial factors associated with depression in the elderly: A systematic literature review’. https://doi.org/10.6084/m9.figshare.20152346.v1 (Hadiwiardjo and Damayanti, 2022c).

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Acknowledgements

The author would like to thank the faculty members at the University of Indonesia and University of Pembangunan Veteran Jakarta for their support and providing a good research environment. Furthermore, ‘thank you’ to the Research Synergy Foundation for the recommendations and support in making this research more successful.

References

Akila GV, Arvind BA, Isaac A: Comparative assessment of psychosocial status of elderly in urban and rural areas, Karnataka, India. J. Family Med. Prim. Care. 2019.
Alexopoulos GS, Kelly RE: Research advances in geriatric depression. World Psychiatry. 2009; 8(3): 140–149. PubMed Abstract | Publisher Full Text
Arve S, Eloranta S, Rovio S, et al.: Depressive symptoms among older people: A 15-year follow-up. Aging Clin. Exp. Res. 2012; 24(5): 501–508. Publisher Full Text
Blazer DG: Depression in late life: Review and commentary. J. Gerontol. A Biol. Sci. Med. Sci. 2003; 58(3): 249–265. PubMed Abstract | Publisher Full Text
Bond L, Carroll R, Mulryan N, et al.: Biopsychosocial factors associated with depression and anxiety in older adults with intellectual disability: results of the wave 3 Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing. J. Intellect. Disabil. Res. 2020; 64(5): 368–380. Publisher Full Text
Brinda EM, Rajkumar AP, Attermann J, et al.: Health, Social, and Economic Variables Associated with Depression Among Older People in Low and Middle Income Countries: World Health Organization Study on Global AGEing and Adult Health. Am. J. Geriatr. Psychiatr. 2016; 24): 1196–1208. Elsevier Inc. Publisher Full Text
Bui BKH: The relationship between social network characteristics and depressive symptoms among older adults in the United States: differentiating between network structure and network function. Psychogeriatrics. 2020; 20(4): 458–468. Publisher Full Text
Carayanni V, Stylianopoulou C, Koulierakis G, et al.: Sex differences in depression among older adults: Are older women more vulnerable than men in social risk factors? The case of open care centers for older people in Greece. Eur. J. Ageing. 2012; 9(2): 177–186. PubMed Abstract | Publisher Full Text
Chan D, Kwok A, Leung J, et al.: Association between life events and change in depressive symptoms in Hong Kong Chinese elderly. J. Affect. Disord. 2012; 136(3): 963–970. Publisher Full Text
Chen Z, Jiang X, Shi G, et al.: Social frailty and longitudinal risk of depressive symptoms in a Chinese population: the Rugao Longevity and Aging Study. Psychogeriatrics: The Official Journal of the Japanese Psychogeriatric Society. 2021; 21(4): 483–490. Publisher Full Text
Chen ZK, Jiang XY, Shi GP, et al.: Social frailty and longitudinal risk of depressive symptoms in a Chinese population: the Rugao Longevity and Aging Study. Psychogeriatrics. 2021; 21(4): 483–490. PubMed Abstract | Publisher Full Text
Choi NG, Kim J, Marti CN, et al.: Late-life depression and cardiovascular disease burden: Examination of reciprocal relationship. Am. J. Geriatr. Psychiatr. 2014; 22(12): 1522–1529. Publisher Full Text
Cordes T, Zwingmann K, Rudisch J, et al.: Multicomponent exercise to improve motor functions, cognition and well-being for nursing home residents who are unable to walk - A randomized controlled trial. Exp. Gerontol. 2021; 153: 111484. PubMed Abstract | Publisher Full Text
Davison TE, McCabe MP, Knight T, et al.: Biopsychosocial factors related to depression in aged care residents. J. Affect. Disord. 2012; 142(1–3): 290–296. PubMed Abstract | Publisher Full Text
Derry HM, Johnston CD, Burchett CO, et al.: Links Between Inflammation, Mood, and Physical Function Among Older Adults With HIV. The Journals of Gerontology: Series B. 2021; 77: 50–60. PubMed Abstract | Publisher Full Text
Diniz BS: The Biopsychosocial Liability for Late-Life Depression. Am. J. Geriatr. Psychiatr. 2020; 28(8): 856–858. PubMed Abstract | Publisher Full Text
Ferrand C, Féart C, Martinent G, et al.: Dietary patterns in French home-living older adults: Results from the PRAUSE study. Arch. Gerontol. Geriatr. 2018; 70: 180–185. Publisher Full Text
Garcia-Toro M, Aguirre I: Biopsychosocial model in Depression revisited. Med. Hypotheses. 2007; 68(3): 683–691. PubMed Abstract | Publisher Full Text
Glei DA, Goldman N, Liu IW, et al.: Sex differences in trajectories of depressive symptoms among older Taiwanese: the contribution of selected stressors and social factors. Aging Ment. Health. 2013; 17(6): 773–783. PubMed Abstract | Publisher Full Text
Gureje O, Oladeji B, Abiona T: Incidence and risk factors for late-life depression in the Ibadan Study of Ageing. Psychol. Med. 2011; 41(9): 1897–1906. PubMed Abstract | Publisher Full Text
Hadiwiardjo YH, Damayanti R: Data Extraction_Depression in Elderly from 54 research papers.csv. figshare. Dataset.2022a. Publisher Full Text
Hadiwiardjo YH, Damayanti R: Prisma flowchart depression in Elderly. figshare. Figure.2022b. Publisher Full Text
Hadiwiardjo YH, Damayanti R: Prisma Checklist Depression in Elderly. figshare. Journal Contribution. 2022c. Publisher Full Text
Hong JH, Lachman ME, Charles ST, et al.: The positive influence of sense of control on physical, behavioral, and psychosocial health in older adults: An outcome-wide approach. Prev. Med. 2021; 149(May): 106612. PubMed Abstract | Publisher Full Text
Horita N, Kaneko T, Shinkai M, et al.: Depression in Japanese patients with chronic obstructive pulmonary disease: A cross-sectional study. Respir. Care. 2013; 58(7): 1196–1203. PubMed Abstract | Publisher Full Text
Isdijoso W, Kusumastuti Rahayu S, Indriani K, et al.: The Situation of the Elderly in Indonesia and Access to Social Protection Programs: Secondary Data Analysis. 2020. Reference Source
Jovanova O, Luik AI, Leening MJG, et al.: The long-term risk of recognized and unrecognized myocardial infarction for depression in older men. Psychol. Med. 2016; 46(9): 1951–1960. Publisher Full Text
Karczewska O, Młynarska A: The Influence of Antiarrhythmic Device Intervention on Biopsychosocial Functioning and Anxiety in Patients with an Implanted Cardioverter Defibrillator. Medicina (Kaunas). 2021; 57(2). PubMed Abstract | Publisher Full Text
Kato K, Zweig R, Schechter CB, et al.: Positive attitude toward life, emotional expression, self-rated health, and depressive symptoms among centenarians and near-centenarians. Aging Ment. Health. 2016; 20(9): 930–939. PubMed Abstract | Publisher Full Text | Free Full Text
Klinedinst NJ, Resnick B, Yerges-Armstrong LM, et al.: The interplay of genetics, behavior, and pain with depressive symptoms in the elderly. Gerontologist. 2015; 55: S67–S77. PubMed Abstract | Publisher Full Text
Kobylańska M, Kowalska J, Neustein J, et al.: The role of biopsychosocial factors in the rehabilitation process of individuals with a stroke. Work (Reading, Mass.). 2018; 61(4): 523–535. PubMed Abstract | Publisher Full Text
Kobylańska M, Kowalska J, Neustein J, et al.: The role of biopsychosocial factors in the rehabilitation process of individuals with a stroke. Work. 2019; 61(4): 523–535. PubMed Abstract | Publisher Full Text
Koo JH, Son N, Yoo K-B: Relationship between the living-alone period and depressive symptoms among the elderly. Arch. Gerontol. Geriatr. 2021; 94: 104341. PubMed Abstract | Publisher Full Text
Kuroda Y, Iwasa H, Goto A, et al.: Occurrence of depressive tendency and associated social factors among elderly persons forced by the Great East Japan Earthquake and nuclear disaster to live as long-term evacuees: A prospective cohort study. BMJ Open. 2017; 7(9): e014339. PubMed Abstract | Publisher Full Text
Laird KT, Siddarth P, Krause-Sorio B, et al.: Anxiety symptoms are associated with smaller insular and orbitofrontal cortex volumes in late-life depression. J. Affect. Disord. 2019; 256: 282–287. PubMed Abstract | Publisher Full Text
Leggett A, Zarit SH, Nguyen NH, et al.: The influence of social factors and health on depressive symptoms and worry: A study of older Vietnamese adults. Aging Ment. Health. 2012; 16(6): 780–786. PubMed Abstract | Publisher Full Text
Lewin A, Jöbges M, Werheid K: The influence of self-efficacy, pre-stroke depression and perceived social support on self-reported depressive symptoms during stroke rehabilitation. Neuropsychol. Rehabil. 2013; 23(4): 546–562. PubMed Abstract | Publisher Full Text
Lewis A: Housing an ageing population: a reading list. House of Commons Library; 2021.
Manaf MRA, Mustafa M, Rahman MRA, et al.: Factors influencing the prevalence of mental health problems among Malay elderly residing in a rural community: A cross-sectional study. PLoS One. 2016; 11(6): 1–12. PubMed Abstract | Publisher Full Text
Matthieu MM, Lawrence KA, Robertson-Blackmore E: The impact of a civic service program on biopsychosocial outcomes of post 9/11 U.S. military veterans. Psychiatry Res. 2017; 248(December 2016): 111–116. PubMed Abstract | Publisher Full Text
Meesters PD, Comijs HC, Sonnenberg CM, et al.: Prevalence and correlates of depressive symptoms in a catchment-area based cohort of older community-living schizophrenia patients. Schizophr. Res. 2014; 157(1–3): 285–291. Publisher Full Text
Misawa J, Kondo K: Social factors relating to depression among older people in Japan: analysis of longitudinal panel data from the AGES project. Aging Ment. Health. 2019; 23(10): 1423–1432. Publisher Full Text
Nadimpalli SB, James BD, Yu L, et al.: The association between discrimination and depressive symptoms among older African Americans: The role of psychological and social factors. Exp. Aging Res. 2015; 41(1): 1–24. PubMed Abstract | Publisher Full Text
Nicolosi GT, Falcão DVDS, Batistoni SST, et al.: Depressive symptoms in old age: Relations among sociodemographic and self-reported health variables. Int. Psychogeriatr. 2011; 23(6): 941–949. PubMed Abstract | Publisher Full Text
Odlum M, Davis N, Owens O, et al.: Correlates and aetiological factors associated with hedonic well-being among an ageing population of US men and women: Secondary data analysis of a national survey. BMJ Open. 2018; 8(11): e020962. PubMed Abstract | Publisher Full Text
Olsen SJS, Schirmer H, Wilsgaard T, et al.: Cardiac rehabilitation and symptoms of anxiety and depression after percutaneous coronary intervention. Eur. J. Prev. Cardiol. 2018; 25(10): 1017–1025. PubMed Abstract | Publisher Full Text
Paralikas T, Maria M, Dimitrios T, et al.: Physical and Mental Health Level of the Elderly Living in Central Greece. Materia Socio Medica. 2021; 33(1): 16–20. PubMed Abstract | Publisher Full Text
Park SD, Yu SH: The effects of Nordic and general walking on depression disorder patients’ depression, sleep, and body composition. J. Phys. Ther. Sci. 2015; 27(8): 2481–2485. PubMed Abstract | Publisher Full Text
Petkus AJ, Gum A, Wetherell JL: Thought suppression is associated with psychological distress in homebound older adults. Depress. Anxiety. 2012; 29(3): 219–225. PubMed Abstract | Publisher Full Text
Piboon K, Subgranon R, Hengudomsub P, et al.: A causal model of depression among older adults in Chon Buri Province, Thailand. Issues Ment. Health Nurs. 2012; 33(2): 118–126. Publisher Full Text
Pocklington C: Review Article Depression in older adults. Br. J. Medical Pract. 2017; 10(1): 7. https://www.bjmp.org/files/2017-10-1/bjmp-2017-10-1-a1007.pdf.
Pollock A, Berge E: How to do a systematic review. Int. J. Stroke. 2018; 13(2): 138–156. Publisher Full Text
Popescu ML, Boisjoly H, Schmaltz H, et al.: Explaining the relationship between three eye diseases and depressive symptoms in older adults. Invest. Ophthalmol. Vis. Sci. 2012; 53(4): 2308–2313. PubMed Abstract | Publisher Full Text
Pusswald G, Fleck M, Lehrner J, et al.: The “Sense of Coherence” and the coping capacity of patients with Parkinson disease. Int. Psychogeriatr. 2012; 24(12): 1972–1979. PubMed Abstract | Publisher Full Text
Rhee MK, Jang Y, Kim SY, et al.: The moderating role of social factors in the relationship between an incident of fall and depressive symptoms: a study with a national sample of older adults in South Korea. Aging Ment. Health. 2021; 25(6): 1086–1093. PubMed Abstract | Publisher Full Text
Rippon I, Steptoe A: Is the relationship between subjective age, depressive symptoms and activities of daily living bidirectional? Soc. Sci. Med. 2018; 214(August): 41–48. PubMed Abstract | Publisher Full Text
Rzewuska M, Mallen CD, Strauss VY, et al.: One-year trajectories of depression and anxiety symptoms in older patients presenting in general practice with musculoskeletal pain: A latent class growth analysis. J. Psychosom. Res. 2015; 79(3): 195–201. PubMed Abstract | Publisher Full Text
Sadler P, McLaren S, Jenkins M: A psychological pathway from insomnia to depression among older adults. Int. Psychogeriatr. 2013; 25(8): 1375–1383. PubMed Abstract | Publisher Full Text
Sakurai R, Kawai H, Suzuki H, et al.: Poor Social Network, Not Living Alone, Is Associated With Incidence of Adverse Health Outcomes in Older Adults. J. Am. Med. Dir. Assoc. 2019; 20(11): 1438–1443. Publisher Full Text
Sanders JB, Comijs HC, Bremmer MA, et al.: A 13-year prospective cohort study on the effects of aging and frailty on the depression-pain relationship in older adults. Int. J. Geriatr. Psychiatry. 2015; 30(7): 751–757. Publisher Full Text
Sjöberg L, Östling S, Falk H, et al.: Secular changes in the relation between social factors and depression: A study of two birth cohorts of Swedish septuagenarians followed for 5 years. J. Affect. Disord. 2013; 150(2): 245–252. Publisher Full Text
Stringa N, Milaneschi Y, van Schoor NM , et al.: Genetic Liability for Depression, Social Factors and Their Interaction Effect in Depressive Symptoms and Depression Over Time in Older Adults. Am. J. Geriatr. Psychiatr. 2020; 28(8): 844–855. Publisher Full Text
Thipprakmas R: Prevalence and Factors Associated with Depression in the Elderly: A Systematic Review. Regioanal Health Promotion Center 9. 2021; 15(37): 325–338.
Wang J, Li W, Yue L, et al.: The Study of White Matter Hyperintensity (WMH) and Factors Related to Geriatric Late-Onset Depression. Shanghai Arch. Psychiatry. 2018; 30(1): 12–19. Publisher Full Text
Wang L, Tao Y, Chen Y, et al.: Association of post stroke depression with social factors, insomnia, and neurological status in Chinese elderly population. Neurol. Sci. 2016; 37(8): 1305–1310. Publisher Full Text
Wild B, Heider D, Maatouk I, et al.: Significance and costs of complex biopsychosocial health care needs in elderly people: Results of a population-based study. Psychosom. Med. 2014; 76(7): 497–502. PubMed Abstract | Publisher Full Text
Woods A, Solomonov N, Liles B, et al.: Perceived Social Support and Interpersonal Functioning as Predictors of Treatment Response Among Depressed Older Adults. Am. J. Geriatr. Psychiatr. 2021; 29(8): 843–852. PubMed Abstract | Publisher Full Text
World Federation for Mental Health: Mental health and older people. 2013. Publisher Full Text
Ylli A, Miszkurka M, Phillips SP, et al.: Clinically relevant depression in old age: An international study with populations from Canada, Latin America and Eastern Europe. Psychiatry Res. 2016; 241: 236–241. PubMed Abstract | Publisher Full Text

