Loneliness in senescence and its relationship with depressive symptoms: an integrative review

The increase in life expectancy and the percentage increase in the older population are related to the reduction in quality of life and social life due to the biopsychosocial changes inherent to the aging process. The present study aimed to verify scientific evidence on the relationship between loneliness and depressive symptoms among older adults. An integrative review was carried out using the following databases: SCOPUS, PubMed, Medline, Web of Science, CINAHL and PyscINFO, applying the descriptors indexed in the Mesh Terms and DeCS “aged”, “loneliness”, “depression”. The PICOS strategy was used to prepare the title and guiding question and the PRISMA methodological guidelines were used to write the report of this review. A total of 827 articles were identified, of which 23 were selected, 16 from the database and seven through a reverse search. Loneliness and depression have some characteristics in common, so that when one of these conditions develops in older adults, another is stimulated. Thus, loneliness is a major risk factor for the development of depression, just as depression is an aggravating factor for loneliness in older adults.

Keywords:
Aging; Health of the Elderly; Loneliness; Depression

Authorship

Letícia Menezes de Oliveira

Universidade Federal da Paraíba, Departamento de Enfermagem. João Pessoa, PB, Brasil.Universidade Federal da ParaíbaBrazilJoão Pessoa, PB, BrazilUniversidade Federal da Paraíba, Departamento de Enfermagem. João Pessoa, PB, Brasil.

https://orcid.org/0000-0002-6200-4854

Gesualdo Gonçalves de Abrantes

https://orcid.org/0000-0002-7074-9995

Gérson da Silva Ribeiro

Universidade Federal da Paraíba, Departamento de Enfermagem Clínica. João Pessoa, PB, Brasil.Universidade Federal da ParaíbaBrazilJoão Pessoa, PB, BrazilUniversidade Federal da Paraíba, Departamento de Enfermagem Clínica. João Pessoa, PB, Brasil.

https://orcid.org/0000-0003-2645-8020

Nilza Maria Cunha

Universidade Federal da Paraíba, Departamento de Enfermagem em Saúde Coletiva. João Pessoa, PB, Brasil.Universidade Federal da ParaíbaBrazilJoão Pessoa, PB, BrazilUniversidade Federal da Paraíba, Departamento de Enfermagem em Saúde Coletiva. João Pessoa, PB, Brasil.

https://orcid.org/0000-0002-8834-3571

Maria de Lourdes de Farias Pontes

https://orcid.org/0000-0002-5187-6876

Selene Cordeiro Vasconcelos

https://orcid.org/0000-0002-8828-1251

Correspondence Letícia Menezes de Oliveira leticia_menezmenezes@hotmail.com

The authors declare there are no conflicts of interest in relation to the present study.

Edited by:

Ana Carolina Lima Cavaletti

SCIMAGO INSTITUTIONS RANKINGS

Figures | Tables

Figures (1)
Tables (1)

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Figure 1
Flowchart of article selection process based on the PRISMA⁷7 Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Loannidis, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions. BMJ. 2009;339:1-28. method. Paraíba, 2019.

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Table 1
Overall characteristics of articles selected for sample, (n=28). Paraíba, 2019.

Figure 1 Flowchart of article selection process based on the PRISMA⁷7 Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Loannidis, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions. BMJ. 2009;339:1-28. method. Paraíba, 2019.

Table 1 Overall characteristics of articles selected for sample, (n=28). Paraíba, 2019.

