Effectiveness of Social Support for Community-Dwelling Elderly with Depression: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Study Selection
2.3. Data Extraction
2.4. Risk of Bias in Individual Studies
2.5. Statistical Analysis
3. Results
3.1. Study Selection
3.2. Study Characteristics
3.3. Risk of Bias within Studies
3.4. Meta-Analysis of Selected Studies
3.4.1. Social Support
3.4.2. Social Participation
3.4.3. Social Connection and Social Network
4. Discussion
4.1. Social Resources Were Effective Interventions for Depression in the Elderly of the Community
4.2. Implications of the Meta-Analysis and Subgroup Analysis Results
4.3. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Author (Year) | Study Design | Country | Object Country | Sample Size (n) | Age (Mean, Range) | Location | Male/Female (n) | Depression Measurement | Social Support Measure | Social Support Explanation | Covariate |
---|---|---|---|---|---|---|---|---|---|---|---|
(City) | |||||||||||
Mulat (2021) | cross-sectional | Ethiopia | Ethiopian | 959 | 69.04 (SD 6.602) | Community (urban/rural) | 463/478 | GDS | Perceived social support: the Oslo-3 scale and individuals score | Perceived social support: social support has been described as support access to an individual through social ties to other individuals, groups, and the larger community | age, gender, occupational status, marital status, family size, living arrangement, known chronic disease, physical disability, sleep medication, a good relationship with neighbors, feeling of loneliness, ever used tobacco |
Choi (2020) | cross-sectional | Korea | Korean | 4751 Depressed1280 Non-depressed3471 | Depressed 73.82 (SD 7.90) Non-depressed71.24 (SD7.42) | Community | Depressed 421/859 Non-depressed1512/1959 | CES-D | Social participation, Emotional social support: Additional survey of the Korean Retirement and Income Study (KReIS) | The social participation
| age, gender, education level, income level, marital status, living alone, chronic disease, self-rated health, limitations on activities of daily living, satisfaction with living conditions |
Adams (2020) | cross-sectional | Tanzania | Tanzanian | 304 | 60–80, >80 | Community (rural) | 149/155 | GDS-15 | the Oslo-3 Social Support Scale (OSS-3) | The scale provides a brief measure of social functioning.
| age, gender, education, occupation, marital status, living alone, participation in social activities, participation in religious activities, consumed alcoholic drink past 12 months, ever consumed tobacco products, history of hypertension, history of stroke, history of diabetes, stressful life events past one year, history of cognitive impairment, family history of depression |
Ahmad (2020) | cross-sectional | Malaysia | Malaysian | 3772 | over 60 | community | 1872/2105 | Malay version of the Geriatric Depression Scale (M-GDS-14) | Duke’s Social Support Index | Duke’s Social Support Index: scores of 11–26 were considered as low social support. | locality, highest education level, sex, living arrangements |
Bal (2020) | cross-sectional | China | Chinese | 1810 | 70 (SD 7.51) (range 60–96) | community | 770/1040 | The Zung self-rating Depression Scale (SDS) | The framework of the World Bank’s Social Capital Assessment Tool and previous works of our research group: six dimensions of social capital |
| age, gender, BMI, residence, living status, marital status, education, smoking, drinking status |
Bui (2020) | longitudinal | United states | American | 2200 | 67.235 (SD 0.229) (range 57–85) | community | 48% male 52% female | CES-D | Social support, Network structure Social network function | Network structure
| depressive symptoms, age, female, white, college or higher, cohabiting |
Jin (2020) | cross-sectional | China | Chinese | 1779 | 69.22 (SD 6.98) | community | 585/1194 | GDS-5 | Social Support Rating Scale (SSRS) |
| age, female, high income, years of schooling, cognitive impairment, number of chronic diseases, ADL score, IADL score, pain, physical frailty score |
Kim (2020) | Prospective cohort | America | American | 2261 | 68.5 (SD = 7.5) 57–85 (range) | community | 48%/52% | CES-D |
|
| - |
Lee (2020) | cross-sectional | Korea | Korean | 10,082 | over 65 | community | 4046/6036 | The Korean version of the Geriatric Depression Scale-Short form (SGDS-K) | Emotional support exchange Social network Social participation |
| education, equivalent household income |
Reynolds (2020) | longitudinal | United states | American | 1592 | 69.3 (SD 7.9) (range 57–85) | community | 48% male 52% female | Epidemiologic Studies Depression Scale | community-layer connection interpersonal-layer connection partner-layer connection |
