research review journal of social science

About the Journal

Research Review Journal of Social Science (RRJSS) is a refereed online journal dedicated to the publishing of scholarly articles from practitioners of and dissenters from international, regional, studies, and it is also dedicated to providing a space for the work in the field of Social Science and Humanities.

This journal publishes high quality papers that engage theoretical and empirical issues in Social Science and Humanities fields. The journal also features case studies focusing on practical implications, or papers related to learning and teaching in Social Science and Humanities disciplines, and finally, book reviews on recently published books.

Most conventional journals publish papers from tightly defined subject areas, making it more difficult for readers from other disciplines to read them. RRJSS has no such barriers, which helps your research reach the entire scientific community.

After the article passes the plagiarism checking stage, each manuscript will be reviewed by at least two independent referees who are within the subject area. The journal follows double-blind peer review process.

This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge.

Research Review Journal of Social Science (RRJSS)

2583-2867 (Online)

Bi-Annual (Two Issues per Year)

English | Hindi | Gujarati

Turnitin

Online

+91-93284 90029

[email protected]

https://rrjournals.co.in/

15/B, Kalyan Nagar Society, Fire Brigade Road, Outside Shahpur Gate, Ahmedabad-380004 Gujarat (India)

Information

• For Readers
• For Authors
• For Librarians

Make a Submission

ISSN: 2583-2867 (Online)

Double blind | Peer-reviewed/ refereed | Bi-annual online journal

Research Review Journal of Social Science (RRJSS) is licensed under a Creative Commons Attribution 4.0 International License .

• Email us: [email protected]
• ISSN Online: 2581 - 8422

• Review Guidelines

Peer reviewers play a role in ensuring the integrity of the scholarly record. The peer-review process depends to a large extent on the trust and willing participation of the scholarly community and requires that everyone involved behaves responsibly and ethically. Peer reviewers play a central and critical part in the peer review process but may come to the role without any guidance and be unaware of their ethical obligations. Journals must provide transparent policies for peer review, and reviewers must conduct reviews in an ethical and accountable manner. Clear communication between the journal and the reviewers is essential to facilitate a consistent, fair and timely review.

Being a Reviewer

Professional Responsibility

Authors who have benefited from the peer review process should consider becoming peer reviewers as a part of their professional responsibilities. Some journals require a formal process of appointment to the review panel, and some require specific expertise; anyone interested in becoming a reviewer should look for the journal guidelines on peer review and follow any requirements posted. To assign appropriate reviewers, editors must match reviewers with the scope of the content in a manuscript to get the best reviews possible. Potential reviewers should provide journals with personal and professional information that is accurate and a fair representation of their expertise, including verifiable and accurate contact information. It is important to recognize that the impersonation of another individual during the review process is considered serious misconduct (e.g. see COPE Case 12-12: Compromised peer review in published papers ). When approached to review, agree to review only if you have the necessary expertise to assess the manuscript and can be unbiased in your assessment. It is better to identify any gaps in your expertise when asked to review.

Competing Interests

Ensure you declare all potential competing, or conflicting, interests. If you are unsure about a potential competing interest that may prevent you from reviewing, do raise this. Competing interests may be personal, financial, intellectual, professional, political or religious. If you are currently employed at the same institution as any of the authors or have been recently (e.g., within the past 3 years) mentors, mentees, close collaborators or joint grant holders, you should not agree to review. Also, you should not agree to review a manuscript just to gain sight of it with no intention of submitting a review or agree to review a manuscript that is very similar to the one you have in preparation or under consideration at another journal.

It is courteous to respond to an invitation to peer review within a reasonable time-frame, even if you cannot undertake the review. If you feel qualified to judge a particular manuscript, you should agree to review only if you can return a review within the proposed or mutually agreed on time-frame. Always inform the journal promptly if your circumstances change and you cannot fulfill your original agreement or if you require an extension. If you cannot review, it is helpful to make suggestions for alternative reviewers if relevant, based on their expertise and without any influence of personal considerations or any intention of the manuscript receiving a specific outcome (either positive or negative).

Conducting a Review

Initial Steps

Read the manuscript, supplementary data files and ancillary material thoroughly (e.g., reviewer instructions, required ethics and policy statements), getting back to the journal if anything is not clear and requesting any missing or incomplete items you need. Do not contact the authors directly without the permission of the journal. It is important to understand the scope of the review before commencing (i.e., is a review of raw data expected?).

Confidentiality

Respect the confidentiality of the peer-review process and refrain from using information obtained during the peer review process for your own or another’s an advantage, or to disadvantage or discredit others (e.g. see COPE Case 14-06: Possible breach of reviewer confidentiality ). Do not involve anyone else in the review of a manuscript (including early career researchers you are mentoring), without first obtaining permission from the journal (e.g. see COPE Case 11-29: Reviewer asks trainee to review manuscript ). The names of any individuals who have helped with the review should be included so that they are associated with the manuscript in the journal’s records and can also receive due recognition for their efforts.

Bias and Competing Interests

It is important to remain unbiased by considerations related to the nationality, religious or political beliefs, gender or other characteristics of the authors, origins of a manuscript or by commercial considerations. If you discover a competing interest that might prevent you from providing a fair and unbiased review, notify the journal and seek advice (e.g. see COPE Case 15-05: Reviewer requests to be added as an author after publication ). While waiting for a response, refrain from looking at the manuscript and associated material in case the request to review is rescinded. Similarly, notify the journal as soon as possible if you find you do not have the necessary expertise to assess the relevant aspects of a manuscript so as not to unduly delay the review process. In the case of double-blind review, if you suspect the identity of the author(s) notify the journal if this knowledge raises any potential competing or conflict of interest.

Suspicion of Ethics Violations

If you come across any irregularities concerning research and publication ethics do let the journal know (e.g. see COPE Case 02-11: Contacting research ethics committees with concerns over studies ). For example, you may have concerns that misconduct occurred during either the research or the writing and submission of the manuscript, or you may notice the substantial similarity between the manuscript and a concurrent submission to another journal or a published article. In the case of these or any other ethical concerns, contact the editor directly and do not attempt to investigate on your own. It is appropriate to cooperate, in confidence, with the journal, but not to personally investigate further unless the journal asks for additional information or advice.

Transferability of Peer Review

Publishers may have policies related to transferring peer reviews to other journals in the publisher’s portfolio (sometimes referred to as portable or cascading peer review). Reviewers may be asked to permit the transfer of their reviews if that is journal policy. If a manuscript is rejected from one journal and submitted to another, and you are asked to review that same manuscript, you should be prepared to review the manuscript afresh as it may have changed between the two submissions and the journal’s criteria for evaluation and acceptance may be different. In the interests of transparency and efficiency, it may be appropriate to provide your original review for the new journal (with permission to do so from the original journal), explaining that you had reviewed the submission previously and noting any changes. (See discussion2 with Pete Binfield and Elizabeth Moylan highlighting some of the issues surrounding portable peer review ).

Preparing a Report

Follow journals’ instructions for writing and posting the review. If a particular format or scoring rubric is required, use the tools supplied by the journal. Be objective and constructive in your review, providing feedback that will help the authors to improve their manuscript. For example, be specific in your critique, and provide supporting evidence with appropriate references to substantiate general statements, to help editors in their evaluation. Be professional and refrain from being hostile or inflammatory and from making libelous or derogatory personal comments or unfounded accusations (e.g. see COPE Case 08-13: Personal remarks within a post-publication literature forum ).

Appropriate Feedback

Bear in mind that the editor requires a fair, honest, and unbiased assessment of the strengths and weaknesses of the manuscript. Most journals allow reviewers to provide confidential comments to the editor as well as comments to be read by the authors. The journal may also ask for a recommendation to accept/revise/reject; any recommendation should be congruent with the comments provided in the review. If you have not reviewed the whole manuscript, do indicate which aspects of the manuscript you have assessed. Ensure your comments and recommendations for the editor are consistent with your report for the authors; most feedback should be put in the report that the authors will see. Confidential comments to the editor should not be a place for denigration or false accusation, done in the knowledge that the authors will not see your comments.

Language and Style

Remember it is the authors’ paper, so do not attempt to rewrite it to your preferred style if it is sound and clear; suggestions for changes that improve clarity are, however, important. Also, be aware of the sensitivities surrounding language issues that are due to the authors writing in a language that is not their first or most proficient language, and phrase the feedback appropriately and with due respect.

Suggestions for Further Work

It is the job of the peer reviewer to comment on the quality and rigor of the work they receive. If the work is not clear because of missing analysis, the reviewer should comment and explain what additional analysis would clarify the work submitted. It is not the job of the reviewer to extend the work beyond its current scope. Be clear which (if any) suggested additional investigations are essential to support claims made in the manuscript under consideration and which will just strengthen or extend the work.

Accountability

Prepare the report by yourself, unless you have permission from the journal to involve another person. Refrain from making unfair negative comments or including unjustified criticisms of any competitors’ work that is mentioned in the manuscript. Refrain from suggesting that authors include citations to your (or an associate’s) work merely to increase citation counts or to enhance the visibility of your or your associate’s work; suggestions must be based on valid academic or technological reasons. Do not intentionally prolong the review process, either by delaying the submission of your review or by requesting unnecessary additional information from the journal or author. If you are the editor handling a manuscript and decide to provide a review of that manuscript yourself (perhaps if another reviewer could not return a report), do this transparently and not under the guise of an anonymous additional reviewer.

What to Consider After Peer Review

If possible, try to accommodate requests from journals to review revisions or resubmissions of manuscripts you have reviewed previously. It is helpful to respond promptly if contacted by a journal about matters related to your review and to provide the information required. Similarly, contact the journal if anything relevant comes to light after you have submitted your review that might affect your original feedback and recommendations. Continue to respect the confidential nature of the review process and do not reveal details of the manuscript after peer review unless you have permission from the author and the journal (e.g. see COPE Case 13- 05: Online posting of the confidential draft by peer reviewer ). See the COPE discussion document Who “owns” peer reviews? 2 for a fuller discussion of the issues.

Source: COPE Ethical Guidelines for Peer Reviewers

• Become a Reviewer
• Peer Review Policy
• Reviewers List

• Open access
• Published: 20 June 2024

The association of social networks and depression in community-dwelling older adults: a systematic review

• Amelie Reiner   ORCID: orcid.org/0009-0002-8789-1303 1 &
• Paula Steinhoff   ORCID: orcid.org/0009-0001-2973-963X 1  

Systematic Reviews volume  13 , Article number:  161 ( 2024 ) Cite this article

163 Accesses

4 Altmetric

Metrics details

Background and objective

Depression is a globally prevalent mental condition, particularly among older adults. Previous research has identified that social networks have a buffering effect on depression. Existing systematic reviews have either limited their research to specific geographic areas or provided evidence from over a decade ago. The vast body of recent literature particularly from the last decade emphasizes the need for a comprehensive review. This systematic review aims to analyze the association of structural aspects of social networks and depression in older adults.

The electronic databases APA PsycINFO, ProQuest, PSYINDEX, PubMed, Scopus, SocINDEX, and Web of Science were searched from date of data base inception until 11 July 2023. Studies were eligible for inclusion if they reported on community-dwelling older adults (defined as a mean age of at least 60 years old), had an acceptable definition for depression, referred to the term social network in the abstract, and were published in English. Quality was appraised using the Newcastle Ottawa Scale for cross-sectional and longitudinal studies. Outcome data were extracted independently from each study and analyzed by direction of the relationship, social network domain and cross-sectional or longitudinal study design.

In total, 127 studies were included. The study categorizes structural network aspects into seven domains and finds that larger and more diverse networks, along with closer social ties, help mitigate depression. The literature on the relationships between depression and network density, homogeneity, and geographical proximity is scarce and inconclusive.

Discussion and implications

Despite inconsistent findings, this review highlights the importance of quantifying complex social relations of older adults. Limitations of this review include publication and language bias as well as the exclusion of qualitative research. Further research should use longitudinal approaches to further investigate the reciprocal relationship between social networks and depression. Following this review, interventions should promote the integration of older adults in larger and more diverse social settings.

Other: This work was supported by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Grant [454899704]. This systematic review was pre-registered. The review-protocol can be accessed at https://doi.org/10.17605/OSF.IO/6QDPK .

Peer Review reports

Depression is a mental condition that is particularly prevalent among older adults [ 1 ]. Scholars have identified a significant association between social networks and depression, with socially integrated older adults showing lower levels of depression than less socially integrated older adults [ 2 , 3 ]. As older adults face a decreasing number of social relationships and a shrinking social network over their life course [ 4 ], this growing population is at risk for depression. Systematizing and quantifying the social networks of older adults is vital to understanding their relationship with depression. The prevalence of depression will increase in the future. Understanding the aspects of social networks that are particularly important for preventing depressive symptomatology in older adults will allow appropriate social gerontological interventions.

Previous systematic reviews have generated important insights into the relationship between social networks and mental health. Across several geographical areas, various social network measures have been found to be significantly associated with mental health in older adults (Middle Eastern countries: [ 5 ]; Iran: [ 6 ]), and specifically depression (Asia: [ 2 ]; Western countries: [ 7 ]). However, only one systematic review has addressed the relationship between social networks and depression among older adults without restricting its evidence to a geographical area [ 3 ]. While Schwarzbach et al.’s [ 3 ] review has been helpful, new evidence about the social relations of older adults and depression outcomes must be reviewed because a significant amount has emerged over the last decade.

Additionally, previous studies and literature reviews have loosely applied the concept of social networks and engaged with different definitions and measures of social networks [ 8 , 9 ]. A social network is traditionally defined as the quantifiable ties binding individuals, families, communities, or businesses (i.e., nodes) together through a shared need, aim, or interest [ 10 , 11 ]. The nature of one’s social network was found to have a significant influence on an individual’s life expectancy, mortality rate, quality of life, and health-related behaviors [ 8 ]. Generally, the literature has distinguished between the quantitative/structural and qualitative/functional aspects of social relationships [ 12 , 13 ]. Qualitative aspects refer to the social network’s function, including the potential of social relationships, such as social support, the perceived quality of support provided, relationship satisfaction, loneliness and social isolation [ 13 , 14 ]. In contrast, quantitative aspects refer to the network’s structure, including its size, composition, and the frequency of contact between network members. Recently, it has become increasingly clear that quantifying social networks, which provides an objective measure of the structure of relationships, is particularly suited for understanding their association with critical health outcomes, such as cognitive decline [ 14 ], dementia [ 15 ], and mortality [ 16 ]. As structural aspects of social networks are causally prior to functional aspects, this review exclusively focuses on their structural aspects while examining their relationship with depression in older adults.

The relationship between social networks and depression can be considered reciprocal. The main effect model [ 17 ] states that social networks positively affect psychological state through mechanisms such as social recognition, a sense of belonging, and normative guidance for health-promoting behavior. Conversely, depression may affect the extent of social networks by causing social withdrawal and decreased social participation. Older adults who experience depression in later life often struggle with maintaining larger and more diverse personal networks and experience disruptions in their contact with social network members [ 18 ]. Existing research has predominantly focused on the effect of social networks on depression. Conversely, the reversed effect of depression on social networks has been largely neglected [ 19 , 20 ].

This systematic review, therefore, aims to synthesize the evidence about the relationship between structural aspects of social networks and depression in community-dwelling older adults. It addresses two research questions: (1) How do structural aspects of social networks impact depression outcomes in community-dwelling older adults? (2) How does depression impact structural aspects of social networks of community-dwelling older adults? It strives to provide a comprehensive picture by gathering cross-sectional as well as longitudinal evidence and by focusing on the reciprocal relationship between social networks and depression in older adults.

This systematic review was pre-registered. The review-protocol can be accessed at https://doi.org/10.17605/OSF.IO/6QDPK . In addition, we followed PRISMA guidelines for the reporting of this systematic review ([ 21 ]; see Additional file 1, Table A1).

Eligibility criteria

We expected to include peer-reviewed articles on the association of structural social network characteristics and depression among community-dwelling older adults. Following the World Health Organization (WHO; [ 22 ]), we define older adults as those, being 60 years and older. To counteract possible regional selection bias induced by language knowledge, we focused on English publications only. We did not exclude studies based on publication year or geographic area.

Related previous systematic reviews informed the inclusion and exclusion criteria [ 2 , 3 , 5 , 6 , 7 , 8 , 13 , 23 , 24 , 25 ]. Articles were included if the population of interest consisted of community-dwelling adults, specifically those older than 40 years, with a study mean age of at least 60 years. We opted for a minimum age in order to include relevant age studies from the age of 40 (e.g., the German DEAS), but focused on older adults by deciding that the mean age of the study participants must be at least 60 years, following the definition of older adults. The exposure or outcome focused on social networks, explicitly mentioned in the abstract of the studies. Further exposure or outcome of interest was depression, with an acceptable definition involving diagnostic criteria or a cut-off point on a depression rating scale. The association between social networks and depression had to be reported using a multivariate analysis adjusting for any confounders (the specifics of the included confounders are evaluated in the quality assessment). Only peer-reviewed journal articles published in English were considered for inclusion. Articles were excluded if they focused on patient groups or included institutionalized individuals, unless the analyses separated community-dwelling and institutionalized participants. Additionally, studies were excluded if they referred to recalled social network characteristics from the past, such as youth and adolescence, to measure present depression outcomes, or if they exclusively focused on online social networks. In terms of study types, editorials, study protocols, conference proceedings, comments, reviews, qualitative studies, grey literature, case studies, and intervention studies were excluded. An overview of the studies that appeared to meet the inclusion criteria but were ultimately excluded and the reasons for this can be found in the Additional file 1, Table A2.