Comments on this article Comments (0)

Version 2

VERSION 2 PUBLISHED 20 Sep 2022

Author details Author details

¹ Medical Faculty, University Pembangunan Nasional Veteran Jakarta, Jakarta, 12450, Indonesia
² Faculty of Public Health, University of Indonesia, Depok, 10430, Indonesia

Yanti Harjono Hadiwiardjo
Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Writing – Original Draft Preparation

Rita Damayanti
Roles: Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (2)

version 2

Revised

Published: 14 Feb 2024, 11:1068

https://doi.org/10.12688/f1000research.121710.2

version 1

Published: 20 Sep 2022, 11:1068

https://doi.org/10.12688/f1000research.121710.1

© 2024 Harjono Hadiwiardjo Y and Damayanti R. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Download

Export To

metrics

	Views	Downloads
F1000Research	-	-
PubMed Central Data from PMC are received and updated monthly.	-	-

Citations

SEE MORE DETAILS

CITE

how to cite this article

Harjono Hadiwiardjo Y and Damayanti R. Biopsychosocial factors associated with depression in the elderly: A systematic literature review [version 2; peer review: 1 approved, 1 approved with reservations]. F1000Research 2024, 11:1068 (https://doi.org/10.12688/f1000research.121710.2)

NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.

track

receive updates on this article

Track an article to receive email alerts on any updates to this article.