| depression, functional health problem, age, job status, assets, sex, education, race: black, race: white, ethnicity: Hispanic |
Wu (2020) | cross-sectional | Taiwan | Taiwanese | 153 | 71.56 (SD 8.46) | community | 57/96 | GDS-15 | Chinese version of the Multidimensional Scale of Perceived Social Support Chinese version of the Intergenerational Relationship Scale |
| age, sex, marital status, education, religious preference, living arrangement, employment, economic status, perceived health, comorbidity, medications, sleep quality, nap habits, regular exercise, leisure activities, Barthel index, IADL, Use of social media |
Gu (2019) | cross-sectional | China | Chinese | 172 | 74.92 (SD = 6.63) 60–92 (range) | community | 62/110 | GDS-15 | Lubben social network scale (LSNS-6) | Family social support network (three items) and friend social support network (three items): the number of relatives or friends whom older people feel close to or ask for support (0 = ‘none’, to 5 = ‘nine or higher’) (Total score range: 0–30, If score < 12: social isolation) | Sex, Age, Educational level, Economic status, Number of chronic illnesses, cognitive function |
Kim (2019) | cross-sectional | South Korea | South Korean | 1000 | 74.9 (SD = 6.4) 65–90 (range) | community | 410/590 | GDS-15 | Lubben social network scale Revised (LSNS-R) |
| Sociodemographic variables(Age, Gender, Marital Status, Education, Income, Living arrangement, Residential area) Health-related variables (Self-rated health, Chronic diseases, IADL) |
Yamaguchi (2019) | Prospective cohort | Japan | Japanese | 29,065 | M:72.3 (SD = 5.4) F:72.4 (SD = 5.4) | community | 14465/14600 | GDS-15 | Social capital
|
| Age, Family structure, Martial Status, Income, Current employment, Educational attainment, Comorbidity |
Chao (2018) | cross-sectional | America (Chicago) | Chinese American | 3157 | 72.8 (SD = 8.3) 60–105 (range) | community urban and rural | 1318/1821 | PHQ-9 (The patient Health Questionnaire) |
|
| Social demographic variables (age, gender, years of education completed, annual personal income, marital status, the number of children, living arrangement, years in the United States, years in the community, country of origin, medical comorbidities) |
Compete (2018) | cross-sectional | Mexico city | Mexican | 526 | age 65 and above | community center | 526 (only women) | GDS-15 | Perceived social support (OSS-3; Oslo scale 3 items) | Perceived social support: the quantity and satisfaction of individuals’ perceived social networks (Total range: 3–14, Higher values represent greater support) | Elder abuse, Age, Education, Household size, Lives alone, Currently employed, Comorbidities, Self-reported health status, Functional impairment(ADL, IADL) |
Gayman (2018) | cross-sectional | America (Miami-Dade) | African American | 248 | 58.11 (SD = 16.26) 18–86 (range) | community | NS | CES-D-20 | Perceived social support (a modified and shortened version of the Provisions of Social Relations scale)
| Perceived Social support
| Socioeconomic Status (Household income), Social stressors, Daily discrimination, Mastery, Self-esteem, Marital Status |
Hu (2018) | Prospective cohort | China | Chinese | 6772 | age 60 and above | rural and urban | 3390/3382 | CES-D | Social support
|
| Individual demographics (gender, age, educational level, physical health status), The domain of family attributes (annual household expenditure per capita), Residential areas |
Kim (2017) | cross-sectional | America | Japanese American | 207 | 86.74 (SD = 6.48) 68–103 (range) | community or institutional | 50/157 | GDS-15 | Social support (MOSS-E; The Measurement Of Social Support in the Elderly scale) | Instrumental support (assisting with physical needs such as cooking and cleaning) & Emotional support (assisting emotions and mental health) & Providing support | Demographic variables (Age, Gender, Martial status, Education, Income), Cognitive function(MMSE) |
Park (2017) | cross-sectional | America | Korean American | 209 | 69.59 (SD = 7.51) | community | 75/134 | CES-D-9 (short form) | Social integration variables
|
| Demographic variables (Age, Gender, Education, Perceived income, Length of stay in the USA), Health variables (Chronic conditions of 9 diseases, Functional disability-ADL, IADL), Living alone |