Search strategy

The systematic database search was performed from date of data base inception up to 11 July 2023. The keywords used for the search strategy included related terms for: “depression” AND “social networks” AND “older adults” (see pre-registered review protocol). These were informed by related systematic reviews about the three main terms [ 2 , 3 , 5 , 6 , 7 , 8 , 13 , 23 , 24 , 25 ]. The following seven databases were searched using the same keywords and search designs: APA PsycINFO, ProQuest, PSYINDEX, PubMed, Scopus, SocINDEX, and Web of Science. We also conducted manual searches for potentially eligible studies from reference lists of related systematic reviews [ 2 , 3 , 5 , 6 , 7 , 8 , 13 , 23 , 24 , 25 ].

Study selection

References from the seven databases were imported into Rayyan [ 26 ]. After deduplication, two researchers (AR, PS) independently screened titles and abstracts, forwarding potentially eligible papers for full text review. Two researchers (AR, PS) independently assessed the full text of potentially eligible citations against the eligibility criteria. Disagreements and discrepancies were resolved by consensus between the researchers. The study selection process was piloted twice with a random sample of a hundred studies of the overall sample per pilot. Piloting the study selection process improves the reliability and validity of the review by ensuring all reviewers have a clear and consistent understanding of the selection process [ 27 ].

Data extraction

Using a standardized data collection form informed by related reviews [ 2 , 3 , 5 , 6 , 7 , 8 , 13 , 23 , 24 , 25 ], two reviewers (AR, AL) independently extracted data on the study population including their sample size, average age and age range, gender ratio, and country. Further, we extracted information on the measurement of depression, the social network assessment, type of social ties, potential exclusion of population groups, data source, the statistical methods, and the results. The outcomes of interest were structural aspects of social networks and/or depression scores among community-dwelling older adults. Any disagreements were resolved by discussion. If this failed, a third reviewer (PS) was consulted. The data extraction process was piloted once with a random sample of twenty studies to ensure the completeness of all relevant information in the data collection form [ 28 ].

Quality appraisal

Quality was assessed using the Newcastle Ottawa Scale (NOS; [ 29 ]) for cross-sectional and longitudinal studies by one reviewer (AR) and double-checked by another reviewer (PS). The NOS has been used in systematic reviews before [ 2 , 30 , 31 , 32 ]. The NOS awards each article an amount of stars within three domains, with a greater number of stars indicate a higher‐quality study [ 29 ]. The study quality is evaluated in terms of design, participant selection, comparability and assessment of exposure and outcome. Following the approach of several reviews [ 2 , 31 , 32 ], we adopted a rigorous methodology to assess the quality of studies, adhering to predetermined thresholds for converting the NOS to Agency for Health Research and Quality (AHRQ) standards. For a cross-sectional study to be considered of good quality, it needed to attain between 3 and 5 stars in the selection domain, alongside 1 or 2 stars in the comparability domain, and finally, 2 or 3 stars in the outcome domain. Those studies that achieved 2 stars in the selection domain, coupled with 1 or 2 stars in comparability, and 2 or 3 stars in outcome were classified as fair quality. However, studies falling short of these criteria were deemed poor quality; they either obtained 0 or 1 star in the selection domain, 0 stars in comparability, or 0 or 1 stars in outcome. In contrast, a longitudinal study was considered of good quality if it garnered between 3 and 4 stars in the selection domain, along with 1 or 2 stars in the comparability domain, and finally, 2 or 3 stars in the outcome domain. Those longitudinal studies achieving 2 stars in the selection domain, paired with 1 or 2 stars in comparability, and 2 or 3 stars in outcome were categorized as fair quality. Conversely, studies failing to meet these benchmarks were classified as poor quality; they either received 0 or 1 star in the selection domain, 0 stars in comparability, or 0 or 1 stars in outcome. For the analyses, we included all studies irrespective of the quality assessment results. However, when excluding studies which were considered as poor quality in a sensitivity analysis, the results were found to remain largely stable.

Synthesis method

Citations were firstly sub-grouped by direction of the relationship, then by structural aspect of social networks, and afterwards by the cross-sectional or longitudinal study design. In a further step, we count the significant associations against the insignificant associations. We compare the significant results across study design to identify differences between cross-sectional and longitudinal relationships. Further, we compare the effects of interest across structural aspects of social networks in the discussion. Tables are used to display the sub-grouped evidence. Further comparisons were carried out by geographical location, gender, family versus friends’ social ties and functional versus structural social network aspects. Findings are reported narratively.

Sample description

Starting from an initial result of 47,702 entries, 26,915 unique citations were identified. The two authors (AR, PS) independently screened the titles and abstracts, resulting in 320 potentially eligible articles. Any disagreement over the eligibility of individual studies was resolved through discussion. After adhering to strict inclusion and exclusion criteria, 127 unique publications were identified. Figure 1 Visualizes a PRISMA flowchart of the selection process.

HYPERLINK "sps:id::fig1||locator::gr1||MediaObject::0"Selection flowchart for papers included in the systematic review

The quality appraisal for each NOS-domain and overall evaluation can be found in the Additional file 1, Table A3 for cross-sectional studies and Table A4 for longitudinal studies. Two thirds of the studies ( n  = 86) were classified as good-quality studies, 27 articles with fair quality and 15 articles with poor quality.

The included articles were published between 1985 and 2023, with half published later than 2016. This highlights the vast body of research that has been conducted on this association, particularly in the last decade. The range of sample sizes was 53 to 60,918, with a median sample size of 1349 respondents. The geographic location of most of the studies was North America ( n  = 46), followed by Asian countries ( n  = 42). Thirty-four studies were conducted in European countries (and Israel), and only three were conducted in South American countries. One study has a mixed geographical location by comparing older adults in North America to those in Asia [ 33 ]. One study did not specify its geographic location [ 34 ].

The majority of studies made use of validated instruments to assess particularly depression. They either used various forms of the Center for Epidemiologic Studies Depression Scale (CES-D, n  = 58) or the Geriatric Depression Scale (GDS, n  = 42) to assess depression. Other studies used the EURO-D scale ( n  = 12), the Composite International Diagnostic Interview (CIDI, n  = 3), the nine-item Patient Health Questionnaire (PHQ-9, n  = 3), or other validated instruments ( n  = 9).

Most studies focused on the cross-sectional relationship between the social networks of older adults and depression ( n  = 96), while 30 articles examined the relationship longitudinally. Only one article had both a cross-sectional and longitudinal focus [ 35 ]. In most aspects of social networks, there were no apparent differences between the cross-sectional and longitudinal investigations. Additionally, 90% ( n  = 114) of the studies exclusively used depression as an outcome variable, while 6% ( n  = 8) exclusively used social network variables as outcome variables. Only five studies focused on the existence of a bi-directional relationship [ 19 , 20 , 36 , 37 , 38 ].

All risk factors for depression related to social networks used within the studies were categorized. Seven structural aspects of social networks were identified: network composition, contact frequency, network density, homo-/heterogeneity, network size, geographic proximity, and network scales. Table 1 provides an overview of the social network aspect descriptions. Notably, ties to friends and family were the covered most frequently in social network measures. The results were largely stable across geographic areas.

Depression as outcome variable

In total, 119 articles examined structural network aspects’ effects on depression. Ninety articles did so cross-sectionally, and 28 articles did so longitudinally. One article focused on the relationship both cross-sectionally and longitudinally [ 35 ].

Most publications focused on network scales ( n  = 44), network size ( n  = 44), network composition ( n  = 30), and contact frequency ( n  = 28) as structural network factors determining depression outcomes in older adults. Significantly fewer articles used density ( n  = 4), geographic proximity ( n  = 3), and homogeneity ( n  = 2). The results are presented below according to their frequency.

Network scales

Some articles used standardized network scales to examine various aspects of social networks’ effects on depression among older adults. Most articles used (modifications or translations of) the Lubben Social Network Scale (LSNS) or the Social Network Index (SNI), with higher scores indicating greater social engagement.

Most associations (40 out of 60 = 67%) between network scales and depression among older adults were reported to be significant (Table  2 ). No meaningful difference was identified between cross-sectional and longitudinal studies concerning effect significance or direction. Consistently, scholars found higher scores on social network scales to buffer depression outcomes among older adults. However, different subscales were used to assess family and friends variables. While some studies suggested that family networks were more predictive of depression outcomes in older adults [ 41 , 42 , 43 ], Singh et al. [ 44 ] indicated the opposite, suggesting that the friend network scale was significantly associated with depression. They found no significant associations in the children, relatives, and confidant network scales.

The results appear to be largely stable across gender. Most of the studies considering gender differences did not find the association of network scales and depression to differ in women and men [ 43 , 50 , 60 , 66 ]. The evidence of studies finding gender differences is inconclusive. While two studies found network scales to be only significant associated with depression in men but not women [ 68 , 80 ], another study found a significant association for the friends’ subscale in women but not men [ 47 ]. Conversely, no gender differences were found regarding the family subscale [ 47 ].

Network size

Network size was the most frequently studied variable besides network scales. In total, 66 measured associations were found in 44 articles (see Table  3 ). No meaningful difference was identified between cross-sectional and longitudinal studies concerning effect significance or direction. The results were inconclusive: Half of the studies found no significant association, while the other half provided significant evidence for an effect of social network size on depression in older adults. Of the effects significantly associated with depression, 32 of 33 were negative. This suggests that more extensive social networks are associated with lower levels of depression in older adults.

There seems to be no consensus regarding the association of the size of different social spheres and depression outcomes among older adults. While Palinkas et al. [ 64 ] and Harada et al. [ 96 ] found friend network size to be more important than relative network size, Lee and Chou [ 98 ] found these variables to be equally important. Furthermore, Minicuci et al. [ 103 ] and Oxman et al. [ 114 ] found them equally unimportant for depression outcomes.

There also seems to be no consensus regarding gender differences in the association of network size and depression. While two scholars found a significant association of network size and depression only in women but not men [ 83 , 111 ], three scholars found no evidence for gender differences [ 91 , 104 , 106 ]. Minicuci et al. [ 103 ] found the numbers of relatives with close contacts to only be significantly associated with depression in women but not men, while the number of close contacts was significantly associated with depression in men and women.

Network composition

Network composition was primarily measured by forming network typologies through clustering (see Table  4 ). This method makes it particularly challenging to compare results; however, studies consistently showed that diverse social networks protect against depression compared to more restricted networks [ 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 ]. Concerning network transitions, individuals remaining in and changing to restricted networks showed significantly higher levels of depression than those remaining in non-restricted networks [ 130 , 131 ]. Consistently, Sicotte et al. [ 132 ] found that an increasing diversity of links (measured by diversity of relationship ties) was associated with lower odds of depressive symptoms. Other studies found no significant association [ 105 , 110 ]. When prestige occupation scores were used as a diversity measure, higher diversity was associated with lower levels of depression compared to less diverse networks [ 133 ]. Conversely, Becker et al. [ 83 ] found diverse networks to be less associated with a lack of depressive symptoms compared to those relying solely on their partner as their social network.

Some studies included the share of particular social aspects, such as gender, family, or friends. Consistently, the proportions of females or kin were not identified as significant predictors of depression [ 19 , 100 , 107 , 138 ]. Furthermore, there was no consensus about the composition of family and friends. Social networks primarily consisting of family were found to buffer depression more than networks primarily consisting of friends [ 82 , 87 ]. This was also the case for network transitions [ 140 ]. Conversely, Fiori et al. [ 121 ] found that the absence of family within a friend context was less detrimental than the absence of friends within a family context. Also, Chao [ 109 ] identified that a network proportion of 25–50% family and 50–75% friends was the most advantageous for preventing depression.

While two scholars found no evidence for gender differences in the association of network composition and depression in older adults [ 132 , 136 ], Choi and Jeon [ 120 ] identified gender-specific network types and their association with depression to differ by gender. They found that restricted social network types were associated with increased depressive symptoms in both men and women, whereas a family-centered network was associated with more depressive symptoms only in women.

Contact frequency

Less consistency was found in social interaction frequency’s influence on depression in older adults (see Table  5 ). The cross-sectional studies found 14 significant and 15 insignificant associations. In contrast, among the longitudinal studies, only one significant piece of evidence was found [ 109 ], while six effects were identified as insignificant. Three effects were found to be significant only in certain population groups [ 141 , 142 ]. Furthermore, Blumstein et al. [ 35 ] found a significant negative association between weekly contact with friends and children and depression cross-sectionally; this became insignificant when examined longitudinally. Although cross-sectional results are inconclusive, this could indicate that the frequency of contact has the potential to buffer depression at the time of the event but is not necessarily a sustainable buffer for depression.

There was no consensus among studies about the association of depression with contact frequencies in particular social spheres, such as friends, children, and non-kin [ 35 , 64 , 87 , 97 , 99 , 109 , 141 , 142 , 143 , 144 , 145 , 149 ]. Chi and Chou [ 87 ] found contact frequency with relatives to be more advantageous in buffering depression than the frequency of contact with friends. In contrast, Jeon and Lubben [ 97 ] found contact frequency with non-kin to be negatively associated with depressive symptoms in older Korean immigrants, while contact frequency with kin was not significantly associated.

Only two scholars accounted for gender differences in the association of contact frequency and depression among older adults. Ermer and Proulx [ 91 ] found no significant association of contact frequency and depression in women or men. In their cross-sectional analysis, Blumstein et al. [ 35 ] also found no gender differences in the association between weekly contact with children and depression, but identified weekly contact with friends to only be significantly associated with depression in women but not men. However, these gender differences did not hold longitudinally.

Four articles examined how social network density was associated with depression in older adults (see Table  6 ). The results were inconclusive, cross-sectionally as well as longitudinally. Coleman et al. [ 110 ] and Vicente and Guadalupe [ 107 ] found no significant associations. Furthermore, the significant associations found were contradictory even though the same data and measurements were used. Dorrance Hall et al. [ 90 ] found that confidant network density was negatively associated with levels of depression cross-sectionally. In contrast, Bui [ 19 ] conducted a longitudinal study and found that a higher network density was significantly associated with increased depressive symptoms.

Geographic proximity

Three cross-sectional articles considered geographical proximity as a social network determinant for depression among older adults (see Table  7 ). No study focused on the respective relationship longitudinally. All the articles found significant but inconclusive results. While Litwin et al. [ 102 ] and Vicente and Guadalupe [ 107 ] found that geographically closer social networks buffer depression, Becker et al. [ 83 ] identified that geographically closer social networks increased depression. This may be attributable to the measurement used to assess geographic proximity: Litwin et al. [ 102 ] included individuals living within the respondent’s household, while Becker et al. [ 83 ] did not. This strongly suggests that the direction of effects is dependent on operationalization.

Homogeneity

Furthermore, two cross-sectional studies examined homo-/heterogeneity (see Table  8 ). Their evidence suggested no significant relationship between network homo-/heterogeneity and depression among older adults. Goldberg et al. [ 94 ] determined network homogeneity through questions about the sex, age, and religion of all network members. They found no significant association with depression. Murayama et al. [ 151 ] measured homo-/heterogeneity through respondents’ perceptions of the (dis)similarity of characteristics. They found a significant negative association with depression. This was only found for individuals with a strongly homogenous network and not for those with a weakly homogenous network. No significant relationship was found between network heterogeneity and depression outcomes.

Structural social network variables as outcome variable

Thirteen studies focused on social networks as outcome variables of depression (see Table  9 ). Seven articles examined this association cross-sectionally, while six articles did so longitudinally.

The articles examining the relationship between depression and social networks specifically focused on social network scale outcomes, network size, network composition, density, and contact frequency.

Evidence about the relationship between depression and network scales was mixed. While Merchant et al. [ 154 ] found no evidence cross-sectionally, other scholars found significant evidence that depression was associated with lower scores on network scales [ 37 , 153 , 159 ] and subscales [ 156 ]. However, the longitudinal evidence found was contradictory [ 20 , 36 ].

Depression was primarily identified as a significant predictor for network size. This was found cross-sectionally [ 155 ] and longitudinally [ 19 , 157 , 158 ]. Shouse et al. [ 155 ] found depression to be a predictor for a smaller inner circle network size. Furthermore, Bui [ 19 ] found that depressive symptoms significantly affected an individual’s number of close ties but not total social network size. In contrast, Houtjes et al. [ 157 ] examined differences in network size depending on depression course types. They found decreasing network sizes for all depression course types in older adults.

Cross-sectionally, Ali et al. [ 152 ] found that individuals with more depressive symptoms had smaller and more strained networks. Bui [ 19 ] did not identify depressive symptoms as a significant predictor of the proportion of females in an individual’s network.

No significant evidence suggested that depression affects contact frequency [ 19 , 158 ].

Network density

Bui [ 19 ] did not find depressive symptoms to significantly predict network density.

Reciprocal relationship of structural network aspects and depression

Only five articles examined the relationship between structural network aspects and depression reciprocally [ 19 , 20 , 36 , 37 , 38 ]. However, no reciprocal relationship was found between depression and network size [ 19 , 38 ], composition [ 19 ], contact frequency [ 19 ], and network scales [ 20 , 36 , 37 ]. Bui [ 19 ] only identified greater network density to significantly reduce depressive symptoms 5 years later, but not the other way around. Network size, number of close ties, contact frequency, or network composition did not significantly affect depressive symptoms 5 years later. Furthermore, Domènech-Abella et al. [ 20 ] found that the social network index significantly affects depression longitudinally; however, this relationship was not reciprocal. In contrast, Zhang et al. [ 36 ] found that higher depression scores at baseline predicted lower social network scores at a 6-month follow-up. However, social network scores did not predict depression at a 6-month follow-up. Bui [ 19 ] found more depressive symptoms to be associated with fewer close ties 5 years later. However, all other structural network measures (network size, composition, and contact frequency) were insignificant; therefore, the author concluded that there was no clear reciprocal relationship between structural network measures and depression [ 19 ].