Open Peer Review

Version 2

VERSION 2

PUBLISHED 14 Feb 2024

Revised

Views

Reviewer Report 02 Apr 2024

Rahul Shidhaye, Department of Psychiatry, Pravara Institute of Medical Sciences, Loni, Maharashtra, India

Approved

https://doi.org/10.5256/f1000research.156507.r246941

Thank you for ... Continue reading

CITE

Report a concern

Respond or Comment

Views

Reviewer Report 23 Mar 2024

Acharaporn Seeherunwong, Department of Mental Health and Psychiatric Nursing, Mahidol University, Nakhon Pathom, Thailand

Approved with Reservations

https://doi.org/10.5256/f1000research.156507.r246942

Comment from the reviewer:
I have the following comments for the first revised manuscript.

The title: I suggest using the term “A systematic review” instead of “A systematic literature review.” The authors did not revise

Comment from the reviewer:
I have the following comments for the first revised manuscript.

The title: I suggest using the term “A systematic review” instead of “A systematic literature review.” The authors did not revise the tile. I have suggested revising it to clarify the method and procedure of the review paper to the reader. There are many types of article review including integrated review, scope review, and systematic review.
In the discussion section, I did not find the knowledge gap in the part of the discussion as the goal of this systematic review. For example, it may need to examine the interaction among the biopsychosocial factors, or the multilevel of the factors.
The gender and sex variables have different meanings. Sex is used as a biological factor, while gender is used as a social factor. Please reconsider this issue.

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Depression, mental health, nursing

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

CITE

Report a concern

Respond or Comment

Version 1

VERSION 1

PUBLISHED 20 Sep 2022

Views

Reviewer Report 17 Feb 2023

Rahul Shidhaye, Department of Psychiatry, Pravara Institute of Medical Sciences, Loni, Maharashtra, India

Approved with Reservations

https://doi.org/10.5256/f1000research.133605.r155783

In the paper titled, ‘Biopsychosocial factors associated with depression in the elderly: A systematic literature review’, the aim of the authors is to review the evidence related to the contribution of biopsychosocial factors to depression in the elderly.

... Continue reading

Large number of studies have investigated the role of biological, psychological, and social factors associated with depression in the general population and in the elderly. In this backdrop, the rationale for undertaking the current systematic review is not clear. Authors mention, "a greater understanding of the individual contributions of biological, psychological, and social risk factors can have a big impact on the adoption of preventive actions to lower the population's risk of depression", but this review doesn’t seem to assess the individual contribution of each of these factors.
Methods section can be re-structured based on the points included in the PRISMA guidelines.
Why was the search limited to the last ten years only?
The meaning of the sentence, "these studies included quantitative synthesis", is not clear. The following sentence is included in the limitations section, "papers included in this review are varied, so they do not allow for quantitative synthesis." Kindly clarify.
Who completed the critical appraisal of all the included papers? The score for each included paper based on the JBI checklist could be presented in a table as part of the supplementary material.
One of the biological factors mentioned is "brain anatomical". Kindly explain.
Limitations of the review and limitations of the included studies need to be described much more elaborately. There are multiple limitations of this study/review which are not discussed at all.
It will be good to compare the findings of this review with other similar studies.
Results from individual papers are presented without a clear high-level synthesis of these findings.
The aim of this review is to identify the research gaps, but this doesn’t seem to be covered anywhere in the paper.

Are the rationale for, and objectives of, the Systematic Review clearly stated?

No
Are sufficient details of the methods and analysis provided to allow replication by others?

Partly
Is the statistical analysis and its interpretation appropriate?

Partly
Are the conclusions drawn adequately supported by the results presented in the review?

No

Competing Interests: Rahul Shidhaye is supported by India Alliance (DBT-WELLCOME Trust) intermediate career fellowship in clinical and public health research.

Reviewer Expertise: Depression, Anxiety Disorders, Elderly, Pregnant women, Yoga, Implementation Science

CITE

Report a concern

Author Response 14 Feb 2024

Yanti Harjono Hadiwiardjo , Faculty of Public Health, University of Indonesia, Depok, 10430, Indonesia

14 Feb 2024

Author Response

One of the key areas of focus in this revision has been the enhancement of the synthesis level in our article. We have made concerted efforts to this revision. By ... Continue reading One of the key areas of focus in this revision has been the enhancement of the synthesis level in our article. We have made concerted efforts to this revision. By meticulously reorganizing and rephrasing sections of the manuscript, we have aimed to present a more cohesive and integrated narrative. Additionally, we have addressed your recommendation regarding the introduction of a JBI score. We have now included this score as a vital component of our methodology, providing a transparent and standardized measure of the quality and reliability of our research.
One of the key areas of focus in this revision has been the enhancement of the synthesis level in our article. We have made concerted efforts to this revision. By meticulously reorganizing and rephrasing sections of the manuscript, we have aimed to present a more cohesive and integrated narrative. Additionally, we have addressed your recommendation regarding the introduction of a JBI score. We have now included this score as a vital component of our methodology, providing a transparent and standardized measure of the quality and reliability of our research.
Competing Interests: No competing interests were disclosed. Close
Report a concern
Author Response 14 Feb 2024

Yanti Harjono Hadiwiardjo , Faculty of Public Health, University of Indonesia, Depok, 10430, Indonesia

14 Feb 2024

Author Response
1. After the author reviews it further, what the author means by individual contribution is if a person already knows these risk factors so they can be prevented, and
... Continue reading
After the author reviews it further, what the author means by individual contribution is if a person already knows these risk factors so they can be prevented, and the incidence of depression can decrease. The author changed the paragraph to “A greater understanding of the individual factors of biological, psychological, and social risk factors can have a big impact on the adoption of preventive actions to lower the population's risk of depression.”

Done for submission, the article re-structured based on the PRISMA guidelines.

The selection of the last 10 years for research is driven by the need to focus on recent and relevant information. This time frame allows us to capture the most up-to-date developments, trends, and insights in the field. The requirement for articles to be written in English and published between 2011 and 2021 further ensures that the sources are contemporary and provide valuable insights within a reasonable time span. This approach enhances the accuracy and relevance of the information gathered for the study.

After reviewing it again, the author revised the limitations sections in the article to be “The limitation of the results of this systematic review is that most papers do not clearly identify the confounding factor so it cannot be determined whether there is bias in the study. Therefore, we discuss the results narratively in order to provide a big picture of the topic.”

Completed for submission, the article includes a paper based on JBI checklist scores as an attachment.

The means of brain anatomical is like a history of trauma, infectious diseases and other abnormalities in the brain.

The limitation of the results of this systematic review is that most papers do not clearly identify the confounding factor so it cannot be determined whether there is bias in the study. Therefore, we discuss the results narratively in order to provide a big picture of the topic.

Thank you for the suggestion, the author will add the section comparing the findings of this review with other similar studies.

The author had limited time, so he did not have time to carry out a meta-analysis.

This article aims to identify research gaps, which means the authors want to analyze current risk factors. The reason is the author feels that the risk factors for depression are different between now and then.
After the author reviews it further, what the author means by individual contribution is if a person already knows these risk factors so they can be prevented, and the incidence of depression can decrease. The author changed the paragraph to “A greater understanding of the individual factors of biological, psychological, and social risk factors can have a big impact on the adoption of preventive actions to lower the population's risk of depression.”

Done for submission, the article re-structured based on the PRISMA guidelines.

The selection of the last 10 years for research is driven by the need to focus on recent and relevant information. This time frame allows us to capture the most up-to-date developments, trends, and insights in the field. The requirement for articles to be written in English and published between 2011 and 2021 further ensures that the sources are contemporary and provide valuable insights within a reasonable time span. This approach enhances the accuracy and relevance of the information gathered for the study.

After reviewing it again, the author revised the limitations sections in the article to be “The limitation of the results of this systematic review is that most papers do not clearly identify the confounding factor so it cannot be determined whether there is bias in the study. Therefore, we discuss the results narratively in order to provide a big picture of the topic.”