Ang (2016) | Prospective cohort | Singapore | Chinese, Malay, Indian | 2766 | age 60 and above | community | 1290/1476 | CES-D | Received social support | Money, Housework help, Material goods (Food, Clothes or other), Mobility help (Help to go to the doctors, marketing, shopping, go out to visit friends, using public transportation), Emotional support or advice | Socio-demographics (Race, living arrangement, employment status, housing type), Functional limitation (ADL, IADL), Chronic illnesses, Difficulty with vision, Difficulty with hearing |
Aung (2016) | cross-sectional | Thailand | Thai | 435 | 83.8 ± 3.5 | community urban and rural | 196/239 | GDS-30 | Social Network Index (SNI) | the number of social roles in which the respondent has regular contact, at least once every 2 weeks, with at least one person: (12) spouse, parents, their children and children-in-law, close relatives, close friends, religious members (such as church or temple), classmates, teachers and students in adult education, coworkers or colleagues, neighbors, volunteer networks, and others organizations (Score: 1–3 (limited), 4–5 (medium), 6 and over (diverse) social network) | Demographics (age, sex, and educational attainment), Health status (dependency, self-impression of health), Cognitive decline (short-term and long-term memory loss) |
Chen (2016) | cross-sectional | Hong Kong | Hong Kong | 400 | 80.2 (SD = 7.5) | community facilities | 174/226 | GDS-15 | Neighborhood support network
| The persons who they relied on for help in buying groceries and daily necessities, and escorting to medical appointments, without setting a limit on the number of people they named. Each person named was classified into 4 ->1), 2), 3), 4) | Age, Gender, ADL, Recent fall history, Marital status, Monthly income, Education level, Perceived proximity |
Li (2016) | cross-sectional | China | Chinese | 5103 | 68.65 (SD = 7.45) 60–101 (range) | community urban and rural | 2552/2551 | CES-D | Social support and participation
|
| Age, Gender, Are (Rural-urban), Socioeconomic status (Education, Pension benefit, Household asset, Community infrastructure), Healthcare access (Distance to healthcare facility, health insurance, No physician visit when ill, No hospitalization when needed, Self-discharge from hospital), Health Status (Chronic conditions, ADL, IADL) |
Tsuboi (2016) | cross-sectional | Japan | Japanese | 24,632 | 65–100 (range) | community | 11,869/12,763 | GDS-15 (Japanese ver.) | Social support (the 2-Way Social Support Scale)
|
| ADL, Socioeconomic status (years of schooling, annual income), living alone |
Vanoh (2016) | cross-sectional | Malaysia | Malaysian | 2264 | With depressive: 69.8 (SD = 6.4) without:68.9 (SD = 6.2) | community | 1083/1181 | GDS-15 | Medical Outcome study Social Support (MOSS) | Assessing social support (not specific) | Sociodemographic, Calorie restriction, Fitness, Health status, Functional status, Cognitive status, Lifestyle activities |
Yoo (2016) | cross-sectional | South Korea | South Korean | 648 | 75.4 (SD = 5.9) | community (Homes, Small community halls, senior welfare centers) | 195/453 | SGDS-K (KoreanversionofGDS-15) | Social support (PSSS; The Perceived Social Support Scale) | PSSS (informational, tangible, emotional support and self-esteem) (Total range: 20–80, Higher values represent greater support) | Background characteristics (Age, Gender, Education, Financial activities, Current health status, Coresident family members), Physical variables (Number of chronic diseases, Functional independence; K-MBI), Psychological variables (Number of stressful life events (in the past year), Life satisfaction) |
Jinhui Li (2015) | cross-sectional | Singapore | Singaporean | 162 | 72.19 (SD = 6.23) | community urban (senior activity centers) | 39/123 | GDS-15 | Social support (DSSI-10; Duke social support index) | DSSI-10: Social satisfaction and social interaction (Total range: 10–30, Higher values represent greater support) | Demographic data (Age, Gender, Education, Living arrangement), Perceived income adequacy, Perceived life quality, Psychological resilience (RAS), Loneliness (ULS-8) |
Ng (2014) | cross-sectional | Singapore | Malay, Chinese, Indian, Others | 2447 | age 60 and above | community | 1048/1399 | GDS-15 | Social support
|
| Chronic Diseases, Functional Status, Pain, Cognition |
Wee (2014) | cross-sectional | Singapore | Singaporean | 559 | age 60 and above | community | 250/309 | GDS-15 | Social network (LSNS-6; Lubben Social Network Scale) | Social network: same as Gu (2019) | Demographic factors (Marital Status), Clinical factors (Falls, visual impairment, musculoskeletal conditions, diabetes mellitus) |
Chen (2012) | Prospective cohort | China | Chinese | 1275 | age 60 and above | community urban | 490/785 | SCID interview (Structured Clinical Interview for DSM-IV), PHQ-9 | Social support from family