Importance of functional network aspects

Thirty articles included social support in their analysis and examined whether social networks’ structural or functional aspects were more important in predicting depression outcomes in older adults. Singh et al.’s [ 44 ] article was excluded because social support measures’ effect sizes and significance were not presented.

However, no consensus can be reached. Seven studies identified structural aspects as more critical in predicting depression in terms of significant effects [ 35 , 53 , 54 , 74 , 98 , 106 , 117 ], while nine scholars found social support to be more relevant [ 34 , 62 , 82 , 95 , 107 , 108 , 110 , 114 , 129 ]. Sixteen studies found that social support and social network aspects were equally (not) predictive of depressive symptoms [ 19 , 80 , 85 , 86 , 87 , 90 , 92 , 103 , 109 , 118 , 122 , 132 , 133 , 136 , 138 , 142 ].

Social network characteristics and depression among older adults

This study aimed to systematize the evidence about the relationship between social networks and depression in older adults. It focused on the structural aspects of social networks because these are particularly suited for understanding their association with critical health outcomes [ 14 , 15 , 16 ]. It differentiated between the causality of relationships and structural and functional social network characteristics’ impact on depression.

Most articles followed the main-effect model [ 17 ] and considered depression as an outcome variable of social network characteristics in examining the relationship between structural social network aspects and depression among older adults. Only eight articles exclusively accounted for the reversed logic of causality: social network characteristics as an outcome of depression [ 152 , 153 , 154 , 155 , 156 , 157 , 158 , 159 ]. Five out of 127 articles examined the reciprocal relationship between structural social network characteristics and depression [ 19 , 20 , 36 , 37 , 38 ]. However, these articles found no clear reciprocal relationship. Therefore, no theoretical conclusions can be drawn based on these findings.

The majority of articles focused on depression as an outcome of older adults’ social network characteristics. They primarily used cross-sectional evidence. Structural network characteristics were predominantly operationalized through network scales, size, composition, and contact frequency. Conversely, they generally neglected network density, homogeneity, and geographical proximity. Evidence about whether and how the latter three social network aspects affect depression outcomes in older adults was inconsistent [ 19 , 83 , 90 , 94 , 102 , 107 , 110 , 151 ]. Most evidence supported the assumption that higher scores on social network scales buffer depression [ 20 , 37 , 41 , 42 , 43 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 56 , 57 , 58 , 61 , 63 , 64 , 65 , 66 , 68 , 69 , 70 , 71 , 72 , 74 , 75 , 76 , 79 , 80 , 81 ]. Corroborating previous literature reviews [ 2 , 13 ], some evidence suggested that a more extensive network size buffers depression outcomes in older adults compared to a smaller network size [ 33 , 64 , 78 , 82 , 83 , 85 , 86 , 87 , 90 , 92 , 93 , 94 , 96 , 98 , 99 , 100 , 101 , 102 , 106 , 109 , 112 , 114 , 115 , 117 , 119 ]. Three quarters of the studies also identified that network composition was significantly associated with depression outcomes in older adults; diverse social networks were found to be more beneficial than restricted networks [ 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 ]. This aligns with Santini et al.’s [ 13 ] findings, who consistently identified diverse types of social networks as associated with favorable depression outcomes. Results on the effect of contact frequency on depression were less consistent: no clear evidence was found cross-sectionally, and no substantial effects of contact frequency were found in longitudinal studies. This confirms Schwarzbach et al.’s [ 3 ] findings, which reported inconsistent results cross-sectionally and longitudinally.

Furthermore, the effects of social network aspects on depression seem to be largely stable for women and men [ 35 , 43 , 47 , 50 , 60 , 66 , 68 , 80 , 83 , 91 , 103 , 104 , 106 , 111 , 120 , 132 , 136 , 151 ]. Notably, no consensus can be reached about whether family or friends are more critical for favorable depression outcomes in older adults [ 41 , 42 , 43 , 44 , 82 , 87 , 109 , 121 , 140 ]. This challenges the previous assumption that family is the most crucial source of good health [ 160 ].

A minority of articles found social network characteristics to be outcomes of depression. While depression did not influence density [ 19 ] and contact frequency [ 19 , 158 ], an unclear effect was found for network scales [ 20 , 36 , 37 , 153 , 154 , 156 , 159 ] and network composition [ 19 , 152 ]. However, depression significantly reduced the size of an individual’s social network and their number of close relationships [ 19 , 155 , 157 , 158 ].

This review does not confirm the previous systematic reviews’ findings [ 3 , 13 ] that social networks’ functional aspects are more important than their structural aspects in predicting depression. The articles that considered functional network characteristics showed no consensus about whether structural or functional network aspects were more important in buffering depression outcomes in older adults [ 19 , 34 , 35 , 53 , 54 , 62 , 74 , 80 , 82 , 85 , 86 , 87 , 90 , 92 , 95 , 98 , 103 , 106 , 107 , 108 , 109 , 110 , 114 , 117 , 118 , 122 , 129 , 132 , 133 , 136 , 138 , 142 ].

Furthermore, very few studies reported effect sizes. However, the studies that reported standardized coefficients almost exclusively identified small effect sizes across all structural social network aspects [ 41 , 43 , 47 , 51 , 52 , 53 , 54 , 55 , 56 , 58 , 59 , 61 , 63 , 64 , 65 , 66 , 85 , 86 , 87 , 93 , 96 , 99 , 101 , 102 , 104 , 112 , 120 , 121 , 123 , 125 , 126 , 128 , 129 , 133 , 137 , 139 , 140 , 147 , 153 , 159 ]. Although the studies covered a wide sample size range, there were no differences in the results. This suggests that structural network aspects have a rather small but stable influence on depression. However, future studies should report effect sizes (e.g., by standardized coefficients) to ensure the comparability of studies and individual effects.

Limitations and future implications

This systematic review is the first to specifically focus on the relationship between structural social network aspects and depression outcomes among older adults. While previous systematic reviews have been helpful, they have loosely applied the constructs of social networks and limited their focus to particular geographic areas. Additionally, the vast body of evidence that has emerged during the last decade highlights the importance of this updated systematic review. However, our review has some limitations. Like other reviews, the articles included in this review may be prone to publication bias. In addition, we did not use controlled vocabulary terms such as MeSH and Psychological Index Terms in our search strategy. As our search strategy and keywords were informed by other reviews [ 2 , 3 , 5 , 6 , 7 , 8 , 13 , 23 , 24 , 25 ], we used a diverse range of keywords relevant to the field. Our comprehensive search strategy is reflected in the high number of initial articles found. Consequently, we anticipate having identified all relevant articles. Furthermore, we only included articles published in English, neglecting the findings reported in different languages. However, we did this to counteract possible regional bias induced by language knowledge of the authors. Additionally, the exclusion of non-English articles was found to have minimal impact on the results and overall conclusions of a review [ 161 , 162 ]. However, future research could employ machine translation to counteract selection bias induced by language restrictions. This should be particularly beneficial in contexts in which limited evidence exists.

Further, it must be emphasized that we focused on community-dwelling older adults, excluding institutionalized individuals from analysis. It should be acknowledged that regional bias may arise, given the different proportions of older adults living in institutions across countries. However, we decided to do this as institutionalized individuals are likely to have predetermined social networks which may affect depression outcomes differently.

Additionally, the use of the term “social network” may exclude studies focusing solely on family networks, which are highly relevant for the mental health of older adults. However, as the individual network should not be limited to family networks alone, we have deliberately opted for the holistic term here, to capture the social network in its entirety. This approach is supported by the ambiguous results on the importance of family and friendship relationships for depression among older adults (see analysis above).

Furthermore, this systematic review included studies from peer-reviewed journals, excluding gray literature. This may limit our findings. However, it ensures that the included articles are high quality. Furthermore, systematic reviews do not allow qualitative studies to be included. While qualitative studies are limited in their potential to establish causal relationships between variables, they provide valuable insights into the understanding and interpretation of psychosocial phenomena that quantitative research often cannot access.

This systematic review aimed to understand the potential of structural social network characteristics holistically by reviewing them all and not limiting the focus on only a few. That is why we did not conduct a meta-analysis. Firstly, evidence is too small to be statistically analyzed, such as in the social network domains network density, homogeneity, and geographical proximity. Secondly, particularly in the social network domain composition, results are not necessarily comparable since cluster analysis results in different numbers of clusters which are consequently characterized differently. However, future research should conduct a meta-analysis with the more comparable domains network scale, size, and contact frequency.

Despite this review’s limitations, its strength lies in its systematic search; multiple keywords and broad terminologies were used to capture as many articles as possible. This is reflected in the significant number of publications included in this review.

Much of the evidence reported here came from cross-sectional studies. Additionally, only eight of the 127 articles exclusively considered social networks as dependent variables, and only five studies examined the reciprocal relationship. This makes it particularly difficult to draw causal conclusions about the relationship between social networks and depression among older adults. Further research is needed to disentangle the reciprocal relationship using longitudinal data. Furthermore, limited literature focused on the relationship between depression and network density, homogeneity, and geographical proximity. Additionally, these results were inconclusive. Therefore, these relationships should be closely examined in future research.

This review gathered evidence and confirmed that having larger and more diverse social networks and closer ties buffers depression among older adults. Evidence about the relationship between contact frequency and depression was inconclusive. Literature on the relationships between depression and network density, homogeneity, and geographical proximity is scarce and inconclusive; therefore, further research is needed. Although this review examined a vast body of research about the relationship between social network aspects and depression among older adults, no conclusions about causality could be drawn. Contrary to other reviews, the evidence suggests that functional and structural networks are equally important in determining depression outcomes in older adults.

This review highlights that quantifying older adults’ social relations is crucial to understanding depression outcomes in older adults. As the population ages and multimorbidity and social isolation increase, appropriate social gerontological interventions are needed. Based on this review, interventions could potentially promote the integration of older adults into larger and more diverse social settings. Following the recommendations of a systematic review about the effectiveness of interventions targeting social isolation in older adults [ 163 ], group interventions like social activities are the most effective in broadening older adults’ social networks and increasing their contacts. These interventions can help to counteract depression in older adults.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. All data generated or analyzed during this study are included in this published article.

World Health Organization. Depression. 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/depression

Mohd T, Yunus R, Hairi F, Hairi N, Choo W. Social support and depression among community dwelling older adults in Asia: a systematic review. BMJ OPEN. 2019;9(7).

Schwarzbach M, Luppa M, Forstmeier S, König H, Riedel-Heller SG. Social relations and depression in late life—A systematic review. Int J Geriatr Psychiatry. 2014;29(1):1–21.

Article   PubMed   Google Scholar  

Wrzus C, Hänel M, Wagner J, Neyer FJ. Social network changes and life events across the life span: A meta-analysis. Psychol Bull. 2013;139(1):53–80.

Tajvar M, Fletcher A, Grundy E, Arab M. Social support and health of older people in Middle Eastern countries: A systematic review: Social support and health of older people. Australas J Ageing. 2013;32(2):71–8.

Fasihi Harandi T, Mohammad Taghinasab M, Dehghan NT. The correlation of social support with mental health: A meta-analysis. Electron Physician. 2017;9(9):5212–22.

Article   Google Scholar  

Gariépy G, Honkaniemi H, Quesnel-Vallée A. Social support and protection from depression: systematic review of current findings in Western countries. Br J Psychiatry. 2016;209(4):284–93.

Ayalon L, Levkovich I. A Systematic Review of Research on Social Networks of Older Adults. Gerontologist. 2019;59(3):e164–76.

Siette J, Gulea C, Priebe S. Assessing Social Networks in Patients with Psychotic Disorders: A Systematic Review of Instruments. Aleksic B editor. PLoS ONE. 2015;10(12):e0145250.

Article   PubMed   PubMed Central   Google Scholar  

Berkman LF, Glass T, Brissette I, Seeman TE. From social integration to health: Durkheim in the new millennium. Soc Sci Med. 2000;51(6):843–57.

Article   CAS   PubMed   Google Scholar  

Cohen S, Underwood LG, Gottlieb BH, Fetzer Institute, editors. Social support measurement and intervention: a guide for health and social scientists. Oxford ; New York: Oxford University Press; 2000. 345 p.

Cohen S. Social relationships and health. Am Psychol. 2004;59(8):676–84.

Santini ZI, Koyanagi A, Tyrovoloas S, Mason C, Haro JM. The association between social relationships and depression: A systematic review. J Affect Disord. 2015;175:53–65.

Kuiper JS, Zuidersma M, Zuidema SU, Burgerhof JGM, Stolk RP, Oude Voshaar RC, et al. Social relationships and cognitive decline: a systematic review and meta-analysis of longitudinal cohort studies. Int J Epidemiol. 2016;45:1169–206.

Kuiper JS, Zuidersma M, Oude Voshaar RC, Zuidema SU, van den Heuvel ER, Stolk RP, et al. Social relationships and risk of dementia: A systematic review and meta-analysis of longitudinal cohort studies. Ageing Res Rev. 2015;22:39–57.

Holt-Lunstad J, Smith TB, Layton JB. Social Relationships and Mortality Risk: A Meta-analytic Review. Brayne C editor PLoS Med. 2010;7(7):e1000316.

Kawachi I, Berkman LF. Social Ties and Mental Health. Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2001;78(3):458–67.

Blazer DG. Depression in Late Life: Review and Commentary. J Gerontol A Biol Sci Med Sci. 2003;58(3):249–65.

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):458–68.

Domènech-Abella J, Mundó J, Haro JM, Rubio-Valera M. Anxiety, depression, loneliness and social network in the elderly: Longitudinal associations from The Irish Longitudinal Study on Ageing (TILDA). J Affect Disord. 2019;246:82–8.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;29: n71.

World Health Organization. Ageing. n.d. Available from: https://www.who.int/health-topics/ageing#tab=tab_1 . Cited 2024 Jun 4

Kelly ME, Duff H, Kelly S, McHugh Power JE, Brennan S, Lawlor BA, et al. The impact of social activities, social networks, social support and social relationships on the cognitive functioning of healthy older adults: a systematic review. Syst Rev. 2017;6(1):259.

Piolatto M, Bianchi F, Rota M, Marengoni A, Akbaritabar A, Squazzoni F. The effect of social relationships on cognitive decline in older adults: an updated systematic review and meta-analysis of longitudinal cohort studies. BMC Public Health. 2022;22(1):278.

Visentini C, Cassidy M, Bird VJ, Priebe S. Social networks of patients with chronic depression: A systematic review. J Affect Disord. 2018;241:571–8.

Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210.

Lefebvre C, Glanville J, Briscoe S, Littlewood A, Marshall C, Metzendorf M, et al. Searching for and selecting studies. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al., editors. Cochrane Handbook for Systematic Reviews of Interventions. 1st ed. Wiley; 2019. p. 67–107. Available from: https://onlinelibrary.wiley.com/doi/ https://doi.org/10.1002/9781119536604.ch4 . Cited 2024 Jun 3

Li T, Higgins JP, Deeks JJ. Collecting data. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al., editors. Cochrane Handbook for Systematic Reviews of Interventions. 1st ed. Wiley; 2019. p. 109–41. Available from: https://onlinelibrary.wiley.com/doi/ https://doi.org/10.1002/9781119536604.ch5 . Cited 2024 Jun 3

Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2014. Available from: https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp . Cited 2024 Mar 28.

Hakeem FF, Bernabé E, Sabbah W. Association between oral health and frailty: A systematic review of longitudinal studies. Gerodontol. 2019;36(3):205–15.

Shamsrizi P, Gladstone BP, Carrara E, Luise D, Cona A, Bovo C, et al. Variation of effect estimates in the analysis of mortality and length of hospital stay in patients with infections caused by bacteria-producing extended-spectrum beta-lactamases: a systematic review and meta-analysis. BMJ Open. 2020;10(1): e030266.

Vivekanantham A, Edwin C, Pincus T, Matharu M, Parsons H, Underwood M. The association between headache and low back pain: a systematic review. J Headache Pain. 2019;20(1):82.

Liu J, Guo M, Xu L, Mao W, Chi I. Family Relationships, Social Connections, and Depressive Symptoms Among Chinese Older Adults in International Migrant Families. J Ethn Cult Divers Soc Work. 2016;26(3):167–84.

Miller M, Lago D. The Well-Being of Older Women: The Importance of Pet and Human Relations. Anthrozoös. 1990;3(4):245–52.

Blumstein T, Benyamini Y, Fuchs Z, Shapira Z, Novikov I, Walter-Ginzburg A, et al. The Effect of a Communal Lifestyle on Depressive Symptoms in Late Life. J Aging Health. 2004;16(2):151–74.

Zhang Y, Kuang J, Xin Z, Fang J, Song R, Yang Y, et al. Loneliness, social isolation, depression and anxiety among the elderly in Shanghai: Findings from a longitudinal study. Arch Gerontol Geriatr. 2023;110: 104980.

Sugie M, Harada K, Nara M, Kugimiya Y, Takahashi T, Kitagou M, et al. Prevalence, overlap, and interrelationships of physical, cognitive, psychological, and social frailty among community-dwelling older people in Japan. Arch Gerontol Geriatr. 2022;100:104659.

Reynolds RM, Meng J, Dorrance HE. Multilayered social dynamics and depression among older adults: A 10-year cross-lagged analysis. Psychol Aging. 2020;35(7):948–62.

Keim-Klärner S, Adebahr P, Brandt S, Gamper M, Klärner A, Knabe A, et al. Social inequality, social networks, and health: a scoping review of research on health inequalities from a social network perspective. Int J Equity Health. 2023;22(1):74.