Completed for submission, the article includes a paper based on JBI checklist scores as an attachment.

The means of brain anatomical is like a history of trauma, infectious diseases and other abnormalities in the brain.

The limitation of the results of this systematic review is that most papers do not clearly identify the confounding factor so it cannot be determined whether there is bias in the study. Therefore, we discuss the results narratively in order to provide a big picture of the topic.

Thank you for the suggestion, the author will add the section comparing the findings of this review with other similar studies.

The author had limited time, so he did not have time to carry out a meta-analysis.

This article aims to identify research gaps, which means the authors want to analyze current risk factors. The reason is the author feels that the risk factors for depression are different between now and then.
Competing Interests: No competing interests were disclosed. Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 14 Feb 2024

Yanti Harjono Hadiwiardjo , Faculty of Public Health, University of Indonesia, Depok, 10430, Indonesia

14 Feb 2024

Author Response

One of the key areas of focus in this revision has been the enhancement of the synthesis level in our article. We have made concerted efforts to this revision. By ... Continue reading One of the key areas of focus in this revision has been the enhancement of the synthesis level in our article. We have made concerted efforts to this revision. By meticulously reorganizing and rephrasing sections of the manuscript, we have aimed to present a more cohesive and integrated narrative. Additionally, we have addressed your recommendation regarding the introduction of a JBI score. We have now included this score as a vital component of our methodology, providing a transparent and standardized measure of the quality and reliability of our research.
One of the key areas of focus in this revision has been the enhancement of the synthesis level in our article. We have made concerted efforts to this revision. By meticulously reorganizing and rephrasing sections of the manuscript, we have aimed to present a more cohesive and integrated narrative. Additionally, we have addressed your recommendation regarding the introduction of a JBI score. We have now included this score as a vital component of our methodology, providing a transparent and standardized measure of the quality and reliability of our research.
Competing Interests: No competing interests were disclosed. Close
Report a concern
Author Response 14 Feb 2024

Yanti Harjono Hadiwiardjo , Faculty of Public Health, University of Indonesia, Depok, 10430, Indonesia

14 Feb 2024

Author Response
1. After the author reviews it further, what the author means by individual contribution is if a person already knows these risk factors so they can be prevented, and
... Continue reading
After the author reviews it further, what the author means by individual contribution is if a person already knows these risk factors so they can be prevented, and the incidence of depression can decrease. The author changed the paragraph to “A greater understanding of the individual factors of biological, psychological, and social risk factors can have a big impact on the adoption of preventive actions to lower the population's risk of depression.”

Done for submission, the article re-structured based on the PRISMA guidelines.

The selection of the last 10 years for research is driven by the need to focus on recent and relevant information. This time frame allows us to capture the most up-to-date developments, trends, and insights in the field. The requirement for articles to be written in English and published between 2011 and 2021 further ensures that the sources are contemporary and provide valuable insights within a reasonable time span. This approach enhances the accuracy and relevance of the information gathered for the study.

After reviewing it again, the author revised the limitations sections in the article to be “The limitation of the results of this systematic review is that most papers do not clearly identify the confounding factor so it cannot be determined whether there is bias in the study. Therefore, we discuss the results narratively in order to provide a big picture of the topic.”

Completed for submission, the article includes a paper based on JBI checklist scores as an attachment.

The means of brain anatomical is like a history of trauma, infectious diseases and other abnormalities in the brain.

The limitation of the results of this systematic review is that most papers do not clearly identify the confounding factor so it cannot be determined whether there is bias in the study. Therefore, we discuss the results narratively in order to provide a big picture of the topic.

Thank you for the suggestion, the author will add the section comparing the findings of this review with other similar studies.

The author had limited time, so he did not have time to carry out a meta-analysis.

This article aims to identify research gaps, which means the authors want to analyze current risk factors. The reason is the author feels that the risk factors for depression are different between now and then.
After the author reviews it further, what the author means by individual contribution is if a person already knows these risk factors so they can be prevented, and the incidence of depression can decrease. The author changed the paragraph to “A greater understanding of the individual factors of biological, psychological, and social risk factors can have a big impact on the adoption of preventive actions to lower the population's risk of depression.”

Done for submission, the article re-structured based on the PRISMA guidelines.

The selection of the last 10 years for research is driven by the need to focus on recent and relevant information. This time frame allows us to capture the most up-to-date developments, trends, and insights in the field. The requirement for articles to be written in English and published between 2011 and 2021 further ensures that the sources are contemporary and provide valuable insights within a reasonable time span. This approach enhances the accuracy and relevance of the information gathered for the study.

After reviewing it again, the author revised the limitations sections in the article to be “The limitation of the results of this systematic review is that most papers do not clearly identify the confounding factor so it cannot be determined whether there is bias in the study. Therefore, we discuss the results narratively in order to provide a big picture of the topic.”

Completed for submission, the article includes a paper based on JBI checklist scores as an attachment.

The means of brain anatomical is like a history of trauma, infectious diseases and other abnormalities in the brain.

The limitation of the results of this systematic review is that most papers do not clearly identify the confounding factor so it cannot be determined whether there is bias in the study. Therefore, we discuss the results narratively in order to provide a big picture of the topic.

Thank you for the suggestion, the author will add the section comparing the findings of this review with other similar studies.

The author had limited time, so he did not have time to carry out a meta-analysis.

This article aims to identify research gaps, which means the authors want to analyze current risk factors. The reason is the author feels that the risk factors for depression are different between now and then.
Competing Interests: No competing interests were disclosed. Close
Report a concern

Views

Reviewer Report 16 Dec 2022

Acharaporn Seeherunwong, Department of Mental Health and Psychiatric Nursing, Mahidol University, Nakhon Pathom, Thailand

Approved with Reservations

https://doi.org/10.5256/f1000research.133605.r155782

The study's objective should be "...biopsychosocial factors associated with or predictors of depression in the elderly."

Comment from reviewer:

The study of “Biopsychosocial factors associated with depression in the elderly: A systematic literature review” ... Continue reading

The title: I suggest using “A systematic review” instead of “A systematic literature review”.
Introduction section: In the 1st paragraph, "In Indonesia, citizens 60 years old or older have reached about 25.7 million people" should be revised to calculate to be a percentage of the total population. As a result, the amount of elderly in Indonesia is comparable to the proportion of elderly in the UK and other countries worldwide.
Result: The outcome has varied the severity of depressive symptoms. I suggest categorizing the paper into two groups, as the outcomes differ in severity. The first group is the elderly diagnosed with MDD or depressive disorder (article nos. 2, 6, 9,13, 30). The second one is elderly with depressive symptoms who were not diagnosed with depressive disorders. The associated factors may be different as well.
Please separate the result section from the discussion section. In addition, the authors should find previous studies to explain the results.

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Partly
Are sufficient details of the methods and analysis provided to allow replication by others?

Yes
Is the statistical analysis and its interpretation appropriate?

Not applicable
Are the conclusions drawn adequately supported by the results presented in the review?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Depression, mental health, nursing

CITE

Report a concern

Author Response 14 Feb 2024

Yanti Harjono Hadiwiardjo , Faculty of Public Health, University of Indonesia, Depok, 10430, Indonesia

14 Feb 2024

Author Response

One of the key areas of focus in this revision has been the enhancement of the synthesis level in our article. We have made concerted efforts to this revision. By ... Continue reading One of the key areas of focus in this revision has been the enhancement of the synthesis level in our article. We have made concerted efforts to this revision. By meticulously reorganizing and rephrasing sections of the manuscript, we have aimed to present a more cohesive and integrated narrative. Additionally, we have addressed your recommendation regarding the introduction of a JBI score. We have now included this score as a vital component of our methodology, providing a transparent and standardized measure of the quality and reliability of our research.
One of the key areas of focus in this revision has been the enhancement of the synthesis level in our article. We have made concerted efforts to this revision. By meticulously reorganizing and rephrasing sections of the manuscript, we have aimed to present a more cohesive and integrated narrative. Additionally, we have addressed your recommendation regarding the introduction of a JBI score. We have now included this score as a vital component of our methodology, providing a transparent and standardized measure of the quality and reliability of our research.
Competing Interests: No competing interests were disclosed. Close
Report a concern
Author Response 14 Feb 2024

Yanti Harjono Hadiwiardjo , Faculty of Public Health, University of Indonesia, Depok, 10430, Indonesia

14 Feb 2024

Author Response
1. The title the title has been changed to "Biopsychosocial factors associated with depression in the elderly: A systematic review"
2. Introduction section: In the 1st paragraph changed
... Continue reading
The title the title has been changed to "Biopsychosocial factors associated with depression in the elderly: A systematic review"

Introduction section: In the 1st paragraph changed to "Demographic Profiles and Implications of the Top 10 Countries with the Highest Number of People Aged 65+ in 2020" delves into a significant global demographic shift observed in the year 2020 with calculations conducted by ESCAP based on the United Nations' Department of Economic and Social Affairs, Population Division (2019). The data reveals the following key insights China emerged as the country with the largest elderly population, with a staggering 172,262 individuals aged 65 and above, representing 46.05% of its total population, India follows closely, with 90,720 seniors, constituting 24.25% of the population, Japan recorded 35,916 elderly citizens, making up 9.60% of its populace, The Russian Federation reported 22,633 seniors, accounting for 6.05% of its total population, Indonesia had 17,219 elderly individuals, representing 4.57% of the population, Pakistan's elderly population reached 9,606, making up 2.56% of its total, Thailand reported 9,044 seniors, equivalent to 2.41% of its population, Bangladesh recorded 8,608 elderly citizens, constituting 2.30% of its populace and Korea reported 8,096 elderly individuals, representing 2.16% of the total population.