Author/Year	Methodological design	Sample	Main Results
Chou, K. L.; Chi, I.; Boey, K. W.¹⁶ 2000	Cross-sectional study.	1,106 older adults.	Older adults living alone (social loneliness) report more depressive symptoms.
Ramos, M.; Wilmoth, J.²⁷27 Ramos M, Wilmoth J. Social relationships and depressive symptoms among older adults in southern Brazil. J Gerontol Ser B Psychol Sci Soc Sci. 2003;58(4):253-61. 2003	Cross-sectional study.	871 older adults.	A lack of social integration increases depressive symptoms and social integration reduces depressive symptoms.
Alpass, F. M.; Neville, S.⁸8 Alpass FM, Neville S. Loneliness, health and depression in older males. Aging Ment Health. 2003;7(3):212-6. 2003	Cross-sectional study.	217 older adults.	Lonely men have higher scores on the GDS scale.
Chou, K. L.; Chi, I.¹¹11 Chou KL, Chi I. Prevalence and correlates of depression in chinese oldest old. Int J Geriatr Psychiatr. 2004;20(1):41-50. 2004	Cross-sectional study.	1,903 older adults.	Loneliness was associated significantly and positively with depression.
Adams, K. B.; Sanders, S.; Auth, E.¹⁵15 Adams KB, Sanders S, Auth EA. Loneliness and depression in independent living retirement communities: risk and resilience factors. Aging Mental Health. 2004;8(6):475-85. 2004	Cross-sectional study.	Older adults aged between 60 and 98 years.	Not everyone who is lonely is depressed. Loneliness is not a determinant of depression, but it is a risk.
Stek, M. L.¹⁴14 Stek ML, Vinkers DJ, Gussekloo J, Beekman ATF, Van Der Mast RC, Westendorp RG. Is depression in old age fatal only when people feel lonely? Ame J Psychiatr. 2005;162(1):178-80. 2005	Longitudinal study.	476 older adults aged 85.	Those who suffered from depression and feelings of loneliness had a 2.1 times greater risk of mortality.
Tiikkainen, P.; Heikkinen, R. L.²⁰20 Tiikkainen P, Heikkinen RL. Associations between loneliness, depressive symptoms and perceived togetherness in older people. Aging Ment Health. 2005;9(6):526-34. 2005	Longitudinal study.	207 older adults aged 80 and 133 aged 85.	In women, depressive symptoms predict greater loneliness than in men; those who were lonely were more depressed and had less social interaction.
Paul, C.; Ayis, S.; Ebrahim, S.²²22 Paul C, Ayis S, Ebrahim S. Psychological distress, loneliness and disability in old age. Psychol Health Med. 2006;11(2):221-32. 2006	Cross-sectional study.	999 older adults.	People who live alone or feel lonely had higher rates of psychological distress.
Barg, F. K. et al.¹⁹19 Barg FK, Ashmore RH, Wittink MN, Murray GF, Bogner HR, Gallo JJ. A mixed-methods approach to understanding loneliness and depression in older adults. J Gerontol Ser B Psychol Sci Soc Sci. 2006;61(6):329-39. 2006	Cross-sectional study.	102 older adults.	Older adults participating in the study reported that loneliness is a precursor to depression and anxiety.
Aylaz, R., et al.⁹9 Aylaz R, Aktürk Ü, Erci B, Öztürk H, Aslan H. Relationship between depression and loneliness in elderly and examination of influential factors. Arch Gerontol Geriatr. 2012;55(3):548-54. 2012	Descriptive study.	17,080 older adults.	There was a positive correlation between geriatric depression and loneliness.
Tsai, F. J.; Motamed, S.; Rougemont, A.¹⁸18 Tsai FJ, Motamed S, Rougemont A. The protective effect of taking care of grandchildren on elders' mental health? Associations between changing patterns of intergenerational exchanges and the reduction of elders' loneliness and depression between 1993 and 2007 in Taiwan. BMC Public Health. 2013;13(1):1-9. 2013	Longitudinal study.	Individuals aged 50 and above.	Older people who live without a partner, without children or who do not provide care to their grandchildren are at greater risk of feeling lonely and depressed.
Dahlberg, l., et al.²⁶26 Dahlberg L, Andersson L, McKee KJ, Lennartsson C. Predictors of loneliness among older women and men in Sweden: A national longitudinal study. Aging Ment Health. 2014;19(5):409-17. 2014	Longitudinal study.	Older adults aged 76 and above.	The increase in depression and recent widowhood were significant predictors of loneliness.