Berkman LF, Syme SL. Social networks, host resistance, and mortality: a nine-year follow-up study of alameda county residents. Am J Epidemiol. 1979;109(2):186–203.

Fernández MB, Rosell J. An Analysis of the Relationship Between Religiosity and Psychological Well-Being in Chilean Older People Using Structural Equation Modeling. J Relig Health. 2022;61(2):1585–604.

Gao J, Hu H, He H. Household indebtedness and depressive symptoms among older adults in China: The moderating role of social network and anticipated support. J Affect Disord. 2022;298(Part A):173–81.

Tang D, Mair CA, Hu Q. Widowhood, social networks, and mental health among Chinese older adults: The moderating effects of gender. Front Psychol. 2023;14:1142036.

Singh L, Singh PK, Arokiasamy P. Social network and mental health among older adults in rural Uttar Pradesh, India: A cross-sectional study. J Cross Cult Gerontol. 2016;31(2):173–92.

Aung MN, Moolphate S, Aung TNN, Kantonyoo C, Khamchai S, Wannakrairot P. The social network index and its relation to later-life depression among the elderly aged >= 80 years in Northern Thailand. CIA. 2016;11:1067–74.

Bae S, Harada K, Chiba I, Makino K, Katayama O, Lee S, et al. A New Social Network Scale for Detecting Depressive Symptoms in Older Japanese Adults. IJERPH. 2020;17(23):8874.

Boey KW, Chiu HFK. Life strain and psychological distress of older women and older men in Hong Kong. Aging Ment Health. 2005;9(6):555–62.

Chan MF, Zeng W. Investigating factors associated with depression of older women in Macau: Depression of older women . J Clin Nurs. 2009;18(21):2969–77.

Chan MF, Zeng W. Exploring risk factors for depression among older men residing in Macau: Depression of older men in Macau. J Clin Nurs. 2011;20(17–18):2645–54.

Chan A, Malhotra C, Malhotra R, Østbye T. Living arrangements, social networks and depressive symptoms among older men and women in Singapore. Int J Geriatr Psychiatry. 2011;26(6):630–9.

Chou KL, Chi I. Stressful life events and depressive symptoms: Social support and sense of control as mediators or moderators? The International Journal of Aging & Human Development. 2001;52(2):155–71.

Article   CAS   Google Scholar  

Gu Y, Ali SH, Guo A. Comparing the role of social connectivity with friends and family in depression among older adults in China: evaluating the moderating effect of urban–rural status. Front Psychiatry. 2023;14:1162982.

Hamid TA, Dzaher A, Ching SM. The role of social network, social support, religiosity and depression among elderly Malaysians who had experienced major life events. Med J Malaysia. 2019;74(3):198–204.

CAS   PubMed   Google Scholar  

Jang Y, Haley WE, Small BJ, Mortimer JA. The role of mastery and social resources in the associations between disability and depression in later life. Gerontologist. 2002;42(6):807–13.

Jang Y, Kim G, Chiriboga DA. Gender Differences in Depressive Symptoms Among Older Korean American Immigrants. Social Work in Public Health. 2011;26(1):96–109.

Jiang F, Kuper H, Zhou C, Qin W, Xu L. Relationship between hearing loss and depression symptoms among older adults in China: The mediating role of social isolation and loneliness. Int J Geriat Psychiatry. 2022;37(6).

Kim K, Lee M. Depressive symptoms of older adults living alone: The role of community characteristics. The International Journal of Aging & Human Development. 2015;80(3):248–63.

Kim BJ, Sangalang CC, Kihl T. Effects of acculturation and social network support on depression among elderly Korean immigrants. Aging Ment Health. 2012;16(6):787–94.

Kim T, Nguyen ET, Yuen EJ, Nguyen T, Sorn R, Nguyen GT. Differential Role of Social Connectedness in Geriatric Depression Among Southeast Asian Ethnic Groups. Prog Community Health Partnersh. 2015;9(4):483–93.

Klug G, Lacruz ME, Emeny RT, Häfner S, Ladwig KH, Huber D. Aging Without Depression: A Cross-Sectional Study. Psychodynamic Psychiatry. 2014;42(1):5–22.

Lee YS, Park SY, Roh S, Koenig HG, Yoo GJ. The Role of Religiousness/Spirituality and Social Networks in Predicting Depressive Symptoms among Older Korean Americans. J Cross Cult Gerontol. 2017;32(2):239–54.

Mehrabi F, Béland F. Frailty as a Moderator of the Relationship between Social Isolation and Health Outcomes in Community-Dwelling Older Adults. IJERPH. 2021;18(4):1675.

Okwumabua JO, Baker FM, Wong SP, Pilgram BO. Characteristics of depressive symptoms in elderly urban and rural African Americans. J Gerontol A Biol Sci Med Sci. 1997;52(4):M241–6.

Palinkas LA, Wingard DL, Barrett-Connor E. The biocultural context of social networks and depression among the elderly. Soc Sci Med. 1990;30(4):441–7.

Park J, Roh S. Daily spiritual experiences, social support, and depression among elderly Korean immigrants. Aging Ment Health. 2013;17(1):102–8.

Park NS, Jang Y, Lee BS, Haley WE, Chiriboga DA. The Mediating Role of Loneliness in the Relation Between Social Engagement and Depressive Symptoms Among Older Korean Americans: Do Men and Women Differ? J Gerontol B Psychol Sci Soc Sci. 2013;68(2):193–201.

Park NS, Lee BS, Chiriboga DA, Chung S. Loneliness as a mediator in the relationship between social engagement and depressive symptoms: Age differences among community-dwelling Korean adults. Health Soc Care Community. 2019;27(3):706–16.

Roh S, Lee YS, Kim Y, Park SY, Chaudhuri A. Gender Differences in the Roles of Religious Support and Social Network Support in Reducing Depressive Symptoms Among Older Korean Americans. J Soc Serv Res. 2015;41(4):484–97.

Santini ZI, Koyanagi A, Tyrovolas S, Haro JM. The association of relationship quality and social networks with depression, anxiety, and suicidal ideation among older married adults: Findings from a cross-sectional analysis of the Irish Longitudinal Study on Ageing (TILDA). J Affect Disord. 2015;179:134–41.

Tang D, Xie L. Whose migration matters? The role of migration in social networks and mental health among rural older adults in China. Ageing Soc. 2021;43:1–20.

Tang D, Lin Z, Chen F. Moving beyond living arrangements: The role of family and friendship ties in promoting mental health for urban and rural older adults in China. Aging Ment Health. 2020;24(9):1523–32.

Tanikaga M, Uemura JI, Hori F, Hamada T, Tanaka M. Changes in Community-Dwelling Elderly’s Activity and Participation Affecting Depression during COVID-19 Pandemic: A Cross-Sectional Study. IJERPH. 2023;20(5):4228.

Taylor H. Social Isolation, Loneliness, and Physical and Mental Health Among Black Older Adults. Annu Rev Gerontol Geriatr. 2021;41(1):123–44.

Google Scholar  

Tsai YF, Yeh SH, Tsai HH. Prevalence and risk factors for depressive symptoms among community-dwelling elders in Taiwan. Int J Geriat Psychiatry. 2005;20(11):1097–102.

Wee LE, Yong YZ, Chng MWX, Chew SH, Cheng L, Chua QHA, et al. Individual and area-level socioeconomic status and their association with depression amongst community-dwelling elderly in Singapore. Aging Ment Health. 2014;18(5):628–41.

Byers AL, Vittinghoff E, Lui LY, Hoang T, Blazer DG, Covinsky KE, et al. Twenty-year depressive trajectories among older women. JAMA Psychiat. 2012;69(10):1073–9.

Förster F, Luppa M, Pabst A, Heser K, Kleineidam L, Fuchs A, et al. The Role of Social Isolation and the Development of Depression. A Comparison of the Widowed and Married Oldest Old in Germany. IJERPH. 2021;18(13):6986.

Kuchibhatla MN, Fillenbaum GG, Hybels CF, Blazer DG. Trajectory classes of depressive symptoms in a community sample of older adults: Trajectory classes of depressive symptoms. Acta Psychiatr Scand. 2012;125(6):492–501.

Ruan H, Shen K, Chen F. Negative Life Events, Social Ties, and Depressive Symptoms for Older Adults in China. Front Public Health. 2022;9: 774434.

Santini ZI, Fiori KL, Feeney J, Tyrovolas S, Haro JM, Koyanagi A. Social relationships, loneliness, and mental health among older men and women in Ireland: A prospective community-based study. J Affect Disord. 2016;204:59–69.

Santini ZI, Koyanagi A, Tyrovolas S, Haro JM, Donovan RJ, Nielsen L, et al. The protective properties of Act-Belong-Commit indicators against incident depression, anxiety, and cognitive impairment among older Irish adults: Findings from a prospective community-based study. Exp Gerontol. 2017;91:79–87.

Antonucci TC, Fuhrer R, Dartigues JF. Social relations and depressive symptomatology in a sample of community-dwelling French older adults. Psychol Aging. 1997;12(1):189–95.

Becker C, Kirchmaier I, Trautmann S. Marriage, parenthood and social network: Subjective well-being and mental health in old age. PLOS ONE. 2019;14(7).

Bisconti TL, Bergeman CS. Perceived Social Control as a Mediator of the Relationships Among Social Support, Psychological Weil-Being, and Perceived Health. Gerontologist. 1999;39(1):94–104.

Braam AW, Beekman ATF, van Tilburg TG, Deeg DJH, van Tilburg W. Religious involvement and depression in older Dutch citizens. Social Psychiatry and Psychiatric Epidemiology: The International Journal for Research in Social and Genetic Epidemiology and Mental Health Services. 1997;32(5):284–91.

Cheng ST, Leung EMF, Chan TWS. Physical and social activities mediate the associations between social network types and ventilatory function in Chinese older adults. Health Psychol. 2014;33(6):524–34.

Chi I, Chou KL. Social support and depression among elderly Chinese people in Hong Kong. The International Journal of Aging & Human Development. 2001;52(3):231–52.

Cho JHJ, Olmstead R, Choi H, Carrillo C, Seeman TE, Irwin MR. Associations of objective versus subjective social isolation with sleep disturbance, depression, and fatigue in community-dwelling older adults. Aging Ment Health. 2019;23(9):1130–8.

Domènech-Abella J, Lara E, Rubio-Valera M, Olaya B, Moneta MV, Rico-Uribe LA, et al. Loneliness and depression in the elderly: the role of social network. Soc Psychiatry Psychiatr Epidemiol. 2017;52(4):381–90.

Dorrance Hall E, Meng J, Reynolds RM. Confidant Network and Interpersonal Communication Associations with Depression in Older Adulthood. Health Commun. 2019;35(7):872–81.

Ermer AE, Proulx CM. The association between relationship strain and emotional well-being among older adult couples: the moderating role of social connectedness. Aging Ment Health. 2022;26(6):1198–206.

Fredriksen-Goldsen KI, Emlet CA, Kim HJ, Muraco A, Erosheva EA, Goldsen J, et al. The physical and mental health of lesbian, gay male, and bisexual (LGB) older adults: The role of key health indicators and risk and protective factors. Gerontologist. 2013;53(4):664–75.

Fuller-Iglesias H, Sellars B, Antonucci TC. Resilience in old age: Social relations as a protective factor. Res Hum Dev. 2008;5(3):181–93.

Goldberg EL, Natta PV, Comstock GW. Depressive symptoms social networks and social support of elderly women. Am J Epidemiol. 1985;121(3):448–56.

Han HR, Kim M, Lee HB, Pistulka G, Kim KB. Correlates of depression in the Korean American elderly: Focusing on personal resources of social support. J Cross Cult Gerontol. 2007;22(1):115–27.

Harada K, Sugisawa H, Sugihara Y, Yanagisawa S, Shimmei M. Big Five Personality Traits, Social Networks, and Depression Among Older Adults in Japan: A Multiple Mediation Analysis. Int J Aging Hum Dev. 2023;97(1):111–28.

Jeon H, Lubben J. The Influence of Social Networks and Supports on Depression Symptoms: Differential Pathways for Older Korean Immigrants and Non-Hispanic White Americans. Care Manag J. 2016;17(1):13–23.

Lee SY, Chou KL. Assessing the relative contribution of social exclusion, income-poverty, and financial strain on depressive symptoms among older people in Hong Kong. Aging Ment Health. 2019;23(11):1487–95.

Lee MS, Crittenden KS, Yu E. Social support and depression among elderly Korean immigrants in the United States. The International Journal of Aging & Human Development. 1996;42(4):313–27.

Li M, Dong X, Kong D. Social networks and depressive symptoms among chinese older immigrants: Does quantity, quality, and composition of social networks matter? Clinical Gerontologist: The Journal of Aging and Mental Health. 2019;44(2):181–91.

Litwin H, Levinsky M. The Interplay of Personality Traits and Social Network Characteristics in the Subjective Well-Being of Older Adults. Res Aging. 2023;45(7–8):538–49.

Litwin H, Stoeckel KJ, Schwartz E. Social networks and mental health among older Europeans: Are there age effects? Eur J Ageing. 2015;12(4):299–309.

Minicuci N, Maggi S, Pavan M, Enzi G, Crepaldi G. Prevalence Rate and Correlates of Depressive Symptoms in Older Individuals: The Veneto Study. The Journals of Gerontology: Series A. 2002;57(3):M155–61.

Pavlidis G, Motel-Klingebiel A, Aartsen M. Exclusion from social relations in later life: on the gendered associations of social networks with mental wellbeing. Aging Ment Health. 2023;27(7):1313–21.

Pilehvari A, You W, Lin X. Retirement’s impact on health: what role does social network play? Eur J Ageing. 2023;20(14).

Sonnenberg CM, Deeg DJH, van Tilburg TG, Vink D, Stek ML, Beekman ATF. Gender differences in the relation between depression and social support in later life. Int Psychogeriatr. 2013;25(1):61–70.

Vicente HT, Guadalupe S. Childlessness, personal social networks and wellbeing at advanced ages: a cross-sectional study in a Southern European familistic welfare state. Ageing Soc. 2022;44:1–25.

Bisschop MI, Kriegsman DMW, Beekman ATF, Deeg DJH. Chronic diseases and depression: the modifying role of psychosocial resources. Soc Sci Med. 2004;59(4):721–33.

Chao SF. Assessing social support and depressive symptoms in older Chinese adults: A longitudinal perspective. Aging Ment Health. 2011;15(6):765–74.

Coleman ME, Manchella MK, Roth AR, Peng S, Perry BL. What kinds of social networks protect older adults’ health during a pandemic? The tradeoff between preventing infection and promoting mental health. Social Networks. 2022;70:393–402.

Hajek A, König HH. Effect of Health Comparisons on Functional Health and Depressive Symptoms - Results of a Population-Based Longitudinal Study of Older Adults in Germany. Tran US, editor. PLoS ONE. 2016;11(5):e0156235.

Harlow SD, Goldberg EL, Comstock GW. A Longitudinal Study of Risk Factors for Depressive Symptomatology in Elderly Widowed and Married Women. Am J Epidemiol. 1991;134(5):526–38.

Holwerda TJ, Jaarsma E, Van Zutphen EM, Beekman ATF, Pan KY, Van Vliet M, et al. The impact of COVID-19 related adversity on the course of mental health during the pandemic and the role of protective factors: a longitudinal study among older adults in The Netherlands. Soc Psychiatry Psychiatr Epidemiol. 2023;58(7):1109–20.

Oxman TE, Berkman LF, Kasl S, Freeman DH, Barrett J. Social Support and Depressive Symptoms in the Elderly. Am J Epidemiol. 1992;135(4):356–68.

Santini ZI, Jose PE, Koyanagi A, Meilstrup C, Nielsen L, Madsen KR, et al. The moderating role of social network size in the temporal association between formal social participation and mental health: a longitudinal analysis using two consecutive waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). Soc Psychiatry Psychiatr Epidemiol. 2021;56(3):417–28.

Schwartz E, Litwin H. Are newly added and lost confidants in later life related to subsequent mental health? Int Psychogeriatr. 2017;29(12):2047–57.

Stringa N, Milaneschi Y, van Schoor NM, Suanet B, van der Lee S, Holstege H, 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 Psychiatry. 2020;28(8):844–55.

Tang F, Jiang Y, Li K, Rosso AL. Residential Segregation and Depressive Symptoms in Older Chinese Immigrants: The Mediating Role of Social Processes. Meeks S, editor. Gerontologist. 2023;63:gnad027.

Werneck AO, Cunha PM, Silva DR. The mediation role of social network size and perception in the association between physical activity and depressive symptoms: a prospective analysis from the SHARE study. Aging Ment Health. 2023;27:1–6.

Choi KW, Jeon GS. Social Network Types and Depressive Symptoms among Older Korean Men and Women. IJERPH. 2021;18(21):11175.

Fiori KL, Antonucci TC, Cortina KS. Social Network Typologies and Mental Health Among Older Adults. J Gerontol B Psychol Sci Soc Sci. 2006;61(1):P25-32.

Harasemiw O, Newall N, Mackenzie CS, Shooshtari S, Menec V. Is the association between social network types, depressive symptoms and life satisfaction mediated by the perceived availability of social support? A cross-sectional analysis using the Canadian Longitudinal Study on Aging. Aging Ment Health. 2019;23(10):1413–22.

Kim YB, Lee SH. Social support network types and depressive symptoms among community-dwelling older adults in South Korea. Asia Pac J Public Health. 2019;31(4):367–75.

Litwin H. The association between social network relationships and depressive symptoms among older Americans: What matters most? Int Psychogeriatr. 2011;23(6):930–40.