Regarding categorizing the paper into two groups, the author feels objections and does not want to categorize it into two groups. Just following the initial research with the expected results as of now.

In the latest and revised article, the author has categorized the results and discussion into different sections according to the reviewer's input.
The title the title has been changed to "Biopsychosocial factors associated with depression in the elderly: A systematic review"

Introduction section: In the 1st paragraph changed to "Demographic Profiles and Implications of the Top 10 Countries with the Highest Number of People Aged 65+ in 2020" delves into a significant global demographic shift observed in the year 2020 with calculations conducted by ESCAP based on the United Nations' Department of Economic and Social Affairs, Population Division (2019). The data reveals the following key insights China emerged as the country with the largest elderly population, with a staggering 172,262 individuals aged 65 and above, representing 46.05% of its total population, India follows closely, with 90,720 seniors, constituting 24.25% of the population, Japan recorded 35,916 elderly citizens, making up 9.60% of its populace, The Russian Federation reported 22,633 seniors, accounting for 6.05% of its total population, Indonesia had 17,219 elderly individuals, representing 4.57% of the population, Pakistan's elderly population reached 9,606, making up 2.56% of its total, Thailand reported 9,044 seniors, equivalent to 2.41% of its population, Bangladesh recorded 8,608 elderly citizens, constituting 2.30% of its populace and Korea reported 8,096 elderly individuals, representing 2.16% of the total population.

Regarding categorizing the paper into two groups, the author feels objections and does not want to categorize it into two groups. Just following the initial research with the expected results as of now.

In the latest and revised article, the author has categorized the results and discussion into different sections according to the reviewer's input.
Competing Interests: No competing interests were disclosed. Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 14 Feb 2024

Yanti Harjono Hadiwiardjo , Faculty of Public Health, University of Indonesia, Depok, 10430, Indonesia

14 Feb 2024

Author Response

One of the key areas of focus in this revision has been the enhancement of the synthesis level in our article. We have made concerted efforts to this revision. By ... Continue reading One of the key areas of focus in this revision has been the enhancement of the synthesis level in our article. We have made concerted efforts to this revision. By meticulously reorganizing and rephrasing sections of the manuscript, we have aimed to present a more cohesive and integrated narrative. Additionally, we have addressed your recommendation regarding the introduction of a JBI score. We have now included this score as a vital component of our methodology, providing a transparent and standardized measure of the quality and reliability of our research.
One of the key areas of focus in this revision has been the enhancement of the synthesis level in our article. We have made concerted efforts to this revision. By meticulously reorganizing and rephrasing sections of the manuscript, we have aimed to present a more cohesive and integrated narrative. Additionally, we have addressed your recommendation regarding the introduction of a JBI score. We have now included this score as a vital component of our methodology, providing a transparent and standardized measure of the quality and reliability of our research.
Competing Interests: No competing interests were disclosed. Close
Report a concern
Author Response 14 Feb 2024

Yanti Harjono Hadiwiardjo , Faculty of Public Health, University of Indonesia, Depok, 10430, Indonesia

14 Feb 2024

Author Response
1. The title the title has been changed to "Biopsychosocial factors associated with depression in the elderly: A systematic review"
2. Introduction section: In the 1st paragraph changed
... Continue reading
The title the title has been changed to "Biopsychosocial factors associated with depression in the elderly: A systematic review"

Introduction section: In the 1st paragraph changed to "Demographic Profiles and Implications of the Top 10 Countries with the Highest Number of People Aged 65+ in 2020" delves into a significant global demographic shift observed in the year 2020 with calculations conducted by ESCAP based on the United Nations' Department of Economic and Social Affairs, Population Division (2019). The data reveals the following key insights China emerged as the country with the largest elderly population, with a staggering 172,262 individuals aged 65 and above, representing 46.05% of its total population, India follows closely, with 90,720 seniors, constituting 24.25% of the population, Japan recorded 35,916 elderly citizens, making up 9.60% of its populace, The Russian Federation reported 22,633 seniors, accounting for 6.05% of its total population, Indonesia had 17,219 elderly individuals, representing 4.57% of the population, Pakistan's elderly population reached 9,606, making up 2.56% of its total, Thailand reported 9,044 seniors, equivalent to 2.41% of its population, Bangladesh recorded 8,608 elderly citizens, constituting 2.30% of its populace and Korea reported 8,096 elderly individuals, representing 2.16% of the total population.

Regarding categorizing the paper into two groups, the author feels objections and does not want to categorize it into two groups. Just following the initial research with the expected results as of now.

In the latest and revised article, the author has categorized the results and discussion into different sections according to the reviewer's input.
The title the title has been changed to "Biopsychosocial factors associated with depression in the elderly: A systematic review"

Introduction section: In the 1st paragraph changed to "Demographic Profiles and Implications of the Top 10 Countries with the Highest Number of People Aged 65+ in 2020" delves into a significant global demographic shift observed in the year 2020 with calculations conducted by ESCAP based on the United Nations' Department of Economic and Social Affairs, Population Division (2019). The data reveals the following key insights China emerged as the country with the largest elderly population, with a staggering 172,262 individuals aged 65 and above, representing 46.05% of its total population, India follows closely, with 90,720 seniors, constituting 24.25% of the population, Japan recorded 35,916 elderly citizens, making up 9.60% of its populace, The Russian Federation reported 22,633 seniors, accounting for 6.05% of its total population, Indonesia had 17,219 elderly individuals, representing 4.57% of the population, Pakistan's elderly population reached 9,606, making up 2.56% of its total, Thailand reported 9,044 seniors, equivalent to 2.41% of its population, Bangladesh recorded 8,608 elderly citizens, constituting 2.30% of its populace and Korea reported 8,096 elderly individuals, representing 2.16% of the total population.

Regarding categorizing the paper into two groups, the author feels objections and does not want to categorize it into two groups. Just following the initial research with the expected results as of now.

In the latest and revised article, the author has categorized the results and discussion into different sections according to the reviewer's input.
Competing Interests: No competing interests were disclosed. Close
Report a concern

Comments on this article Comments (0)

Version 2

VERSION 2 PUBLISHED 20 Sep 2022

Open Peer Review

Reviewer Status

Reviewer Reports

	Invited Reviewers
	1	2
Version 2 (revision) 14 Feb 24	read	read
Version 1 20 Sep 22	read	read

Acharaporn Seeherunwong, Mahidol University, Nakhon Pathom, Thailand
Rahul Shidhaye, Pravara Institute of Medical Sciences, Loni, India

Comments on this article

All Comments(0)

Add a comment

Browse by related subjects

Back to all reports

Reviewer Report

3 Views

02 Apr 2024 | for Version 2

Rahul Shidhaye, Department of Psychiatry, Pravara Institute of Medical Sciences, Loni, Maharashtra, India

3 Views Cite this report Responses(0)

Approved

Thank you for addressing all the comments.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Depression, Anxiety Disorders, Elderly, Pregnant women, Yoga, Implementation Science

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Respond to this report

Responses (0)

Back to all reports

Reviewer Report

8 Views

23 Mar 2024 | for Version 2

Acharaporn Seeherunwong, Department of Mental Health and Psychiatric Nursing, Mahidol University, Nakhon Pathom, Thailand

8 Views Cite this report Responses(0)

Approved With Reservations

Comment from the reviewer:
I have the following comments for the first revised manuscript.

