Pinar Soysal1, Nicola Veronese2, Trevor Thompson3, Kai G Kahl4, Brisa S Fernandes5, A Matthew Prina6, Marco Solmi7, Patricia Schofield8, Ai Koyanagi9, Ping-Tao Tseng10, Pao-Yao Lin11, Che-Sheng Chu12, Theodore D Cosco13, Matteo Cesari14, Andre F Carvalho15, Brendon Stubbs16. 1. Kayseri Education and Research Hospital, Geriatric Center, Kayseri, Turkey. 2. National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy; Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy. 3. Faculty of Education and Health, University of Greenwich, London, United Kingdom. 4. Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. 5. IMPACT Strategic Research Centre, Deakin University School of Medicine, and Barwon Health, Geelong, VIC, Australia; Laboratory of Calcium Binding Proteins in the Central Nervous System, Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. 6. Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom. 7. Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy; Department of Neurosciences, University of Padova, Padova, Italy; Local Health Unit 17, Mental Health Department, Padova, Italy. 8. Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom. 9. Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain. 10. Department of Psychiatry, Tsyr- Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Taiwan. 11. Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan; Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. 12. Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan. 13. MRC Unit for Lifelong Health and Ageing at UCL, 33 Bedford Place, London WC1 B5JU, United Kingdom; Oxford Institute of Population Ageing, University of Oxford, 66 Banbury Road, Oxford, OX2 6PR, United Kingdom. 14. Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France; Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France. 15. Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil. 16. Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom; Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom. Electronic address: brendon.stubbs@kcl.ac.uk.
Abstract
AIM: Depression and frailty are prevalent and burdensome in older age. However, the relationships between these entities are unclear and no quantitative meta- analysis exists. We conducted a systematic review and meta-analysis to investigate the associations between depression and frailty. METHODS: Two authors searched major electronic databases from inception until November-2016 for cross-sectional/longitudinal studies investigating depression and frailty. The strength of the reciprocal associations between frailty and depression was assessed through odds ratios (ORs) adjusted for potential confounders. RESULTS: From 2306 non duplicated hits, 24 studies were included. The overall prevalence of depression in 8023 people with frailty was 38.60% (95% CI 30.07-47.10, I2=94%). Those with frailty were at increased odds of having depression (OR adjusted for publication bias 4.42, 95%CI 2.66-7.35, k=11), also after adjusting for potential confounders (OR=2.64; 95%CI: 1.59-4.37, I2=55%, k=4). The prevalence of frailty in 2167 people with depression was 40.40% (95%CI 27.00-55.30, I2=97%). People with depression were at increased odds of having frailty (OR=4.07, 95%CI 1.93-8.55, k=8). The pooled OR for incident frailty, adjusted for a median of 7 confounders, was 3.72 (95%CI 1.95-7.08, I2=98%, k=4), whilst in two studies frailty increased the risk of incident depression with an OR=1.90 (95%CI 1.55-2.32, I2=0%). CONCLUSION: This meta-analysis points to a reciprocal interaction between depression and frailty in older adults. Specifically, each condition is associated with an increased prevalence and incidence of the other, and may be a risk factor for the development of the other. However, further prospective investigations are warranted.
AIM: Depression and frailty are prevalent and burdensome in older age. However, the relationships between these entities are unclear and no quantitative meta- analysis exists. We conducted a systematic review and meta-analysis to investigate the associations between depression and frailty. METHODS: Two authors searched major electronic databases from inception until November-2016 for cross-sectional/longitudinal studies investigating depression and frailty. The strength of the reciprocal associations between frailty and depression was assessed through odds ratios (ORs) adjusted for potential confounders. RESULTS: From 2306 non duplicated hits, 24 studies were included. The overall prevalence of depression in 8023 people with frailty was 38.60% (95% CI 30.07-47.10, I2=94%). Those with frailty were at increased odds of having depression (OR adjusted for publication bias 4.42, 95%CI 2.66-7.35, k=11), also after adjusting for potential confounders (OR=2.64; 95%CI: 1.59-4.37, I2=55%, k=4). The prevalence of frailty in 2167 people with depression was 40.40% (95%CI 27.00-55.30, I2=97%). People with depression were at increased odds of having frailty (OR=4.07, 95%CI 1.93-8.55, k=8). The pooled OR for incident frailty, adjusted for a median of 7 confounders, was 3.72 (95%CI 1.95-7.08, I2=98%, k=4), whilst in two studies frailty increased the risk of incident depression with an OR=1.90 (95%CI 1.55-2.32, I2=0%). CONCLUSION: This meta-analysis points to a reciprocal interaction between depression and frailty in older adults. Specifically, each condition is associated with an increased prevalence and incidence of the other, and may be a risk factor for the development of the other. However, further prospective investigations are warranted.
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