Litwin H. Physical activity, social network type, and depressive symptoms in late life: An analysis of data from the National Social Life, Health and Aging Project. Aging Ment Health. 2012;16(5):608–16.

Park NS, Jang Y, Lee BS, Ko JE, Chiriboga DA. The Impact of Social Resources on Depressive Symptoms in Racially and Ethnically Diverse Older Adults: Variations by Groups With Differing Health Risks. Res Aging. 2014;36(3):322.

Park NS, Jang Y, Lee BS, Chiriboga DA, Chang S, Kim SY. Associations of a social network typology with physical and mental health risks among older adults in South Korea. Aging Ment Health. 2018;22(5):631–8.

Sohn SY, Joo W, Kim WJ, Kim SJ, Youm Y, Kim HC, et al. Social network types among older Korean adults: Associations with subjective health. Soc Sci Med. 2017;173:88–95.

Ye L, Zhang X. Social Network Types and Health among Older Adults in Rural China: The Mediating Role of Social Support. IJERPH. 2019;16(3):410.

Kim B, Park S, Antonucci TC. Longitudinal changes in social networks, health and wellbeing among older Koreans. Ageing Soc. 2016;36(9):1915–36.

Förster F, Stein J, Löbner M, Pabst A, Angermeyer MC, König HH, et al. Loss experiences in old age and their impact on the social network and depression– Results of the Leipzig Longitudinal Study of the Aged (LEILA 75+). J Affect Disord. 2018;241:94–102.

Sicotte M, Alvarado BE, León EM, Zunzunegui MV. Social networks and depressive symptoms among elderly women and men in Havana. Cuba Aging & Mental Health. 2008;12(2):193–201.

Cao W, Li L, Zhou X, Zhou C. Social capital and depression: evidence from urban elderly in China. Aging Ment Health. 2015;19(5):418–29.

Golden J, Conroy RM, Bruce I, Denihan A, Greene E, Kirby M, et al. Loneliness, social support networks, mood and wellbeing in community-dwelling elderly. Int J Geriat Psychiatry. 2009;24(7):694–700.

Gumà J, Fernández-Carro C. Life goes on: The influence of the perceived quality of social relations on older women’s mental health after the loss of a partner in Europe. Aging Ment Health. 2021;25(1):53–60.

Mechakra-Tahiri SD, Zunzunegui MV, Preville M, Dube M. Gender, social relationships and depressive disorders in adults aged 65 and over in Quebec. Chronic Diseases in Canada. Chronic Diseases in Canada. 2010;30(2):56–65.

Stoeckel KJ, Litwin H. The impact of social networks on the relationship between functional impairment and depressive symptoms in older adults. Int Psychogeriatr. 2016;28(1):39–47.

Webster NJ, Antonucci TC, Ajrouch KJ, Abdulrahim S. Social networks and health among older adults in Lebanon: The mediating role of support and trust. J Gerontol B Psychol Sci Soc Sci. 2015;70(1):155–66.

Litwin H, Levinsky M. Always alone? Network transitions among detached older Europeans and their effects. Ageing Soc. 2021;41(10):2299–313.

Litwin H, Levinsky M, Schwartz E. Network type, transition patterns and well-being among older Europeans. Eur J Ageing. 2020;17(2):241–50.

Gan DRY, Best JR. Prior Social Contact and Mental Health Trajectories during COVID-19: Neighborhood Friendship Protects Vulnerable Older Adults. IJERPH. 2021;18(19):9999.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Husaini BA. Predictors of depression among the elderly: Racial differences over time. Am J Orthopsychiatry. 1997;67(1):48–58.

Castro-Costa É, Lima-Costa MF, Carvalhais S, Firmo JOA, Uchoa E. Factors associated with depressive symptoms measured by the 12-item General Health Questionnaire in Community-Dwelling Older Adults (The Bambuí Health Aging Study). Rev Bras Psiquiatr. 2008;30(2):104–9.

Forsman AK, Nyqvist F, Schierenbeck I, Gustafson Y, Wahlbeck K. Structural and cognitive social capital and depression among older adults in two nordic regions. Aging Ment Health. 2012;16(6):771–9.

La Gory M, Fitzpatrick K. The Effects of Environmental Context on Elderly Depression. J Aging Health. 1992;4(4):459–79.

Litwin H, Levinsky M. Social networks and mental health change in older adults after the Covid-19 outbreak. Aging Ment Health. 2022;26(5):925–31.

Marshall GL, Rue TC. Perceived Discrimination and Social Networks Among Older African Americans and Caribbean Blacks. Fam Community Health. 2012;35(4):300–11.

Marshall-Fabien GL, Miller DB. Exploring Ethnic Variation in the Relationship Between Stress, Social Networks, and Depressive Symptoms Among Older Black Americans. J Black Psychol. 2016;42(1):54–72.

Taylor HO, Taylor RJ, Nguyen AW, Chatters L. Social isolation, depression, and psychological distress among older adults. J Aging Health. 2018;30(2):229–46.

Wu CS, Yu SH, Lee CY, Tseng HY, Chiu YF, Hsiung CA. Prevalence of and risk factors for minor and major depression among community-dwelling older adults in Taiwan. Int Psychogeriatr. 2017;29(7):1113–21.

Murayama H, Nofuji Y, Matsuo E, Nishi M, Taniguchi Y, Fujiwara Y, et al. Are neighborhood bonding and bridging social capital protective against depressive mood in old age? A multilevel analysis in Japan. Soc Sci Med. 2015;124:171–9.

Ali T, Elliott MR, Antonucci TC, Needham BL, Zelner J, Mendes de Leon CF. Multidimensional Social Network Types and Their Correlates in Older Americans. Savla JT, editor. Innovation in Aging. 2022;6(1):1–16.

CAS   Google Scholar  

Bincy K, Logaraj M, Anantharaman VV. Social network and its effect on selected dimension of health and quality of life among community dwelling urban and rural geriatric population in India. Clinical Epidemiology and Global Health. 2022;16: 101083.

Merchant RA, Liu SG, Lim JY, Fu X, Chan YH. Factors associated with social isolation in community-dwelling older adults: A cross-sectional study. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation. 2020;29(9):2375–81.

Shouse JN, Rowe SV, Mast BT. Depression and cognitive functioning as predictors of social network size. Clinical Gerontologist: The Journal of Aging and Mental Health. 2013;36(2):147–61.

Wendel F, Bauer A, Blotenberg I, Brettschneider C, Buchholz M, Czock D, et al. Social Network and Participation in Elderly Primary Care Patients in Germany and Associations with Depressive Symptoms—A Cross-Sectional Analysis from the Age Well de Study. JCM. 2022;11(19):5940.

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 Psychiatry. 2014;29(10):1010–7.

Voils CI, Allaire JC, Olsen MK, Steffens DC, Hoyle RH, Bosworth HB. Five-year trajectories of social networks and social support in older adults with major depression. Int Psychogeriatr. 2007;19(6):1110–24.

Li W, Wang Q, Yin H, Song Y, Tu W, Wang L, et al. Construction of path analysis model on related factors of social isolation in older people. Psychogeriatrics. 2022;22(5):743–56.

Antonucci TC, Birditt KS, Sherman CW, Trinh S. Stability and change in the intergenerational family: a convoy approach. Ageing Soc. 2011;31(7):1084–106.

Hartling L, Featherstone R, Nuspl M, Shave K, Dryden DM, Vandermeer B. Grey literature in systematic reviews: a cross-sectional study of the contribution of non-English reports, unpublished studies and dissertations to the results of meta-analyses in child-relevant reviews. BMC Med Res Methodol. 2017;17(1):64.

Nussbaumer-Streit B, Klerings I, Dobrescu AI, Persad E, Stevens A, Garritty C, et al. Excluding non-English publications from evidence-syntheses did not change conclusions: a meta-epidemiological study. J Clin Epidemiol. 2020;118:42–54.

Dickens AP, Richards SH, Greaves CJ, Campbell JL. Interventions targeting social isolation in older people: a systematic review. BMC Public Health. 2011;11(1):647.

Download references

Acknowledgements

We thank Alexander Trinidad for the useful information in the beginning of the article process. We particularly thank Anna Leuwer (AL) for the extraction of the data as quality check. Special thanks to Lea Ellwardt and Karsten Hank for the valuable feedback on earlier versions of this manuscript.

Open Access funding enabled and organized by Projekt DEAL. This work was supported by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Grant [454899704].

Author information

Authors and affiliations.

Institute of Sociology and Social Psychology, University of Cologne, Albertus-Magnus-Platz, 50923, Cologne, Germany

Amelie Reiner & Paula Steinhoff

You can also search for this author in PubMed   Google Scholar

Contributions

AR participated in the design of the study, screened the articles, led the analysis and interpretation of the data, and drafted the first draft of the manuscript. PS participated in the design of the study, screened the articles, and contributed to the analysis and interpretation of the data. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Amelie Reiner .

Ethics declarations

Ethics approval and consent to participate.

Not applicable.

Consent for publication

Competing interests.

The authors declare that they have no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Supplementary material 1., rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Reiner, A., Steinhoff, P. The association of social networks and depression in community-dwelling older adults: a systematic review. Syst Rev 13 , 161 (2024). https://doi.org/10.1186/s13643-024-02581-6

Download citation

Received : 13 March 2024

Accepted : 10 June 2024

Published : 20 June 2024

DOI : https://doi.org/10.1186/s13643-024-02581-6

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Social network
• Mental health
• Older adults
• Systematic review

Systematic Reviews

ISSN: 2046-4053

• Submission enquiries: Access here and click Contact Us
• General enquiries: [email protected]

Information

• Author Services

Initiatives

You are accessing a machine-readable page. In order to be human-readable, please install an RSS reader.

All articles published by MDPI are made immediately available worldwide under an open access license. No special permission is required to reuse all or part of the article published by MDPI, including figures and tables. For articles published under an open access Creative Common CC BY license, any part of the article may be reused without permission provided that the original article is clearly cited. For more information, please refer to https://www.mdpi.com/openaccess .

Feature papers represent the most advanced research with significant potential for high impact in the field. A Feature Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for future research directions and describes possible research applications.

Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive positive feedback from the reviewers.

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

Original Submission Date Received: .

• Active Journals
• Find a Journal
• Proceedings Series
• For Authors
• For Reviewers
• For Editors
• For Librarians
• For Publishers
• For Societies
• For Conference Organizers
• Open Access Policy
• Institutional Open Access Program
• Special Issues Guidelines
• Editorial Process
• Research and Publication Ethics
• Article Processing Charges
• Testimonials
• Preprints.org
• SciProfiles
• Encyclopedia

Article Menu

• Subscribe SciFeed
• Google Scholar
• on Google Scholar
• Table of Contents

Find support for a specific problem in the support section of our website.

Please let us know what you think of our products and services.

Visit our dedicated information section to learn more about MDPI.

JSmol Viewer

Exploring the nature of diversity dishonesty within predominantly white schools of medicine, pharmacy, and public health at the most highly selective and highly ranked u.s. universities.

Share and Cite

Burrell, D.N. Exploring the Nature of Diversity Dishonesty within Predominantly White Schools of Medicine, Pharmacy, and Public Health at the Most Highly Selective and Highly Ranked U.S. Universities. Soc. Sci. 2024 , 13 , 332. https://doi.org/10.3390/socsci13070332

Burrell DN. Exploring the Nature of Diversity Dishonesty within Predominantly White Schools of Medicine, Pharmacy, and Public Health at the Most Highly Selective and Highly Ranked U.S. Universities. Social Sciences . 2024; 13(7):332. https://doi.org/10.3390/socsci13070332

Burrell, Darrell Norman. 2024. "Exploring the Nature of Diversity Dishonesty within Predominantly White Schools of Medicine, Pharmacy, and Public Health at the Most Highly Selective and Highly Ranked U.S. Universities" Social Sciences 13, no. 7: 332. https://doi.org/10.3390/socsci13070332

Article Metrics

Further information, mdpi initiatives, follow mdpi.

Subscribe to receive issue release notifications and newsletters from MDPI journals

• All subject areas
• Agricultural and Biological Sciences
• Arts and Humanities
• Biochemistry, Genetics and Molecular Biology
• Business, Management and Accounting
• Chemical Engineering
• Computer Science
• Decision Sciences
• Earth and Planetary Sciences
• Economics, Econometrics and Finance
• Engineering
• Environmental Science
• Health Professions
• Immunology and Microbiology
• Materials Science
• Mathematics
• Multidisciplinary
• Neuroscience
• Pharmacology, Toxicology and Pharmaceutics
• Physics and Astronomy
• Social Sciences
• All subject categories
• Anthropology
• Communication
• Cultural Studies
• Development
• Gender Studies
• Geography, Planning and Development
• Health (social science)
• Human Factors and Ergonomics
• Library and Information Sciences
• Life-span and Life-course Studies
• Linguistics and Language
• Political Science and International Relations
• Public Administration
• Safety Research
• Social Sciences (miscellaneous)
• Social Work
• Sociology and Political Science
• Transportation
• Urban Studies
• All regions / countries
• Asiatic Region
• Eastern Europe
• Latin America
• Middle East
• Northern America
• Pacific Region
• Western Europe
• ARAB COUNTRIES
• IBEROAMERICA
• NORDIC COUNTRIES
• Afghanistan
• Bosnia and Herzegovina
• Brunei Darussalam
• Czech Republic
• Dominican Republic
• Netherlands
• New Caledonia
• New Zealand
• Papua New Guinea
• Philippines
• Puerto Rico
• Russian Federation
• Saudi Arabia
• South Africa
• South Korea
• Switzerland
• Syrian Arab Republic
• Trinidad and Tobago
• United Arab Emirates
• United Kingdom
• United States
• Vatican City State
• Book Series
• Conferences and Proceedings
• Trade Journals

• Citable Docs. (3years)
• Total Cites (3years)

-->

	Title	Type
1		journal	14.943 Q1	115	16	42	403	896	41	24.10	25.19	77.78
2		journal	14.618 Q1	160	70	247	587	5353	230	21.11	8.39	58.79
3		journal	14.175 Q1	210	28	92	3163	1260	86	10.59	112.96	42.59
4		journal	13.080 Q1	260	243	827	1865	14374	679	16.58	7.67	62.53
5		journal	10.275 Q1	121	9	113	401	2441	102	21.97	44.56	75.00
6		journal	7.724 Q1	267	316	823	10099	11926	446	13.56	31.96	32.89
7		journal	7.553 Q1	200	87	220	3808	1366	220	5.40	43.77	24.53
8		journal	7.366 Q1	115	250	516	9291	10802	379	18.52	37.16	34.58
9		book series	5.826 Q1	129	25	72	3241	900	72	10.73	129.64	46.94
10		journal	5.775 Q1	177	95	464	9818	13119	450	24.28	103.35	28.01
11		journal	5.772 Q1	186	43	74	5366	1338	73	12.59	124.79	64.39
12		journal	5.428 Q1	220	49	165	3498	1277	163	7.41	71.39	52.29
13		journal	5.070 Q1	203	193	302	13168	2435	294	6.59	68.23	35.12
14		journal	5.057 Q1	72	141	453	4641	5217	232	11.83	32.91	45.25
15		journal	5.020 Q1	54	33	88	2448	1303	88	14.39	74.18	29.11
16		journal	4.948 Q1	148	60	106	4376	1539	93	14.31	72.93	42.02
17		journal	4.932 Q1	163	28	115	2431	1112	113	8.61	86.82	24.00
18		journal	4.629 Q1	204	128	204	7247	1324	204	6.29	56.62	25.75
19		journal	4.612 Q1	83	64	103	2113	722	103	6.06	33.02	20.89
20		journal	4.375 Q1	189	51	149	6494	1607	141	10.51	127.33	35.29
21		journal	4.324 Q1	30	144	334	2888	1904	141	5.48	20.06	44.01
22		journal	4.321 Q1	142	118	208	11698	2845	197	12.23	99.14	53.76
23		journal	4.314 Q1	132	69	163	3330	1135	159	5.84	48.26	21.15
24		journal	4.295 Q1	230	38	122	4361	1094	116	7.21	114.76	32.53
25		journal	4.176 Q1	185	89	218	6841	1687	216	6.45	76.87	26.42
26		journal	4.060 Q1	43	28	49	2013	819	49	8.72	71.89	49.47
27		journal	4.006 Q1	56	97	232	5911	5002	232	15.63	60.94	29.27
28		journal	3.956 Q1	151	67	205	3036	2030	198	6.76	45.31	48.23
29		journal	3.914 Q1	73	58	116	4766	837	109	7.32	82.17	27.78
30		journal	3.874 Q1	100	48	130	5704	2101	129	12.20	118.83	57.87
31		journal	3.863 Q1	130	84	216	7477	2702	214	4.93	89.01	55.99
32		journal	3.824 Q1	128	89	121	8012	1961	109	12.39	90.02	25.98
33		journal	3.788 Q1	94	80	192	4880	1624	189	8.24	61.00	30.11
34		journal	3.760 Q1	187	289	777	21339	10766	772	11.83	73.84	28.50
35		journal	3.737 Q1	171	150	371	8487	2337	371	5.69	56.58	37.27
36		journal	3.666 Q1	147	398	720	37890	13489	713	17.88	95.20	36.54
37		journal	3.651 Q1	232	163	597	13475	9892	596	12.14	82.67	47.96
38		journal	3.647 Q1	125	99	217	4796	1400	217	5.33	48.44	34.13
39		journal	3.610 Q1	434	93	438	8471	3295	436	5.79	91.09	47.95
40		journal	3.600 Q1	29	20	106	728	1040	92	4.94	36.40	45.90
41		journal	3.597 Q1	162	112	228	9975	2031	221	8.20	89.06	48.87
42		journal	3.520 Q1	68	72	199	2880	2148	182	10.46	40.00	44.83
43		journal	3.491 Q1	129	108	228	8464	1500	228	5.53	78.37	31.13
44		journal	3.447 Q1	216	129	529	8173	6125	510	9.42	63.36	39.68
45		journal	3.408 Q1	172	187	319	17090	4506	310	13.38	91.39	42.08
46		journal	3.385 Q1	118	108	336	4683	1026	312	2.76	43.36	23.83
47		journal	3.357 Q1	178	72	245	7916	2495	242	8.61	109.94	43.52
48		journal	3.352 Q1	255	117	496	10604	7653	495	14.57	90.63	40.97
49		journal	3.348 Q1	105	54	127	2859	1305	121	5.69	52.94	44.66
50		journal	3.334 Q1	118	115	155	7277	1216	154	7.05	63.28	31.23

Follow us on @ScimagoJR Scimago Lab , Copyright 2007-2024. Data Source: Scopus®

Cookie settings

Cookie Policy

Legal Notice

Privacy Policy

• Technical Support
• Find My Rep

You are here

The Journal of Social Studies Research

University of Central Florida, USA

Preview this book

• Aims and Scope
• Editorial Board
• Abstracting / Indexing
• Submission Guidelines

The Journal of Social Studies Research (JSSR) is an internationally recognized peer-reviewed journal designed to foster the dissemination of ideas and research findings related to the social studies. JSSR is the official publication of The International Society for the Social Studies (ISSS). JSSR is published four times a year. 