The title: I suggest using the term “A systematic review” instead of “A systematic literature review.” The authors did not revise the tile. I have suggested revising it to clarify the method and procedure of the review paper to the reader. There are many types of article review including integrated review, scope review, and systematic review.
In the discussion section, I did not find the knowledge gap in the part of the discussion as the goal of this systematic review. For example, it may need to examine the interaction among the biopsychosocial factors, or the multilevel of the factors.
The gender and sex variables have different meanings. Sex is used as a biological factor, while gender is used as a social factor. Please reconsider this issue.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Depression, mental health, nursing

Respond to this report

Responses (0)

Back to all reports

Reviewer Report

17 Views

17 Feb 2023 | for Version 1

Rahul Shidhaye, Department of Psychiatry, Pravara Institute of Medical Sciences, Loni, Maharashtra, India

17 Views Cite this report Responses(2)

Approved With Reservations

Large number of studies have investigated the role of biological, psychological, and social factors associated with depression in the general population and in the elderly. In this backdrop, the rationale for undertaking the current systematic review is not clear. Authors mention, "a greater understanding of the individual contributions of biological, psychological, and social risk factors can have a big impact on the adoption of preventive actions to lower the population's risk of depression", but this review doesn’t seem to assess the individual contribution of each of these factors.
Methods section can be re-structured based on the points included in the PRISMA guidelines.
Why was the search limited to the last ten years only?
The meaning of the sentence, "these studies included quantitative synthesis", is not clear. The following sentence is included in the limitations section, "papers included in this review are varied, so they do not allow for quantitative synthesis." Kindly clarify.
Who completed the critical appraisal of all the included papers? The score for each included paper based on the JBI checklist could be presented in a table as part of the supplementary material.
One of the biological factors mentioned is "brain anatomical". Kindly explain.
Limitations of the review and limitations of the included studies need to be described much more elaborately. There are multiple limitations of this study/review which are not discussed at all.
It will be good to compare the findings of this review with other similar studies.
Results from individual papers are presented without a clear high-level synthesis of these findings.
The aim of this review is to identify the research gaps, but this doesn’t seem to be covered anywhere in the paper.

Are the rationale for, and objectives of, the Systematic Review clearly stated?

No
Are sufficient details of the methods and analysis provided to allow replication by others?

Partly
Is the statistical analysis and its interpretation appropriate?

Partly
Are the conclusions drawn adequately supported by the results presented in the review?

No

Competing Interests

Rahul Shidhaye is supported by India Alliance (DBT-WELLCOME Trust) intermediate career fellowship in clinical and public health research.

Reviewer Expertise

Depression, Anxiety Disorders, Elderly, Pregnant women, Yoga, Implementation Science

Respond to this report

Responses (2)

Author Response

14 Feb 2024

Yanti Harjono Hadiwiardjo , Faculty of Public Health, University of Indonesia, Depok, 10430, Indonesia

One of the key areas of focus in this revision has been the enhancement of the synthesis level in our article. We have made concerted efforts to this revision. By meticulously reorganizing and rephrasing sections of the manuscript, we have aimed to present a more cohesive and integrated narrative. Additionally, we have addressed your recommendation regarding the introduction of a JBI score. We have now included this score as a vital component of our methodology, providing a transparent and standardized measure of the quality and reliability of our research.

View more View less

Competing Interests

No competing interests were disclosed.

Author Response

14 Feb 2024

Yanti Harjono Hadiwiardjo , Faculty of Public Health, University of Indonesia, Depok, 10430, Indonesia

After the author reviews it further, what the author means by individual contribution is if a person already knows these risk factors so they can be prevented, and the incidence of depression can decrease. The author changed the paragraph to “A greater understanding of the individual factors of biological, psychological, and social risk factors can have a big impact on the adoption of preventive actions to lower the population's risk of depression.”
Done for submission, the article re-structured based on the PRISMA guidelines.
The selection of the last 10 years for research is driven by the need to focus on recent and relevant information. This time frame allows us to capture the most up-to-date developments, trends, and insights in the field. The requirement for articles to be written in English and published between 2011 and 2021 further ensures that the sources are contemporary and provide valuable insights within a reasonable time span. This approach enhances the accuracy and relevance of the information gathered for the study.
After reviewing it again, the author revised the limitations sections in the article to be “The limitation of the results of this systematic review is that most papers do not clearly identify the confounding factor so it cannot be determined whether there is bias in the study. Therefore, we discuss the results narratively in order to provide a big picture of the topic.”
Completed for submission, the article includes a paper based on JBI checklist scores as an attachment.
The means of brain anatomical is like a history of trauma, infectious diseases and other abnormalities in the brain.
The limitation of the results of this systematic review is that most papers do not clearly identify the confounding factor so it cannot be determined whether there is bias in the study. Therefore, we discuss the results narratively in order to provide a big picture of the topic.
Thank you for the suggestion, the author will add the section comparing the findings of this review with other similar studies.
The author had limited time, so he did not have time to carry out a meta-analysis.
This article aims to identify research gaps, which means the authors want to analyze current risk factors. The reason is the author feels that the risk factors for depression are different between now and then.

View more View less

Competing Interests

No competing interests were disclosed.

Back to all reports

Reviewer Report

24 Views

16 Dec 2022 | for Version 1

Acharaporn Seeherunwong, Department of Mental Health and Psychiatric Nursing, Mahidol University, Nakhon Pathom, Thailand

24 Views Cite this report Responses(2)

Approved With Reservations

The title: I suggest using “A systematic review” instead of “A systematic literature review”.
Introduction section: In the 1st paragraph, "In Indonesia, citizens 60 years old or older have reached about 25.7 million people" should be revised to calculate to be a percentage of the total population. As a result, the amount of elderly in Indonesia is comparable to the proportion of elderly in the UK and other countries worldwide.
Result: The outcome has varied the severity of depressive symptoms. I suggest categorizing the paper into two groups, as the outcomes differ in severity. The first group is the elderly diagnosed with MDD or depressive disorder (article nos. 2, 6, 9,13, 30). The second one is elderly with depressive symptoms who were not diagnosed with depressive disorders. The associated factors may be different as well.
Please separate the result section from the discussion section. In addition, the authors should find previous studies to explain the results.

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Partly
Are sufficient details of the methods and analysis provided to allow replication by others?

Yes
Is the statistical analysis and its interpretation appropriate?

Not applicable
Are the conclusions drawn adequately supported by the results presented in the review?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Depression, mental health, nursing

Respond to this report

Responses (2)

Author Response

14 Feb 2024

Yanti Harjono Hadiwiardjo , Faculty of Public Health, University of Indonesia, Depok, 10430, Indonesia

View more View less

Competing Interests

No competing interests were disclosed.

Author Response

14 Feb 2024

Yanti Harjono Hadiwiardjo , Faculty of Public Health, University of Indonesia, Depok, 10430, Indonesia

The title the title has been changed to "Biopsychosocial factors associated with depression in the elderly: A systematic review"
Introduction section: In the 1st paragraph changed to "Demographic Profiles and Implications of the Top 10 Countries with the Highest Number of People Aged 65+ in 2020" delves into a significant global demographic shift observed in the year 2020 with calculations conducted by ESCAP based on the United Nations' Department of Economic and Social Affairs, Population Division (2019). The data reveals the following key insights China emerged as the country with the largest elderly population, with a staggering 172,262 individuals aged 65 and above, representing 46.05% of its total population, India follows closely, with 90,720 seniors, constituting 24.25% of the population, Japan recorded 35,916 elderly citizens, making up 9.60% of its populace, The Russian Federation reported 22,633 seniors, accounting for 6.05% of its total population, Indonesia had 17,219 elderly individuals, representing 4.57% of the population, Pakistan's elderly population reached 9,606, making up 2.56% of its total, Thailand reported 9,044 seniors, equivalent to 2.41% of its population, Bangladesh recorded 8,608 elderly citizens, constituting 2.30% of its populace and Korea reported 8,096 elderly individuals, representing 2.16% of the total population.
Regarding categorizing the paper into two groups, the author feels objections and does not want to categorize it into two groups. Just following the initial research with the expected results as of now.
In the latest and revised article, the author has categorized the results and discussion into different sections according to the reviewer's input.

View more View less

Competing Interests

No competing interests were disclosed.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

[1] Akila GV, Arvind BA, Isaac A: Comparative assessment of psychosocial status of elderly in urban and rural areas, Karnataka, India. J. Family Med. Prim. Care. 2019.