|
| Sociodemographic (Gender, Education level), Health status(medical burden-CIRS, daily life function-IADL) |
Gong (2012) | cross-sectional | China | Chinese | 1317 | 68.67 (SD = 6.54) | community rural | 655/662 | BDI-II (Back Depression Inventory-II) | Support from family members | Support from family members: Asked respondents to rate support from five types of family member (spouse, parents, sons and/or daughters, siblings, and other relatives) (3 levels: Bad, Fair, Good) | Demographic(Age, gender, years of schooling), Self-perceived physical health, Family characteristics(Living with spouse, Living with descendant, Self-reported family economic status, Family-related negative life events) |
Kim (2012) | cross-sectional | South Korea | South Korean | 263 | age 65 and above M:71.0 ± 5.8 F:74.4 ± 6.6 | community | 103/160 | SGDS (Short form of Geriatric Depression scale-Korean ver.) |
|
| Disease stress, Economic stress, Perceived health status, Education level, Age, Hypertension |
Wang (2012) | cross-sectional | China | Chinese | 209 | Depressed: 64.5 ± 2.86 Not-depressed:63.8 ± 2.84 | community urban | 98/111 | GDS | Multidimensional Scale of Perceived Social Support (MSPSS)
| Multidimensional Scale of Perceived Social Support (MSPSS): Social support from friends, family and significant others (Higher scores indicate lower perceived support) | Family functioning (PS-Problem solving, CM-communication, RL-Roles, AR-Affective responsiveness, AI-Affective involvement, BC-Behavioral control, GF-General functioning), Marital status |
Chan (2011) | cross-sectional | Macau | Chinese | 839 | 71.4 (SD = 7.7) Median:70 (60–98) | community | NA | GDS-15 | Lubben Social Network Scale (SNS) | Lubben Social Network Scale (SNS)
| Demographic factors (Age, Education, Ethics group, Marital status, Live status, Ability to meet living costs, Monthly income, Need spectacles, Need a hearing aid), Daily activity factors ((MBI, Ability to do the following tasks), Health needs/behavior factors (Chronic illness, Symptoms in the previous three months, Perceived health) |
Chao (2011) | Prospective cohort | Taiwan | Taiwanese | 1743 (2003yr) | 87.1 (SD = 4.6) (2003yr) | community | 926/817 | CES-D | Social support
|
| Demographic (Age, Gender, Education, Ethnicity), Physical health status (IADL) |
Chan (2010) | cross-sectional | Singapore | Singaporean, Chinese, Malays, Indians, others | 4489 | 69.3 ± 7.2 60–97 (range) | community | 2078/2411 | 11-item CES-D | Living arrangement Modified Lubben’s revised social network scale (LSLS-12) | Living arrangement LSLS-12: Social networks with friends and with relatives outside the household
| Living arrangements, Ethnic group, Education, Presence of ADL limitations, Presence of IADL limitation, Housing type, Social activities |
Suttajit (2010) | cross-sectional | Thailand | Thai | 1104 | 60–79, over80 | community rural | 495/609 | EURO-D | The scale of Six Social Support deficits |
| Age, Gender, Marital status, Education, Socioeconomic status, Work status |
Chan (2009) | cross-sectional | Macau | Chinese, Asian, European, American | 1042 | 71.4 ± 7.4 median 71.0 60–98 (range) | community | NA | GDS-15 | Lubben Social Network Scale (LSNS) | Lubben Social Network Scale (SNS)
| Demographic factors (Age, Education, Ethics group, Marital status, Live status, Ability to meet living costs, Monthly income, Need spectacles, Need a hearing aid), Daily activity factors ((MBI, Ability to do the following tasks), Health needs/behavior factors (Chronic illness, Symptoms in the previous three months, Perceived health, Required to pay for the consultation fee) |
Mechakra-Tahiri (2009) | cross-sectional | Canada | Canadian | 2670 | 65–84, over 85 (range) | Community | 1073/1596 | ESA Diagnostic Questionnaire and based on the DSM-IV(ESA-Q) | Social relationship: Structural relationship (Informal network, Formal network), Functional relationship (social support, presence of conflict) | Structural relationship
| Age, Area of residence, Chronic condition, Self-rated health |
Shin (2008) | cross-sectional | Korea | Korean | 787 NSS (Normal social support):592 PSS (Poor social support):195 | NSS:75.61 ± 08.44, PSS:74.89 ± 08.32 | community | NSS: 52.7% (female) PSS:52.8% (Female) | DSM-IV criteria, Korean version of the Geriatric Depression Scale(GDS-K) Korean version of the Hamilton Depression Rating Scale(HAM-D) | Medical Outcome Study Social Support Survey (MOS-SSS) |
| Age, Gender, Education |