University of Tennessee, USA

East Tennessee State University, USA

	University of South Florida, USA
	Kansas State University, USA
	Western Oregon University, USA
	East Tennessee State University, USA
	University of Tennessee, USA
	Ankara, Turkey

Manuscript Submission Guidelines: The Journal of Social Studies Research

Please read the guidelines below then visit the Journal’s submission site [ https://mc.manuscriptcentral.com/ssr ] to upload your manuscript. Please note that manuscripts not conforming to these guidelines may be returned. Remember you can log in to the submission site at any time to check on the progress of your paper through the peer review process.

Sage Publishing disseminates high-quality research and engaged scholarship globally, and we are committed to diversity and inclusion in publishing. We encourage submissions from a diverse range of authors from across all countries and backgrounds.

Only manuscripts of sufficient quality that meet the aims and scope of The Journal of Social Studies Research will be reviewed.

There are no fees payable to submit or publish in this Journal. Open Access options are available - see section 3.3 below.

As part of the submission process you will be required to warrant that you are submitting your original work, that you have the rights in the work, and that you have obtained and can supply all necessary permissions for the reproduction of any copyright works not owned by you, that you are submitting the work for first publication in the Journal and that it is not being considered for publication elsewhere and has not already been published elsewhere. Please see our guidelines on prior publication and note that The Journal of Social Studies Research will consider submissions of papers that have been posted on preprint servers; please alert the Editorial Office when submitting (contact details are at the end of these guidelines) and include the DOI for the preprint in the designated field in the manuscript submission system. Authors should not post an updated version of their paper on the preprint server while it is being peer reviewed for possible publication in the Journal. If the article is accepted for publication, the author may re-use their work according to the Journal's author archiving policy.

If your paper is accepted, you must include a link on your preprint to the final version of your paper.

If you have any questions about publishing with Sage, please visit the Sage Journal Solutions Portal .

• What do we publish? 1.1 Aims & Scope 1.2 Article types 1.3 Writing your paper
• Editorial policies 2.1 Peer review policy 2.2 Authorship 2.3 Acknowledgements 2.4 Funding 2.5 Declaration of conflicting interests 2.6 Research data
• Publishing policies 3.1 Publication ethics 3.2 Contributor’s publishing agreement 3.3 Open access and author archiving
• Preparing your manuscript 4.1 Formatting 4.2 Artwork, figures and other graphics 4.3 Identifiable information 4.4 Supplemental material 4.5 Reference style 4.6 English language editing services
• Submitting your manuscript 5.1 ORCID 5.2 Information required for completing your submission 5.3 Permissions
• On acceptance and publication 6.1 Sage Production 6.2 Online First publication 6.3 Access to your published article 6.4 Promoting your article
• Further information 7.1 Appealing the publication decision

1. What do we publish?

1.1 Aims & Scope

Before submitting your manuscript to The Journal of Social Studies Research, please ensure you have read the Aims & Scope .

1.2 Article types

• Original Research
• Book Reviews
• Media Reviews

Typical submissions range between 20-35 pages not including the title, keywords/ abstract, or references.

There are no limit to the number of references.

1.3 Writing your paper

The Sage Author Gateway has some general advice on how to get published , plus links to further resources.

Sage Author Services also offers authors a variety of ways to improve and enhance your article including English language editing, plagiarism detection, and video abstract and infographic preparation.

1.3.1 Make your article discoverable

For information and guidance on how to make your article more discoverable, visit our Gateway page on How to Help Readers Find Your Article Online .

Back to top

2. Editorial policies

2.1 Peer review policy

Sage does not permit the use of author-suggested (recommended) reviewers at any stage of the submission process, be that through the web-based submission system or other communication.

Reviewers should be experts in their fields and should be able to provide an objective assessment of the manuscript. Our policy is that reviewers should not be assigned to a paper if:

• The reviewer is based at the same institution as any of the co-authors.
• The reviewer is based at the funding body of the paper.
• The author has recommended the reviewer.
• The reviewer has provided a personal (e.g. Gmail/Yahoo/Hotmail) email account and an institutional email account cannot be found after performing a basic Google search (name, department and institution).

The journal’s policy is to have manuscripts reviewed by two expert reviewers. The Journal of Social Studies Research utilizes a double-anonymized peer review process in which the reviewer and authors’ names and information are withheld from the other. Reviewers may at their own discretion opt to reveal their names to the author in their review but our standard policy practice is for their identities to remain concealed. All manuscripts are reviewed as rapidly as possible, while maintaining rigor. Reviewers make comments to the author and recommendations to the Editor who then makes the final decision.

The Editor or members of the Editorial Board may occasionally submit their own manuscripts for possible publication in the Journal. In these cases, the peer review process will be managed by alternative members of the Board and the submitting Editor/Board member will have no involvement in the decision-making process.

The Journal of Social Studies Research is committed to delivering high quality, fast peer-review for your paper, and as such has partnered with Web of Science (previously Publons). Web of Science is a third-party service that seeks to track, verify and give credit for peer review. Reviewers for The Journal of Social Studies Research can opt in to Web of Science in order to claim their reviews or have them automatically verified and added to their reviewer profile. Reviewers claiming credit for their review will be associated with the relevant journal, but the article name, reviewer’s decision and the content of their review is not published on the site. For more information visit the Web of Science website.

2.2 Authorship

All parties who have made a substantive contribution to the article should be listed as authors. Principal authorship, authorship order, and other publication credits should be based on the relative scientific or professional contributions of the individuals involved, regardless of their status. A student is usually listed as principal author on any multiple-authored publication that substantially derives from the student’s dissertation or thesis.

Please note that AI chatbots, for example ChatGPT, should not be listed as authors. For more information see the policy on Use of ChatGPT and generative AI tools .

2.3 Acknowledgements

All contributors who do not meet the criteria for authorship should be listed in an Acknowledgements section. Examples of those who might be acknowledged include a person who provided purely technical help, or a department chair who provided only general support.

Please supply any personal acknowledgements separately to the main text to facilitate anonymous peer review.

Per ICMJE recommendations , it is best practice to obtain consent from non-author contributors who you are acknowledging in your paper.

2.3.1 Third party submissions

Where an individual who is not listed as an author submits a manuscript on behalf of the author(s), a statement must be included in the Acknowledgements section of the manuscript and in the accompanying cover letter. The statements must:

• Disclose this type of editorial assistance – including the individual’s name, company and level of input
• Identify any entities that paid for this assistance
• Confirm that the listed authors have authorized the submission of their manuscript via third party and approved any statements or declarations, e.g. conflicting interests, funding, etc.

Where appropriate, Sage reserves the right to deny consideration to manuscripts submitted by a third party rather than by the authors themselves.

2.3.2 Writing assistance

Individuals who provided writing assistance, e.g., from a specialist communications company, do not qualify as authors and so should be included in the Acknowledgements section. Authors must disclose any writing assistance – including the individual’s name, company and level of input – and identify the entity that paid for this assistance. It is not necessary to disclose use of language polishing services.

2.4 Funding

The Journal of Social Studies Research requires all authors to acknowledge their funding in a consistent fashion under a separate heading.  Please visit the Funding Acknowledgements page on the Sage Journal Author Gateway to confirm the format of the acknowledgment text in the event of funding, or state that: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. 

2.5 Declaration of conflicting interests

It is the policy of The Journal of Social Studies Research to require a declaration of conflicting interests from all authors enabling a statement to be carried within the paginated pages of all published articles.

Please ensure that a ‘Declaration of Conflicting Interests’ statement is included at the end of your manuscript, after any acknowledgements and prior to the references. If no conflict exists, please state that ‘The Author(s) declare(s) that there is no conflict of interest’. For guidance on conflict of interest statements, please see the ICMJE recommendations here .

2.6 Research data

The Journal is committed to facilitating openness, transparency and reproducibility of research, and has the following research data sharing policy. For more information, including FAQs please visit the Sage Research Data policy pages .

Subject to appropriate ethical and legal considerations, authors are encouraged to:

• Share your research data in a relevant public data repository
• Include a data availability statement linking to your data. If it is not possible to share your data, use the statement to confirm why it cannot be shared.
• Cite this data in your research

Peer reviewers may be asked to peer review the research data prior to publication.

• Peer reviewers may be asked to assess compliance with the research data policy
• Peer reviewers may be asked to assess research data files

If you need to anonymize your research data for peer review, please refer to our Research Data Sharing FAQs for guidance.  

3. Publishing policies

3.1 Publication ethics

Sage is committed to upholding the integrity of the academic record. We encourage authors to refer to the Committee on Publication Ethics’ International Standards for Authors and view the Publication Ethics page on the Sage Author Gateway .

3.1.1 Plagiarism

The Journal of Social Studies Research and Sage take issues of copyright infringement, plagiarism or other breaches of best practice in publication very seriously. We seek to protect the rights of our authors and we always investigate claims of plagiarism or misuse of published articles. Equally, we seek to protect the reputation of the Journal against malpractice. Submitted articles may be checked with duplication-checking software. Where an article, for example, is found to have plagiarized other work or included third-party copyright material without permission or with insufficient acknowledgement, or where the authorship of the article is contested, we reserve the right to take action including, but not limited to: publishing an erratum or corrigendum (correction); retracting the article; taking up the matter with the head of department or dean of the author's institution and/or relevant academic bodies or societies; or taking appropriate legal action.

3.1.2 Prior publication

If material has been previously published it is not generally acceptable for publication in a Sage journal. However, there are certain circumstances where previously published material can be considered for publication. Please refer to the guidance on the Sage Author Gateway or if in doubt, contact the Editor at the address given below.

3.2 Contributor’s publishing agreement

Before publication, Sage requires the author as the rights holder to sign a Journal Contributor’s Publishing Agreement. Sage’s Journal Contributor’s Publishing Agreement is an exclusive license agreement which means that the author retains copyright in the work but grants Sage the sole and exclusive right and license to publish for the full legal term of copyright. Exceptions may exist where an assignment of copyright is required or preferred by a proprietor other than Sage. In this case copyright in the work will be assigned from the author to the society. For more information, please visit the Sage Author Gateway .

3.3 Open access and author archiving

The Journal of Social Studies Research offers optional open access publishing via the Sage Choice programme and Open Access agreements, where authors can publish open access either discounted or free of charge depending on the agreement with Sage. Find out if your institution is participating by visiting Open Access Agreements at Sage . For more information on Open Access publishing options at Sage please visit Sage Open Access . For information on funding body compliance, and depositing your article in repositories, please visit Sage’s Author Archiving and Re-Use Guidelines and Publishing Policies .

4. Preparing your manuscript

4.1 Formatting

The preferred format for your manuscript is Word.

4.2 Artwork, figures and other graphics

For guidance on the preparation of illustrations, pictures and graphs in electronic format, please visit Sage’s Manuscript Submission Guidelines .

4.3 Identifiable information

Where a journal uses double-anonymized peer review, authors are required to submit:

• A version of the manuscript which has had any information that compromises the anonymity of the author(s) removed or anonymized. This version will be sent to the peer reviewers.
• A separate title page which includes any removed or anonymized material. This will not be sent to the peer reviewers.

See https://us.sagepub.com/en-us/nam/Manuscript-preparation-for-double-anonymized-journal for detailed guidance on making an anonymous submission.

Figures supplied in color will appear in color online regardless of whether or not these illustrations are reproduced in color in the printed version. For specifically requested color reproduction in print, you will receive information regarding the costs from Sage after receipt of your accepted article.

4.4 Supplemental material

This Journal is able to host additional materials online (e.g., datasets, podcasts, videos, images etc.) alongside the full-text of the article. For more information please refer to our guidelines on submitting supplemental files .

4.5 Reference style

The Journal of Social Studies Research adheres to the APA reference style. View the APA guidelines to ensure your manuscript conforms to this reference style.

4.6 English language editing services

Authors seeking assistance with English language editing, translation, or figure and manuscript formatting to fit the Journal’s specifications should consider using Sage Language Services. Visit Sage Language Services on our Journal Author Gateway for further information.

5. Submitting your manuscript

The Journal of Social Studies Research is hosted on Sage Track, a web based online submission and peer review system powered by ScholarOne™ Manuscripts. Visit [ https://mc.manuscriptcentral.com/ssr ] to login and submit your article online.

IMPORTANT : Please check whether you already have an account in the system before trying to create a new one. If you have reviewed or authored for the Journal in the past year it is likely that you will have had an account created.  For further guidance on submitting your manuscript online please visit ScholarOne Online Help .

As part of our commitment to ensuring an ethical, transparent and fair peer review process Sage is a supporting member of ORCID, the Open Researcher and Contributor ID . ORCID provides a unique and persistent digital identifier that distinguishes researchers from every other researcher, even those who share the same name, and, through integration in key research workflows such as manuscript and grant submission, supports automated linkages between researchers and their professional activities, ensuring that their work is recognized.

The collection of ORCID IDs from corresponding authors is now part of the submission process of this Journal. If you already have an ORCID ID you will be asked to associate that to your submission during the online submission process. We also strongly encourage all co-authors to link their ORCID ID to their accounts in our online peer review platforms. It takes seconds to do: click the link when prompted, sign into your ORCID account and our systems are automatically updated. Your ORCID ID will become part of your accepted publication’s metadata, making your work attributable to you and only you. Your ORCID ID is published with your article so that fellow researchers reading your work can link to your ORCID profile and from there link to your other publications.

If you do not already have an ORCID ID please follow this link to create one or visit our ORCID homepage to learn more.

5.2 Information required for completing your submission

You will be asked to provide contact details and academic affiliations for all co-authors via the submission system and identify who is to be the corresponding author. These details must match what appears on your manuscript. The affiliation listed in the manuscript should be the institution where the research was conducted. If an author has moved to a new institution since completing the research, the new affiliation can be included in a manuscript note at the end of the paper. At this stage please ensure you have included all the required statements and declarations and uploaded any additional supplementary files (including reporting guidelines where relevant).

5.3 Permissions

Please also ensure that you have obtained any necessary permission from copyright holders for reproducing any illustrations, tables, figures or lengthy quotations previously published elsewhere. For further information including guidance on fair dealing for criticism and review, please see the Copyright and Permissions page on the Sage Author Gateway .

6. On acceptance and publication

6.1 Sage Production

Your Sage Production Editor will keep you informed as to your article’s progress throughout the production process. Proofs will be made available to the corresponding author via our editing portal Sage Edit or by email, and corrections should be made directly or notified to us promptly. Authors are reminded to check their proofs carefully to confirm that all author information, including names, affiliations, sequence and contact details are correct, and that Funding and Conflict of Interest statements, if any, are accurate.

6.2 Online First publication

Online First allows final articles (completed and approved articles awaiting assignment to a future issue) to be published online prior to their inclusion in a journal issue, which significantly reduces the lead time between submission and publication. Visit the Sage Journals help page for more details, including how to cite Online First articles.

6.3 Access to your published article

Sage provides authors with online access to their final article.

6.4 Promoting your article

Publication is not the end of the process! You can help disseminate your paper and ensure it is as widely read and cited as possible. The Sage Author Gateway has numerous resources to help you promote your work. Visit the Promote Your Article page on the Gateway for tips and advice.

7. Further information

Any correspondence, queries or additional requests for information on the manuscript submission process should be sent to The Journal of Social Studies Research editorial office as follows:

[email protected] and [email protected]

7.1 Appealing the publication decision

Editors have very broad discretion in determining whether an article is an appropriate fit for their journal. Many manuscripts are declined with a very general statement of the rejection decision. These decisions are not eligible for formal appeal unless the author believes the decision to reject the manuscript was based on an error in the review of the article, in which case the author may appeal the decision by providing the Editor with a detailed written description of the error they believe occurred.

If an author believes the decision regarding their manuscript was affected by a publication ethics breach, the author may contact the publisher with a detailed written description of their concern, and information supporting the concern, at [email protected] .