Houtjes, W., et al.²⁴24 Houtjes W, van Meijel B, van de Ven PM, Deeg D, van Tilburg T, Beekman A. The impact of an unfavorable depression course on network size and loneliness in older people: a longitudinal study in the community. Int J Geriatr Psychiatr. 2014;29(10):1010-7. 2014	Longitudinal study.	Older adults with depressive symptoms.	Depression has been associated with higher levels of loneliness over time, especially in men and older adults.
Kvaal, K.; Halding, A. G.; Kvigne, K.³⁰30 Kvaal K, Halding AG, Kvigne K. Social provision and loneliness among older people suffering from chronic physical illness. A mixed methods approach. Scand J Caring Sci. 2013;28(1):104-11. 2014	Comparative study.	101 older adults.	18% of older adults who felt lonely were diagnosed with depression. Loneliness was related to the feeling of emptiness and negative emotions.
Navarro, J. R.; Benito-Leon, J.; Olazaran, K. A. P.¹²12 Navarro JR, Leon JB, Olazaran KAP. Depression in the aging: an important health problem in Mexico. Am Lat Hoy Rev Cienc Soc. 2015;71:103-18. 2015	Cross-sectional study.	1,126 older adults.	Lack of social support and loneliness were identified as factors that favor the onset of depressive symptoms. Widowhood and living alone are risk factors for depression.
Li, J.; Theng, Y. L.; foo, S.¹⁰10 Li J, Theng YL, Foo S. Depression and psychosocial risk factors among community-dwelling older adults in Singapore. J Cross Cult Gerontol. 2015;30(4):409-22. 2015	Cross-sectional study.	162 older adults.	Among the main psychosocial factors, loneliness has a stronger association with geriatric depression.
Fried, E. I., et al.¹⁷17 Fried EI, Bockting C, Arjadi R, Borsboom D, Amshoff M, Cramer AOJ, et al. From loss to loneliness: the relationship between bereavement and depressive symptoms. J Abnorm Psychol. 2015;124(2):256-65. 2015	Longitudinal study.	1,532 married older adults.	Grieving for a spouse mainly affected loneliness, which in turn activated other depressive symptoms.
Holvast, F., et al.³⁴34 Holvast F, Burger H, de Waal MMW, van Marwijk HWJ, Comijs HC, Verhaak PFM. Loneliness is associated with poor prognosis in late-life depression: longitudinal analysis of the Netherlands study of depression in older persons. J Affect Dis. 2015;185:1-7. 2015	Cohort study.	Individuals between 60 and 90 of age with major depression, dysthymia or minor depression.	Lonely respondents had fewer social networks and experienced more severe depressive symptoms.
Holwerda, T. J., et al.²¹21 Holwerda TJ, van Tilburg TG, Deeg DJH, Schutter N, Van R, Dekker J, et al. Impact of loneliness and depression on mortality: results from the Longitudinal Ageing Study Amsterdam. Br J Psychiatr. 2016;209(2):127-34. 2016	Cohort study.	2,878 individuals between 55 and 85 years old.	Women suffer more emotional loneliness and men, more social loneliness. Depression was associated with premature death in men, with higher mortality in the group of lonely people.
Wong, N. M. L., et al.²⁵25 Wong NML, Liu HL, Lin C, Huang CM, Wai YY, Lee SH, et al. Loneliness in late-life depression: structural and functional connectivity during affective processing. Psychol Med. 2016;46(12):2485-99. 2016	Cross-sectional study.	54 older adults.	Loneliness was a determinant of the negative affective processing of delayed depression.
Fernandes, S.; Davidson, J. G. S.; Guthrie, D. M.³⁵ 2017	Cohort study.	2,499 severely ill older adults.	Worsening symptoms of depression, declining social activities and not living with a primary caregiver increase the risk of loneliness.
Wang, G. et al.¹³13 Wang G, Hu M, Xiao S, Zhou L. Loneliness and depression among rural empty-nest elderly adults in Liuyang, China: a cross-sectional study. BMJ Open. 2017; 7(10):e016091 [8 p.]. 2017	Cluster trial.	814 older adults with at least one child.	Loneliness from empty nest syndrome leads to symptoms and major depressive episodes.
Conde-Sala, J. L. et al.³¹31 Conde-Sala JL, Olmo JG, Perxas LC, Garriga OT, Franch JV, et al. Course of depressive symptoms and associated factors in people aged 65+ in Europe: a two-year follow-up. J Affect Dis. 2019;245:440-50. 2019	Cohort study.	31,491 older adults.	One of the risk factors associated with depressive symptoms was loneliness and the female gender.

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Loneliness in senescence and its relationship with depressive symptoms: an integrative review

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[1] Correspondence Letícia Menezes de Oliveira leticia_menezmenezes@hotmail.com