[2] Alexopoulos GS, Kelly RE: Research advances in geriatric depression. World Psychiatry. 2009; 8(3): 140–149. PubMed Abstract | Publisher Full Text

[3] Arve S, Eloranta S, Rovio S, et al.: Depressive symptoms among older people: A 15-year follow-up. Aging Clin. Exp. Res. 2012; 24(5): 501–508. Publisher Full Text

[4] Blazer DG: Depression in late life: Review and commentary. J. Gerontol. A Biol. Sci. Med. Sci. 2003; 58(3): 249–265. PubMed Abstract | Publisher Full Text

[5] Bond L, Carroll R, Mulryan N, et al.: Biopsychosocial factors associated with depression and anxiety in older adults with intellectual disability: results of the wave 3 Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing. J. Intellect. Disabil. Res. 2020; 64(5): 368–380. Publisher Full Text

[6] Brinda EM, Rajkumar AP, Attermann J, et al.: Health, Social, and Economic Variables Associated with Depression Among Older People in Low and Middle Income Countries: World Health Organization Study on Global AGEing and Adult Health. Am. J. Geriatr. Psychiatr. 2016; 24): 1196–1208. Elsevier Inc. Publisher Full Text

[7] Bui BKH: The relationship between social network characteristics and depressive symptoms among older adults in the United States: differentiating between network structure and network function. Psychogeriatrics. 2020; 20(4): 458–468. Publisher Full Text

[8] Carayanni V, Stylianopoulou C, Koulierakis G, et al.: Sex differences in depression among older adults: Are older women more vulnerable than men in social risk factors? The case of open care centers for older people in Greece. Eur. J. Ageing. 2012; 9(2): 177–186. PubMed Abstract | Publisher Full Text

[9] Chan D, Kwok A, Leung J, et al.: Association between life events and change in depressive symptoms in Hong Kong Chinese elderly. J. Affect. Disord. 2012; 136(3): 963–970. Publisher Full Text

[10] Chen Z, Jiang X, Shi G, et al.: Social frailty and longitudinal risk of depressive symptoms in a Chinese population: the Rugao Longevity and Aging Study. Psychogeriatrics: The Official Journal of the Japanese Psychogeriatric Society. 2021; 21(4): 483–490. Publisher Full Text

[11] Chen ZK, Jiang XY, Shi GP, et al.: Social frailty and longitudinal risk of depressive symptoms in a Chinese population: the Rugao Longevity and Aging Study. Psychogeriatrics. 2021; 21(4): 483–490. PubMed Abstract | Publisher Full Text

[12] Choi NG, Kim J, Marti CN, et al.: Late-life depression and cardiovascular disease burden: Examination of reciprocal relationship. Am. J. Geriatr. Psychiatr. 2014; 22(12): 1522–1529. Publisher Full Text

[13] Cordes T, Zwingmann K, Rudisch J, et al.: Multicomponent exercise to improve motor functions, cognition and well-being for nursing home residents who are unable to walk - A randomized controlled trial. Exp. Gerontol. 2021; 153: 111484. PubMed Abstract | Publisher Full Text

[14] Davison TE, McCabe MP, Knight T, et al.: Biopsychosocial factors related to depression in aged care residents. J. Affect. Disord. 2012; 142(1–3): 290–296. PubMed Abstract | Publisher Full Text

[15] Derry HM, Johnston CD, Burchett CO, et al.: Links Between Inflammation, Mood, and Physical Function Among Older Adults With HIV. The Journals of Gerontology: Series B. 2021; 77: 50–60. PubMed Abstract | Publisher Full Text

[16] Diniz BS: The Biopsychosocial Liability for Late-Life Depression. Am. J. Geriatr. Psychiatr. 2020; 28(8): 856–858. PubMed Abstract | Publisher Full Text

[17] Ferrand C, Féart C, Martinent G, et al.: Dietary patterns in French home-living older adults: Results from the PRAUSE study. Arch. Gerontol. Geriatr. 2018; 70: 180–185. Publisher Full Text

[18] Garcia-Toro M, Aguirre I: Biopsychosocial model in Depression revisited. Med. Hypotheses. 2007; 68(3): 683–691. PubMed Abstract | Publisher Full Text

[19] Glei DA, Goldman N, Liu IW, et al.: Sex differences in trajectories of depressive symptoms among older Taiwanese: the contribution of selected stressors and social factors. Aging Ment. Health. 2013; 17(6): 773–783. PubMed Abstract | Publisher Full Text

[20] Gureje O, Oladeji B, Abiona T: Incidence and risk factors for late-life depression in the Ibadan Study of Ageing. Psychol. Med. 2011; 41(9): 1897–1906. PubMed Abstract | Publisher Full Text

[21] Hadiwiardjo YH, Damayanti R: Data Extraction_Depression in Elderly from 54 research papers.csv. figshare. Dataset.2022a. Publisher Full Text

[22] Hadiwiardjo YH, Damayanti R: Prisma flowchart depression in Elderly. figshare. Figure.2022b. Publisher Full Text

[23] Hadiwiardjo YH, Damayanti R: Prisma Checklist Depression in Elderly. figshare. Journal Contribution. 2022c. Publisher Full Text

[24] Hong JH, Lachman ME, Charles ST, et al.: The positive influence of sense of control on physical, behavioral, and psychosocial health in older adults: An outcome-wide approach. Prev. Med. 2021; 149(May): 106612. PubMed Abstract | Publisher Full Text

[25] Horita N, Kaneko T, Shinkai M, et al.: Depression in Japanese patients with chronic obstructive pulmonary disease: A cross-sectional study. Respir. Care. 2013; 58(7): 1196–1203. PubMed Abstract | Publisher Full Text

[26] Isdijoso W, Kusumastuti Rahayu S, Indriani K, et al.: The Situation of the Elderly in Indonesia and Access to Social Protection Programs: Secondary Data Analysis. 2020. Reference Source

[27] Jovanova O, Luik AI, Leening MJG, et al.: The long-term risk of recognized and unrecognized myocardial infarction for depression in older men. Psychol. Med. 2016; 46(9): 1951–1960. Publisher Full Text

[28] Karczewska O, Młynarska A: The Influence of Antiarrhythmic Device Intervention on Biopsychosocial Functioning and Anxiety in Patients with an Implanted Cardioverter Defibrillator. Medicina (Kaunas). 2021; 57(2). PubMed Abstract | Publisher Full Text

[29] Kato K, Zweig R, Schechter CB, et al.: Positive attitude toward life, emotional expression, self-rated health, and depressive symptoms among centenarians and near-centenarians. Aging Ment. Health. 2016; 20(9): 930–939. PubMed Abstract | Publisher Full Text | Free Full Text

[30] Klinedinst NJ, Resnick B, Yerges-Armstrong LM, et al.: The interplay of genetics, behavior, and pain with depressive symptoms in the elderly. Gerontologist. 2015; 55: S67–S77. PubMed Abstract | Publisher Full Text

[31] Kobylańska M, Kowalska J, Neustein J, et al.: The role of biopsychosocial factors in the rehabilitation process of individuals with a stroke. Work (Reading, Mass.). 2018; 61(4): 523–535. PubMed Abstract | Publisher Full Text

[32] Kobylańska M, Kowalska J, Neustein J, et al.: The role of biopsychosocial factors in the rehabilitation process of individuals with a stroke. Work. 2019; 61(4): 523–535. PubMed Abstract | Publisher Full Text

[33] Koo JH, Son N, Yoo K-B: Relationship between the living-alone period and depressive symptoms among the elderly. Arch. Gerontol. Geriatr. 2021; 94: 104341. PubMed Abstract | Publisher Full Text

[34] Kuroda Y, Iwasa H, Goto A, et al.: Occurrence of depressive tendency and associated social factors among elderly persons forced by the Great East Japan Earthquake and nuclear disaster to live as long-term evacuees: A prospective cohort study. BMJ Open. 2017; 7(9): e014339. PubMed Abstract | Publisher Full Text

[35] Laird KT, Siddarth P, Krause-Sorio B, et al.: Anxiety symptoms are associated with smaller insular and orbitofrontal cortex volumes in late-life depression. J. Affect. Disord. 2019; 256: 282–287. PubMed Abstract | Publisher Full Text

[36] Leggett A, Zarit SH, Nguyen NH, et al.: The influence of social factors and health on depressive symptoms and worry: A study of older Vietnamese adults. Aging Ment. Health. 2012; 16(6): 780–786. PubMed Abstract | Publisher Full Text

[37] Lewin A, Jöbges M, Werheid K: The influence of self-efficacy, pre-stroke depression and perceived social support on self-reported depressive symptoms during stroke rehabilitation. Neuropsychol. Rehabil. 2013; 23(4): 546–562. PubMed Abstract | Publisher Full Text

[38] Lewis A: Housing an ageing population: a reading list. House of Commons Library; 2021.