• Read Online
• Sample Issues
• Current Issue
• Email Alert
• Permissions
• Foreign rights
• Reprints and sponsorship
• Advertising

Individual Subscription, E-access

Individual Subscription, Combined (Print & E-access)

Institutional Subscription, E-access

Institutional Subscription & Backfile Lease, E-access Plus Backfile (All Online Content)

Institutional Subscription, Print Only

Institutional Subscription, Combined (Print & E-access)

Institutional Subscription & Backfile Lease, Combined Plus Backfile (Current Volume Print & All Online Content)

Institutional Backfile Purchase, E-access (Content through 1998)

Individual, Single Print Issue

Institutional, Single Print Issue

To order single issues of this journal, please contact SAGE Customer Services at 1-800-818-7243 / 1-805-583-9774 with details of the volume and issue you would like to purchase.

New research highlights where 'The Big One' earthquake could hit

Northern part of the long pacific ocean fault most likely to produce a major earthquake, scientists say.

Social Sharing

New research offers a clearer picture of a fault line hundreds of kilometres long off the West Coast that is predicted to generate a major earthquake and tsunami commonly known as "The Big One."

The study confirms that the northern part of the fault, close to Vancouver Island and Washington state, is most likely to produce a major earthquake. 

"It's giving us the first really detailed look at this huge megathrust fault that we've long known about but haven't had any details about," Edwin Nissen, a University of Victoria earth and ocean science researcher who was not involved in the research into the fault line where two tectonic plates meet.

The research, recently published in the prestigious journal Science Advances, produced the most detailed picture researchers have yet had of the fault zone spanning more than 900 kilometres from northern California to Vancouver Island — imaging they say helps them understand the magnitude and probability of earthquakes. 

Clearer picture of B.C.’s ‘big one’ emerges — and it’s not good

Subduction zones are regions where two tectonic plates collide — one plate sliding under the other toward the Earth's mantle.

In the Cascadia Subduction Zone, the Juan de Fuca tectonic plate is slowly sliding underneath the North American plate.

Most of the time, the plates are locked in place, pushing against each other and building stress. Once every several hundred years or so, they generate a  major megathrust earthquake  and large tsunami. 

According to Suzanne Carbotte, the study's lead author and Columbia University marine geophysicist, many subduction zones produce small earthquakes. These help researchers understand the faults and fragmentations deep in the Earth. However, in the Cascadia zone, where these earthquakes aren't common, researchers didn't have that information. 

About 50 researchers and crew took to the water on a ship that traced the Cascadia fault line. The ship was equipped with sophisticated imaging technology, which Nissen said is usually used by oil and gas companies for exploration. 

"Most academic scientists don't have the kind of money these companies have," Nissen said. "To get this kind of data for a purely scientific purpose is really exciting."

Researchers sent low-frequency sound pulses into the fault. A 15-kilometre-long receiver, towed behind the boat equipped with hydrophones, picked up the resulting echoes. With this information, researchers created high-resolution images.

Earthquakes: "The Big One" is coming

They found the surface where the Juan de Fuca and North American plates interlock is much more complex and jagged than they had previously mapped.

Kelin Wang, a researcher with the Geological Survey of Canada and adjunct professor at the University of Victoria who was not involved in the research, said a survey of this scale hasn't been conducted before. 

He said it helps explain historical earthquakes near the northern Pacific Ocean, such as the one  that hit North America and the resulting tsunami that reached Japan in 1700. 

"In a couple of years, we'll know a lot more about this system if we begin to model earthquakes and incorporate this information," he said.

• How Metro Vancouver is earthquake-proofing its water reservoirs in preparation for the 'Big One'
• Earthquake 'swarm' strikes off B.C. coast, but no sign of the 'Big One'

While it's not possible to actually predict earthquakes, Carbotte said the information will help hazard-researchers understand the probabilities of earthquakes and tsunamis. Those models can inform building codes and tsunami evacuation plans to protect coastal populations. 

"The probabilities are high that we're going to see a megathrust earthquake in the [Pacific Northwest] in the next 100 years," Carbotte said. "[This research] does very much inform the hazard and resilience mitigation efforts."

ABOUT THE AUTHOR

Reporter/Editor

Isaac Phan Nay is a CBC News reporter/editor in Vancouver. Please contact him at [email protected].

With files from Lyndsay Duncombe

Related Stories

• Top stories from British Columbia
• Vancity lays off 7 per cent of workforce
• B.C. man ascends treacherous Grouse Grind a record 5,000 times
• Gig workers in B.C. to be paid minimum of $20.88 an hour

• SUGGESTED TOPICS
• The Magazine
• Newsletters
• Managing Yourself
• Managing Teams
• Work-life Balance
• The Big Idea
• Data & Visuals
• Reading Lists
• Case Selections
• HBR Learning
• Topic Feeds
• Account Settings
• Email Preferences

How to Vet Information Before Making a Decision

• Alex Edmans

Four questions to ask when you’re considering the evidence.

The daily decisions modern leaders face are increasingly complex. But executives have a tool to combat these challenges – information. At the click of a mouse or the press of a thumb, they can call up cutting edge research on virtually any topic. With so much information available, how do we know what to trust? What executives need is a simple taxonomy of misinformation so they know what to look out for. Drawing on the tools of social science research we can categorize misinformation into four missteps. This framework can be useful to leaders of all kinds who need to ask better questions to manage their own information onslaughts.

The challenges facing business leaders have never been greater. Regular decisions are increasingly complex, given inflation, trade tensions, and political uncertainty. Human capital issues now include diversity, equity and inclusion, mental health, and upskilling for the fourth industrial revolution. Environmental, social and governance concerns can no longer be delegated to a corporate social responsibility department; they’re the duty of the C-suite. Artificial intelligence brings myriad new opportunities, but also multiple new threats.

• Alex Edmans is a Professor of Finance at London Business School, where he specializes in corporate finance, behavioral finance, and corporate social responsibility. He earned his BA from Oxford University and his Ph.D. from MIT, where he was a Fulbright scholar. He is the author of May Contain Lies: How Stories, Statistics, and Studies Exploit Our Biases – And What We Can Do About It (Penguin Random House, 2024).

Partner Center

• Español (Spanish)
• Français (French)
• Bahasa Indonesia (Indonesian)
• Brasil (Portuguese)
• हिंदी (Hindi)

Reimagining insect research: Interview with Roel van Klink and Leandro Nascimento

• Three out of every four known species on Earth are insects, but efforts to monitor, study and protect them have been lagging worldwide.
• A new themed issue published in the journal Philosophical Transactions of the Royal Society delves into four tech tools that have the ability to reshape insect research in the coming years.
• The issue highlights acoustic monitoring, remote sensing using radars, computer vision, and DNA sequencing as potential tools that could help scientists and researchers ramp up global insect biodiversity monitoring.

They might comprise close to 75% of all known animal species. But when it comes to the monitoring and protection of insects, global efforts have been inadequate.

The numbers tell a harrowing story.

A global review of insect populations published in 2019 in the journal Biological Conservation found that 40% of insect species are threatened with extinction, which could lead to “a catastrophic collapse” of ecosystems worldwide.

“Most insects are relatively uninteresting for humans,” Roel van Klink, senior researcher at the Biodiversity Synthesis Research Group at the German Centre for Integrative Biodiversity Research, told Mongabay in a video interview. “It’s very laborious work, and society has not been willing to pay for the time that it actually needs to do this well.”

Even as technology is being increasingly deployed to study and monitor insects globally, van Klink said he realized that groups developing these tools were often unaware of developments in other spheres. “It seemed that they were not talking to each other,” he said. “There were parallel developments in different countries.”

As a first step toward addressing this concern and to get people to collaborate, van Klink brought together a group of scientists, researchers and technologists working on insect biodiversity. Working with them, he and a team collected, compiled and edited a special issue of studies titled “ Towards a toolkit for global insect biodiversity monitoring ” that was published in the journal Philosophical Transactions of the Royal Society .

The issue comprises research from 142 authors in 27 countries with a focus on four cutting-edge technological developments that could potentially reshape insect biodiversity monitoring in the years ahead. They include acoustic monitoring to identify insects from sound; computer vision to identify them from images; radar technology to detect insects remotely; and the use of DNA to identify species.

Roel van Klink spoke with Mongabay’s Abhishyant Kidangoor about the state of global insect biodiversity monitoring and how technology might help fill the gaps. He was also joined by bioacoustics scientist Leandro Nascimento, who was part of the editorial team for the special issue. This interview has been edited for length and clarity.

Mongabay: How is insect biodiversity monitoring faring globally?

Roel van Klink: The status is actually really bad. It’s all being done with traditional methods, which means you need to catch the insects and then you need to identify and count morphologically. Everything is done manually. Most of that is done in Europe. We have a very long tradition going back to maybe the 1920s. In the U.S., too, they’ve been doing that for a very long time. But it’s usually for very specific groups of insects. For example, we have a good network for butterfly counting that’s well established in Europe, but there are still European countries that don’t have it. Even in the best case, it goes back only to the ’70s. But again, it’s only for butterflies. In the U.S., they have been measuring mosquitoes going back to the ’60s, but that’s only mosquitoes. Everything else is just random depending on whether there was a person that was willing to or interested in identifying one specific group of insects at one place.

Eventually, the situation is that we may be monitoring only ground beetles in one place, butterflies in another place and mosquitoes in another. And that’s for only some countries. Most of the rest of the world, there’s just almost nothing. It’s really bad for most groups of insects. We don’t even know how they’re doing. We don’t even know which species there are in the tropics.

Mongabay: Why is it this way?

Roel van Klink: Most insects are relatively uninteresting for humans. We can do pest monitoring or disease vector monitoring, and track butterflies, because they’re easy. You can get lots of people to do it. But for all the other obscure little flies and wasps that are out there, it’s very hard even to identify them. For specialists, the literature is huge. There are so many species. Most species have not been described, and it is very laborious work. Society has not been willing to pay for the time that it actually needs to do this well.

Mongabay: What are the gaps in the traditional methods of monitoring and studying insects?

Roel van Klink: The usual methods to catch insects would be something like pitfall trapping. In that, you will only catch the stuff that’s walking on the ground surface and can fall into the trap. If you want to catch flying insects, you will do that with a different method. For example, with a net Malaise trap. Everything that flies in goes up, and there they get caught. If you want to get stuff below the ground, there are different methods that you need. If you want to get insects in vegetation, you would need different methods. Every group of insects needs a different way of getting them.

And then you need so much specialist knowledge to identify all those species because you have a large group to choose from. Here in Germany, for example, we have 33,000 species. Nobody knows all of them. It’s impossible. The people that have most species knowledge can maybe identify 4,000 beetle species. That seems to be really the maximum. If you go to tropical countries, the diversity is even larger. So you have to specialize in one specific group to identify, and therefore you cannot get everything identified. Therefore, for most of the things, we just don’t know what it is.

That’s where these modern methods can help us to monitor many more species, because artificial intelligence essentially can learn unlimited amounts of species in contrast to a human. We can use these methods to identify more species for more locations over longer time periods with much less human effort.

Leandro Nascimento: If monitored more efficiently, we don’t need to be sending people all the time to the field to collect these animals and to kill them. That’s another problem some people are starting to discuss. Most of these traditional methods are lethal. That means you kill insects. And, who knows, maybe you are capturing an insect that is already endangered or is at risk of extinction. With these other technologies, you don’t necessarily have to kill them. For example, in acoustic monitoring, we’ll be recording the sound passively without killing them. That’s another big advantage.

Mongabay: What was the spark for getting this issue on global insect biodiversity monitoring together?

Roel van Klink: We started this coming from a working group. Me and a colleague had been working on traditional insect monitoring data for quite a while, and we were noticing that lots of different groups of people were trying to develop these modern methods. But it seemed that they were not talking to each other. There were parallel developments in different countries. Radars were being developed. There was acoustics being developed better and better. Then there was the molecular stuff in its own right. We figured we needed to get all these people to start talking to each other. So we organized a workshop in 2021. It had to be virtual, but it was quite well-attended.

Then, in 2022, we could finally do an in-person workshop. That’s where the idea came up to do this as a special issue. We had a very interdisciplinary group. We have ecologists, but we also have computer-vision experts, laser physicists and geneticists. You can do this only in an interdisciplinary manner because of the specialized knowledge that you need, both on insects and the methodology. No one person can do all of that.

Leandro Nascimento: I was called in because my expertise is in bioacoustics. I was working in acoustics for over 10 years. I realized that most of the people working in bioacoustics didn’t have the tools to monitor insects, like training data. They were using bioacoustics and doing mostly classification of birds and mammals, but the insects were again being neglected. In places like the Amazon, India and most tropical countries, insects are the most biodiverse group. Even if you just walk in the forest, you hear all these sounds. We might be recording their sounds, but why are we not studying them? Why are we not classifying them and trying to collect data on them? That was the main motivation for me.

Mongabay: Could you tell me the types of technology that interested you and why you thought they were worth mentioning in your issue?

Roel van Klink: These were the four technologies we started with because they are the best developed. Since then, only two have really started to become established. But these four are the ones that have probably the biggest potential and the widest application. They have different strengths and weaknesses.

With molecular methods, you can probably get the best data on the species identity, but you cannot really get reliable estimates of how many individuals there were in your sample or any environment. But it’s becoming quite an established method. Lots of people are working on it, with barcoding and meta barcoding. And now it has even become possible to do large-scale individual-level barcoding. All of these are established.

The only ones that are really quite new are the lidar stuff. So it’s a laser that gives you very detailed information about anything flying through the laser. We have only very little about that in this issue because it’s fairly new and very few people are working on it.

The use of substrate vibrations is also relatively new. It is the sound that insects make when they knock on wood, or they are gnawing inside the wood or in a plant or in the soil. So it’s related to acoustics in some way. But you need very specific machinery to detect these signals, either with a laser or with the microphone.

Leandro Nascimento: That’s right. Vibration is quite new. But so is everything else about the hardware. For tracking animals, for example, visually, the way we do for large species is by using camera traps. But we cannot use a camera that is activated by motion sensors to study insects. They’re too tiny for that. So people have been developing new hardware to try to identify insects. And that brings a whole new set of challenges. For visual identification, software is more advanced than hardware.

Roel van Klink: Yeah, software is working quite well. For example, all these apps for identifying stuff like iNaturalist and other observation apps, they work amazingly well with a picture of one insect. If you have enough training data, it works really well. But if you really want a standardized sample of insects, and you need to attract them in some way to a screen with light or a yellow screen and then take a photo of them, that hardware is still being developed. People have been working on it for years, but it’s a slow process. And, basically, you start from scratch because nobody has ever done anything like that before. It’s happening and, hopefully, in a few years, we will have something that can really do this well.

Leandro Nascimento: You can deploy it, for example, in large-scale monitoring programs. The molecular methods, the acoustic methods and even the lidar, you have national-level programs where people are trying to monitor or count insects. But with just camera traps for insects, that’s not still not at that level yet even though the software is quite well developed for recognizing patterns and visual identification.

Roel van Klink: As for the other methods that we cover, radar is quite well developed. And we’ve known actually for a very long time that a radar can detect insects. They did that in the U.K. for a very long time starting in the ’90s. There were some good papers coming out and now there is actually a radar network that can detect anything flying through the beam. But because the radar waves are relatively long, you do not get a whole lot of detail on the organism flying through the beam. And whenever there’s a bird flying through your beam, it gives such a bright signal that everything else cannot be seen anymore. It’s a very interesting method, and it needs more development to really get more information about the insects flying through the beam. But at least there is a network. There are probably 20 radars deployed in Europe now.

In the U.S., they’re working a lot on the weather radar systems. These are horizontal radars that try to capture the rainfall and stuff. They will also detect insects, but that wavelength is even bigger. So the resolution of what you get is much coarser and you can probably only detect the biggest insects. But it covers such a large area that it becomes very interesting because it can measure at places where we have no data. And so that’s why we believe that the combination of all of these different methods gives us the best overview of what’s happening to insects.

Mongabay: How can we better bring all these tools together and make them work seamlessly?

Roel van Klink: What we are hoping for is to maybe establish a network of sensors. But then, we do need to get good sensors first. The computer-vision stuff will be absolutely crucial to have. And then what we hope is that we can combine the observations at the ground level from the camera traps and the molecular data with what we observe higher in the sky using the radar, and maybe there will be a lidar in between. Eventually, we hope to scale it up.

What we need to know is how the information is related between all of these different strata. If you have all these different sensors and stations that are local, and you have at the same time the radar going above it at a very high level, then what we hope is that we can extrapolate what we detect at the local level. From that, we hope that the radar detects things where we do not have stations by extrapolating down to what’s happening there. But first, we need proof of principle that these methods can be combined, and more details on what information is being transported between the different levels.

Mongabay: How are you planning to get that moving?

Roel van Klink: What we are hoping to do is get some money to do this. We have a very international team of people. Even in Europe, this is not easy. We have European grants that can work internationally, but they’re extremely competitive. Most of the grants that you can actually get are at the national level. We can maybe get national funding in Germany for developing computer-vision traps. But if we want the best acoustic experts, then we probably need two people from France because the French have developed their methods especially for bush crickets in France. The best radar people are located in Switzerland. The amount of money you need and having all these different countries involved is very challenging. And it’s not straightforward to get funding for all of these different institutes.

Leandro Nascimento: Especially if it is purely for research. I think companies in the private sector can also play a role in getting the fund because then you can get funding not only from the government agencies, but also from private sector investors to try to invest in these technologies. Because many of them are working with these different technologies to get an overall biodiversity assessment of the area. It’s just that they use the technology in isolation and so they’re not combining it. Either they are doing acoustic monitoring, or they’re doing some molecular monitoring, or just using traditional methods, but then not combining them. I also think that the traditional methods are always going to be necessary to describe new species to do the taxonomy work, but it can be integrated with these newer technologies.

I have a lot of taxonomist friends working in Brazil. When they go to collect new species or describe a new species, they don’t take, for example, recorders because it’s not part of their agenda. But why not also record these animals so we can have a reference library of how those animals sound? Then people across science can train machines based on that data.