Leung (2007) | cross-sectional | Taiwan | Taiwanese | 507 | 72.26 (SD = 4.70) 65–92 (range) | community industrial city/rural | 321/186 | Chinese version of Symptom Checklist 90-R(SCL-90-R) | Social Support Rating Scale(SSRS) Chinese modification of the Family Emotional Involvement and Criticism Scale (FEICS) | SSRS: Perceived instrumental and emotional support FEICS: Family functioning | Age, Gender, Location, ADL, Cognitive function, Chronic disease, Intimacy, Criticism |
Chen (2005) | cross-sectional | China | Chinese | 1600 | 60–80, over 80 | rural | 754/846 | Geriatric Mental State(GMS), Automated Geriatric Examination for Computer Assisted Taxonomy(AGECAT) | Social support
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Chi (2005) | cross-sectional | Hong Kong | Chinese | 917 | over 60 | community households | 445/472 | GDS-15 | Lubben Social Network Scale (LSNS) | LSNS: Social support from family members and friends
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Koizumi (2005) | Prospective cohort | Japan | Japanese | 753 | over 70 | community urban | NA | GDS | Social support questionnaire | Social support:
| sex, age, GDS score in the 2002 CGA, presence or absence of spouse, number of household members, number of past physical diseases, age at finishing school education, MMSE score, physical function, pain, self-rated health |
Lee (2005) | cross-sectional | Korea and Japan | Korean and Japanese | K:1298/J:1495 | over 65 | community | K: 60.3% (female) J: 60.8% (female) | GDS-15 | Social support index: Comprised of both receiving and giving social support | Comprised of both receiving and giving social support | Age, gender, Education, Poor self-rated health, Functional capacity, Cognitive impairment, Smoking, Sleep, BMI, Hospitalization, lifetime occupation, Chronic condition |
Tsai (2005) | cross-sectional | Taiwan | Taiwanese | 1200 | With:74.6 (SD = 5.6) without:74.3 (SD = 5.4) | community | with:164/166 without:506/364 | GDS-15 | Social support scale
| Social support scale: social support among elders living alone
| gender, educational level, marital status, number of diseases, satisfaction with living situation, perceived health status, perceived income adequacy, cognitive status, functional status, disease |
Adams (2004) | cross-sectional | America | American | 234 | 81.35 ± 7.0 60–98(range) | Independent living section of congregate retirement housing (Residentsaregenerallyretiredandwithoutadultchildrenorgrandchildrenlivinginthesamehousehold) | 56/159 (not respond:19) | GDS | Lubben Social Network Scale(LSNS) Number visitors/week Visitor type | Lubben social Network Scale
Visitor type: neighbor, visitor: Adult child, Visitor: Friend | Age, Gender, Marital status, Facility, Number of chronic health conditions, Grieving, Number activities/week, Church attendance/month, UCLA Loneliness Scale |
Chi (2001) | cross-sectional | Hong Kong | Chinese | 1106 | 72.55 (SD = 7.33) 60–95 (range) | community | 488/618 | CES-D | social support | Social support
| Demographic (Age, Gender, Years of education), Functional impairment (ADL, IADL, Physical performance) |
Hays (1998) | cross-sectional | America | American | 4162 | 72.92 (SD = 6.29) 64–100(range) | Community Household | NA | CES-D | Perceived social support |
| Age, Gender, Race, Years of education, Family income, Cognitive impairment, Chronic health problems, Functional disability, Negative life events |
Antonucci (1997) | cross-sectional | France | French | 3777 | 75.21 (SD = 6.92) | community urban | 1576/2201 | CES-D | Social relation: version of portions of the Social networks in Adult life Questionnaire |
| Age, Gender, Functional impairment |
Henderson (1997) | Prospective cohort | Australia | Australian | 1045 | 80.1 (SD = 4.9) 73–102 (range) | community Wave1:communityorinstitution | NA | Canberra Interview for the Elderly (CIE) (ICD-10 andDSM-III-RorDSM-IV) | Social support |
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Lee, S.H.; Lee, H.; Yu, S. Effectiveness of Social Support for Community-Dwelling Elderly with Depression: A Systematic Review and Meta-Analysis. Healthcare 2022, 10, 1598. https://doi.org/10.3390/healthcare10091598
Lee SH, Lee H, Yu S. Effectiveness of Social Support for Community-Dwelling Elderly with Depression: A Systematic Review and Meta-Analysis. Healthcare. 2022; 10(9):1598. https://doi.org/10.3390/healthcare10091598
Chicago/Turabian StyleLee, Seon Heui, Hanju Lee, and Soyoung Yu. 2022. "Effectiveness of Social Support for Community-Dwelling Elderly with Depression: A Systematic Review and Meta-Analysis" Healthcare 10, no. 9: 1598. https://doi.org/10.3390/healthcare10091598