[39] Manaf MRA, Mustafa M, Rahman MRA, et al.: Factors influencing the prevalence of mental health problems among Malay elderly residing in a rural community: A cross-sectional study. PLoS One. 2016; 11(6): 1–12. PubMed Abstract | Publisher Full Text

[40] Matthieu MM, Lawrence KA, Robertson-Blackmore E: The impact of a civic service program on biopsychosocial outcomes of post 9/11 U.S. military veterans. Psychiatry Res. 2017; 248(December 2016): 111–116. PubMed Abstract | Publisher Full Text

[41] Meesters PD, Comijs HC, Sonnenberg CM, et al.: Prevalence and correlates of depressive symptoms in a catchment-area based cohort of older community-living schizophrenia patients. Schizophr. Res. 2014; 157(1–3): 285–291. Publisher Full Text

[42] Misawa J, Kondo K: Social factors relating to depression among older people in Japan: analysis of longitudinal panel data from the AGES project. Aging Ment. Health. 2019; 23(10): 1423–1432. Publisher Full Text

[43] Nadimpalli SB, James BD, Yu L, et al.: The association between discrimination and depressive symptoms among older African Americans: The role of psychological and social factors. Exp. Aging Res. 2015; 41(1): 1–24. PubMed Abstract | Publisher Full Text

[44] Nicolosi GT, Falcão DVDS, Batistoni SST, et al.: Depressive symptoms in old age: Relations among sociodemographic and self-reported health variables. Int. Psychogeriatr. 2011; 23(6): 941–949. PubMed Abstract | Publisher Full Text

[45] Odlum M, Davis N, Owens O, et al.: Correlates and aetiological factors associated with hedonic well-being among an ageing population of US men and women: Secondary data analysis of a national survey. BMJ Open. 2018; 8(11): e020962. PubMed Abstract | Publisher Full Text

[46] Olsen SJS, Schirmer H, Wilsgaard T, et al.: Cardiac rehabilitation and symptoms of anxiety and depression after percutaneous coronary intervention. Eur. J. Prev. Cardiol. 2018; 25(10): 1017–1025. PubMed Abstract | Publisher Full Text

[47] Paralikas T, Maria M, Dimitrios T, et al.: Physical and Mental Health Level of the Elderly Living in Central Greece. Materia Socio Medica. 2021; 33(1): 16–20. PubMed Abstract | Publisher Full Text

[48] Park SD, Yu SH: The effects of Nordic and general walking on depression disorder patients’ depression, sleep, and body composition. J. Phys. Ther. Sci. 2015; 27(8): 2481–2485. PubMed Abstract | Publisher Full Text

[49] Petkus AJ, Gum A, Wetherell JL: Thought suppression is associated with psychological distress in homebound older adults. Depress. Anxiety. 2012; 29(3): 219–225. PubMed Abstract | Publisher Full Text

[50] Piboon K, Subgranon R, Hengudomsub P, et al.: A causal model of depression among older adults in Chon Buri Province, Thailand. Issues Ment. Health Nurs. 2012; 33(2): 118–126. Publisher Full Text

[51] Pocklington C: Review Article Depression in older adults. Br. J. Medical Pract. 2017; 10(1): 7. https://www.bjmp.org/files/2017-10-1/bjmp-2017-10-1-a1007.pdf.

[52] Pollock A, Berge E: How to do a systematic review. Int. J. Stroke. 2018; 13(2): 138–156. Publisher Full Text

[53] Popescu ML, Boisjoly H, Schmaltz H, et al.: Explaining the relationship between three eye diseases and depressive symptoms in older adults. Invest. Ophthalmol. Vis. Sci. 2012; 53(4): 2308–2313. PubMed Abstract | Publisher Full Text

[54] Pusswald G, Fleck M, Lehrner J, et al.: The “Sense of Coherence” and the coping capacity of patients with Parkinson disease. Int. Psychogeriatr. 2012; 24(12): 1972–1979. PubMed Abstract | Publisher Full Text

[55] Rhee MK, Jang Y, Kim SY, et al.: The moderating role of social factors in the relationship between an incident of fall and depressive symptoms: a study with a national sample of older adults in South Korea. Aging Ment. Health. 2021; 25(6): 1086–1093. PubMed Abstract | Publisher Full Text

[56] Rippon I, Steptoe A: Is the relationship between subjective age, depressive symptoms and activities of daily living bidirectional? Soc. Sci. Med. 2018; 214(August): 41–48. PubMed Abstract | Publisher Full Text

[57] Rzewuska M, Mallen CD, Strauss VY, et al.: One-year trajectories of depression and anxiety symptoms in older patients presenting in general practice with musculoskeletal pain: A latent class growth analysis. J. Psychosom. Res. 2015; 79(3): 195–201. PubMed Abstract | Publisher Full Text

[58] Sadler P, McLaren S, Jenkins M: A psychological pathway from insomnia to depression among older adults. Int. Psychogeriatr. 2013; 25(8): 1375–1383. PubMed Abstract | Publisher Full Text

[59] Sakurai R, Kawai H, Suzuki H, et al.: Poor Social Network, Not Living Alone, Is Associated With Incidence of Adverse Health Outcomes in Older Adults. J. Am. Med. Dir. Assoc. 2019; 20(11): 1438–1443. Publisher Full Text

[60] Sanders JB, Comijs HC, Bremmer MA, et al.: A 13-year prospective cohort study on the effects of aging and frailty on the depression-pain relationship in older adults. Int. J. Geriatr. Psychiatry. 2015; 30(7): 751–757. Publisher Full Text

[61] Sjöberg L, Östling S, Falk H, et al.: Secular changes in the relation between social factors and depression: A study of two birth cohorts of Swedish septuagenarians followed for 5 years. J. Affect. Disord. 2013; 150(2): 245–252. Publisher Full Text

[62] Stringa N, Milaneschi Y, van Schoor NM , et al.: Genetic Liability for Depression, Social Factors and Their Interaction Effect in Depressive Symptoms and Depression Over Time in Older Adults. Am. J. Geriatr. Psychiatr. 2020; 28(8): 844–855. Publisher Full Text

[63] Thipprakmas R: Prevalence and Factors Associated with Depression in the Elderly: A Systematic Review. Regioanal Health Promotion Center 9. 2021; 15(37): 325–338.

[64] Wang J, Li W, Yue L, et al.: The Study of White Matter Hyperintensity (WMH) and Factors Related to Geriatric Late-Onset Depression. Shanghai Arch. Psychiatry. 2018; 30(1): 12–19. Publisher Full Text

[65] Wang L, Tao Y, Chen Y, et al.: Association of post stroke depression with social factors, insomnia, and neurological status in Chinese elderly population. Neurol. Sci. 2016; 37(8): 1305–1310. Publisher Full Text

[66] Wild B, Heider D, Maatouk I, et al.: Significance and costs of complex biopsychosocial health care needs in elderly people: Results of a population-based study. Psychosom. Med. 2014; 76(7): 497–502. PubMed Abstract | Publisher Full Text

[67] Woods A, Solomonov N, Liles B, et al.: Perceived Social Support and Interpersonal Functioning as Predictors of Treatment Response Among Depressed Older Adults. Am. J. Geriatr. Psychiatr. 2021; 29(8): 843–852. PubMed Abstract | Publisher Full Text

[68] World Federation for Mental Health: Mental health and older people. 2013. Publisher Full Text

[69] Ylli A, Miszkurka M, Phillips SP, et al.: Clinically relevant depression in old age: An international study with populations from Canada, Latin America and Eastern Europe. Psychiatry Res. 2016; 241: 236–241. PubMed Abstract | Publisher Full Text

Biopsychosocial factors associated with depression in the elderly: A systematic literature review

Abstract

Background

Methods

Results

Conclusions

Keywords

Revised Amendments from Version 1

Introduction

Objectives

Methods

Results

Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.

Figure 2. Origin of included studies.

Figure 3. Design of included studies.

Figure 4. Year of publication for included studies.

Figure 5. Critical appraisal based on Joanna Briggs Institute (JBI) checklist.

Table 1. Data extracted from eligible studies.

Table 2. JBI Score.

Biological factor

Psychological factors

Social factor

Discussion

Biological factors

Psychological factors

Social factors

Limitations

Conclusions

Data availability

Underlying data

Extended data

Reporting guidelines

Acknowledgements

References

Comments on this article Comments (0)

Open Peer Review

Comments on this article Comments (0)

Open Peer Review

Reviewer Status

Reviewer Reports

Comments on this article

Browse by related subjects

Competing Interests Policy

Stay Updated