Roel van Klink: This library issue is really, really important. It’s not just for the acoustics, but also for computer vision, which does not have enough images. You cannot take a machine that was trained in Denmark and put it to use even in Switzerland, let alone in a tropical country. So you’re going to need local experts to identify what the species are. And then you need to have enough photos or sounds to actually train the classifier. This is the challenging part.

For radar and lidar, we probably just have to accept that we’re not going to know everything. Whereas for acoustics, we can get really far in associating a sound with a species. Since we still have 80% of the species on Earth undescribed, it’s going to be a lot of work to also record the sounds of these things as they get described.

What we actually need is a large campaign. There have been big campaigns to record all the DNA sequences of all the species. We’re making progress in that field, but the same should be done for sounds and images so that we can actually start using AI to recognize all these things.

Banner image: A dragonfly perched on a leaf in Thailand. Image by Andre Mouton via Pexels (Public domain).

Abhishyant Kidangoor  is a staff writer at Mongabay. Find him on 𝕏   @AbhishyantPK .

Bioacoustics in your backyard: Q&A with conservation technologist Topher White

Special series

Forest trackers.

• Narco activity takes heavy toll on Colombia’s protected forests, satellite data show
• Photos confirm narcotraffickers operating in Peru’s Kakataibo Indigenous Reserve
• Bolivia’s El Curichi Las Garzas protected area taken over by land-grabbers
• Authorities struggle to protect Bolivian national park from drug-fueled deforestation

• Indonesia’s Avatar sea nomads enact Indigenous rules to protect octopus
• Ghost nets haunt marine life in Malaysian marine park, study finds
• Icelandic government grants new license to whaling company to hunt 128 fin whales
• Report: Illegal fishing and labor abuse rampant in China’s Indian Ocean fleet

Amazon Conservation

• Indigenous Wai Wai seek markets for Brazil nuts without middlemen
• Revealed: Illegal cattle boom in Arariboia territory in deadliest year for Indigenous Guajajara
• New bill to expand farmlands in the Amazon may derail Brazil’s green efforts
• Bird populations are mysteriously declining at an Amazon park in Ecuador & beyond

Land rights and extractives

• Critics see payback in Indonesia’s plan to grant mining permits to religious groups
• Impunity and pollution abound in DRC mining along the road to the energy transition
• Women weave a culture of resistance and agroecology in Ecuador’s Intag Valley
• Hyundai ends aluminum deal with Adaro Minerals following K-pop protest

Endangered Environmentalists

• Mongabay video screening at Chile’s Supreme Court expected to help landmark verdict in Brazil
• Indonesian activist freed in hate speech case after flagging illegal shrimp farms
• Final cheetah conservationists freed in Iran, but the big cat’s outlook remains grim
• Indonesian activists face jail over FB posts flagging damage to marine park

Indonesia's Forest Guardians

• On a Borneo mountainside, Indigenous Dayak women hold fire and defend forest
• Fenced in by Sulawesi national park, Indigenous women make forestry breakout
• In Borneo, the ‘Power of Mama’ fight Indonesia’s wildfires with all-woman crew
• Pioneer agroforester Ermi, 73, rolls back the years in Indonesia’s Gorontalo

Conservation Effectiveness

• How effective is the EU’s marquee policy to reduce the illegal timber trade?
• The conservation sector must communicate better (commentary)
• Thailand tries nature-based water management to adapt to climate change
• Forest restoration to boost biomass doesn’t have to sacrifice tree diversity

Southeast Asian infrastructure

• Study: Indonesia’s new capital city threatens stable proboscis monkey population
• Indonesia’s new capital ‘won’t sacrifice the environment’: Q&A with Nusantara’s Myrna Asnawati Safitri
• Small farmers in limbo as Cambodia wavers on Tonle Sap conservation rules
• To build its ‘green’ capital city, Indonesia runs a road through a biodiverse forest

you're currently offline

Research & Reviews: Journal of Social Sciences

• +447389646377
• Journal h-index : 5
• Journal cite score : 0.87
• Journal impact factor : 0.66
• Average acceptance to publication time (5-7 days)
• Average article processing time (30 - 45 days) Less than 5 volumes 30 days 8 - 9 volumes 40 days 10 and more volumes 45 days

Welcome to the Journal

We are delighted to invite Eminent Academicians and Researchers to submit their original research articles for publication Research & Reviews: Journal of Social Sciences an International journal publishing biannually aspect of Social Sciences for an effective scientific reading and public view with an aim to reach the world wide researchers.

Social sciences deal with the study of a society and inter relationships of individuals with the society. It is one the major branches of science where one studies the manners and influence of a society in this world around us. Man is a social animal progressing from ancient history ages to this modern civilization.

Sociology is an intellectual study of social behavior, its origin and developments. Geography deals with study of land and its related features. The study of human population is called demography. Sociolinguistics relates to the use of any language on our society. All proposals should be manuscripts as an e-mail attachment to the Editorial Office at or online at

The manuscript would be considered under the specific branches of Social Sciences

This is an open access journal where one can find scientific research as in form of research articles, review articles, case reports, special issues and short communications where it undergoes a series of steps to attain a standard and a unique scientific piece of research.

The Journal Social sciences is published biannually (Online and Print version) emphasizing on various social studies, thereby providing an insight into our society. We invite researchers, academicians and worldwide scientists to share their research for the global enlightenment and benefit of academic community on an open access platform for one and all.

Fast Editorial Execution and Review Process (FEE-Review Process):

Research & Reviews: Journal of Social Sciences is participating in the Fast Editorial Execution and Review Process (FEE-Review Process) with an additional prepayment of $99 apart from the regular article processing fee. Fast Editorial Execution and Review Process is a special service for the article that enables it to get a faster response in the pre-review stage from the handling editor as well as a review from the reviewer. An author can get a faster response of pre-review maximum in 3 days since submission, and a review process by the reviewer maximum in 5 days, followed by revision/publication in 2 days. If the article gets notified for revision by the handling editor, then it will take another 5 days for external review by the previous reviewer or alternative reviewer.

Acceptance of manuscripts is driven entirely by handling editorial team considerations and independent peer-review, ensuring the highest standards are maintained no matter the route to regular peer-reviewed publication or a fast editorial review process. The handling editor and the article contributor are responsible for adhering to scientific standards. The article FEE-Review process of $99 will not be refunded even if the article is rejected or withdrawn for publication.

The corresponding author or institution/organization is responsible for making the manuscript FEE-Review Process payment. The additional FEE-Review Process payment covers the fast review processing and quick editorial decisions, and regular article publication covers the preparation in various formats for online publication, securing full-text inclusion in a number of permanent archives like HTML, XML, and PDF, and feeding to different indexing agencies.

Anthropology

Study of Human beings and their sub-divisions are comes under the study of Anthropological studies.

Related Journals of Anthropology Max Weber Studies, Milbank Quarterly, New Internationalist, Social Research, Sociological Review, Sociology, Ageing and Society, American Journal of Sociology.

Archaeology

Races of ancient human studies and finding the traces of the truth behind ancient theories of living comes under archaeology.

Related Journals of Archaeology Historical Materialism, History of the Human Sciences, International Journal of Labour Research, International Journal of Social Research Methodology, International Sociology, Jane's Police Review, Journal of Development Studies.

Social work

It is defined as the improving the quality of life regards with professional and academic discipline is called as Social Work.

Related Journals of Social Work Sociology, Humanities, Integrative  social science, Rural science, Social psychology, Social work, Media studies, Ethnic and Racial Studies.  

Social psychology

It is defined as the study of people and their thoughts, feelings, behaviour influenced by imagination and dependence of implied by others is called as Social psychology.

Related Journals of Social Psychology Criminology, Punishment & Society, Theory and Society, Urban Studies, Women and Criminal Justice, Women, Employment and Society, Canadian Journal of Criminology And Criminal Justice.  

Rural science

It is defined as ecology, biology, associated fields and theory of Agriculture is said to be Rural science.

Related Journals of Rural science Jane's Policy Review, Journal of Development Studies, Journal of Ethnic and Migration Studies, Journal of Refugee Studies, Max Weber Studies.  

Integrative social science

Interdisciplinary introduction to the body of knowledge and instructional programs that emphasize the overlapping boundaries in a socialistic way is called as Integrative Social Science.

Related Journals of Integrative  social science Linguistics, Pedagogy, Political Science, Psychology, Science Education, Sociology, Humanities, Integrative  social science, Rural science.

Study of Human culture and their academic disciplines is called as Humanities.

Related Journals of Humanities Historical Materialism, History of the Human Sciences, International Journal of Labour Research, International Journal of Social Research Methodology,International Sociology, Jane's Police Review, Journal of Development Studies.  

It is defined as study of origin of social behaviour including its origin and institutions in a manner of analysing social order and social change is called as sociology.

Related Journals of Sociology Humanities, Integrative  social science, Rural science, Social psychology, Social work, Media studies, Ethnic and Racial Studies, European Journal of Social Equality.  

Science Education

It is defined as education of scientific studies with content and process in a sharing manner are considered apart of scientific community.

Related Journals of Science Education Anthropology, Archaeology, Criminology, Demography, Economics, Geography, International Relations, Law, Linguistics, Pedagogy, Political Science.  

It is defined as the study of mental ability of the Brain and its Behaviour and understand its individualism is called as psychology.

Related Journals of Psychology Police Practice and Research, Punishment & Society, Theory and Society, Urban Studies, Women and Criminal Justice, Women, Employment and Society, Canadian Journal of Criminology And Criminal Justice.  

Education practice related to teaching related to explaining some theoretical subject is called as pedagogy.

Related Journals of Pedagogy Journal of Development Studies, Journal of Ethnic and Migration Studies, Journal of Refugee Studies, Max Weber Studies

Linguistics

Different types of human language study including sounds, gestures with related to speech up the organisation of sentences, words and meaning etc…

Related Journals of Linguistics Comparative Studies in Society and History, Contemporary Sociology, Police Practice and Research, Punishment & Society, Theory and Society, Urban Studies,Women and Criminal Justice.

It is defined as the rules which are enforcing through govern by social institutions which are made by Legislature.

Related Journals of Law Health, Health and Social Care in the Community, Historical Materialism, History of the Human Sciences, International Journal of Labour Research.  

International Relations

Political Science’s main Branch is International Relations and its states that relationships with the roles of sovereign states and Inter governal organisations.

Related Journals of International Relations New Internationalist, Social Research, Sociological Review, Sociology, Ageing and Society, American Journal of Sociology. British Journal of Criminology, British Journal of Sociology.

Geography (Human)

Dealing with Race of human communities and their cultures with emphasising relations is said to be Human geography.

Related Journals of Geography Anthropology, Archaeology, Geography.

Determination of production, consumption distribution of goods and its services is called as economics. It is two types Macro economics and Micro economics.

Related Journals of Economics Comparative Studies in Society and History, Contemporary Sociology, Police Practice and Research, Punishment & Society, Theory and Society, Urban Studies.  

Popualtion studies of humans in a statistical manner with analysing a living population is called as Demography.

Related Journals of Demography British Journal of Sociology, Capital & Class, Criminal Justice Matters, Community Care, Community Development Journal. Comparative Studies in Society and History.

Criminology

It is defined as the control, extent, consequences , prevention of violent behaviour of criminals is said to be Criminology.

Related Journals of Criminology British Journal of Criminology, British Journal of Sociology, Capital & Class, Criminal Justice Matters, Community Care, Community Development Journal.

*2023 Journal impact factor was established by dividing the number of articles published in 2021 and 2022 with the number of times they are cited in 2023 based on Google Scholar Citation Index database. If 'X' is the total number of articles published in 2021 and 2022, and 'Y' is the number of times these articles were cited in indexed journals during 2023 then, impact factor = Y/X

Articles published in Research & Reviews: Journal of Social Sciences have been cited by esteemed scholars and scientists all around the world. Research & Reviews: Journal of Social Sciences has got h-index 5 , which means every article in Research & Reviews: Journal of Social Sciences has got 5 average citations.

Recently Published Articles

Societal attitudes toward chinese university students with a history of parental depression and factors influencing the respective attitudes: a cross-sectional study.

 Jafar Rashidnia1*, Zhang Min1, Shen Heyong1

Determining the Economic Impact of Crypto-currency Adoption on International Trade from a Gravity Model Framework

Eric R. Chen

The Prevalence of Practice-Oriented Research in Applied Linguistics

 Heath Rose

The Research has further demonstrated in applied linguistics

Ismet Ozturk

The Roles of Nurture in the Recruitment and Retention of Primary Care Physicians

Brooks Robert G

A Mini Review on Fundamentals of Conventional Financial Development and It��?s Functions to Accomplish Economic Benefit

Cartreal Davison

Relevant Topics

Journal highlights, google scholar citation report, citations : 142.

Research & Reviews: Journal of Social Sciences received 142 citations as per Google Scholar report

Research & Reviews: Journal of Social Sciences peer review process verified at publons

View More »

By continuing to browse the site you are agreeing to our use of cookies and similar tracking technologies described in our privacy policy .

Voice of the Discipline

News and publications.

Access AHA news and publications supporting the work of historians.

Stay up-to-date with the AHA

June 24, 2024

Action Alert Opposing Ohio SB 83

The AHA has shared the following action alert with our Ohio members. SB 83 is being considered by the Ohio…

June 21, 2024

AHA Signs On to CIE Letter Urging HEA-Title VI Funding for FY 2025

June 18, 2024

Welcome to the AHA’s New Website

May 30, 2024

AHA Signs on to ACLS Statement on 2024 Campus Protests

The American Historical Review is the flagship journal of the AHA and the journal of record for the historical discipline in the United States, bringing together scholarship from every major field of historical study.

Perspectives on History is the newsmagazine of the AHA and is the principal source for news and information about the discipline of history. Since 1962, Perspectives has promoted our work by publishing articles and commentary on all aspects of the historical discipline.

History in Focus Podcast

Environmental Crisis and Recovery

Collaborative history + revisiting marion thompson wright, teaching historiography + chilling affects, aha booklets.

The AHA publishes booklets that address a diversity of topics to serve the needs of history students and historians in all professions. Our publications include career advice for history graduates, overviews and syntheses of current historical topics and fields, and guides to teaching and learning in history.

For the Press

The AHA is pleased to provide resources for journalists and press. If you are a member of the media and would like to submit a request for a referral or interview, please email [email protected] . Please provide any pertinent deadlines and we will do our best to accommodate your request. The AHA can find you a historian for any topic, and assists with dozens of inquiries each year.

The AHA encourages the reading of history with periodic reading challenges.

Permission to Use AHA Copyrighted Material

All material published by the American Historical Association in any medium is protected by copyright.

Join the AHA

The AHA brings together historians from all specializations and all work contexts, embracing the breadth and variety of activity in history today.

• News & Events
• Faculty and Staff
• Student Learning Outcomes
• Academic Advising
• Physics BS/BA
• Biomedical Physics Concentration
• Physics Education Concentration
• Physics Minor
• Physics Course Permit Form
• Physics Scholarships
• Senior Capstone Project
• Physics Careers
• Find Internships
• Mathematica
• Faculty Resources
• Mallory Kountze Planetarium
• Aim For the Stars
• Faculty Research

Student Research Journal

Physics student research journal.

UNO physics majors create innovations before graduation. Every major completes a capstone project before graduation and produces a paper on their project.

Every UNO physics major completes a capstone project before graduation and produces a paper on their project in the style of an American Physical Society journal article. These papers are published here. This page contains student reports by academic year and information for student authors (style, templates, etc.).

Sequential double ionization of Ar to Ar2+ over intense laser field pulses Kate Chain

Modeling Lightweight High-Temperature Expandable Radiator Structures for Space-Based Nuclear Power Systems and Small Satellites in Low Earth Orbit (LEO) Matt Crews

Interplay of structural, electronic, and magnetic properties of doped CdS Edgar Ramirez

Creating a Hubble diagram for a galaxy cluster using Hubble’s methods Austin Aiken

Exploring the Relationship between Thyroid Hormones and Iodine Detection through X-ray Fluorescence Analysis in Biological Samples A. Drake McFayden

Carving Up Reality: Can Physics Provide a Moderate Solution to the Special Composition Question? Carli Borsh

Calculating the Speed of Light Steven (Niq) Cunningham

Using Gd-DOTA and NP attached to DNA at Different Distances Keegan Duhon

For Student Authors

To write and submit your Senior Project written report, you will use the free, online LaTeX editor Overleaf. LaTeX allows for readable reports with rich mathematics. It is also a standard used by most physics scientific journals, so LaTeX is a skill that is useful on its own. Once you get the hang of writing math in LaTeX, it is also significantly faster than mouse-click WYSIWYG equation editors. You will use a template to format your article, which is discussed below.

Register for a Free Account

First, go to the Overleaf homepage and click on the giant "Register" button, or choose to register using a Goggle account.

Using the Course Overleaf Article Template

Once you have an account, you can open and view the template using the following link:

https://www.overleaf.com/read/kqhtwmkmxynt

This template is set to READ-ONLY, which means you cannot edit it. To create a new article based on this template you will need to create a copy.

Click where it says "Menu" in the top left corner.

Next, click "Copy Project."

A text box will pop up, there you should enter the name of the new project, then click Copy .

A new project will open in the editor with a copy of the files of the template that you just cloned.

Learn LaTeX in 30 Minutes

Finally, read through Overleaf's great resource " Learn LaTeX in 30 Minutes ." The template has lots of comments to help you and lots of equations to give you a good sense of how they are written. You can refer back to this quick guide, as well as the through LaTeX documentation on the linked website. When stuck on how to do something in LaTeX, you can always use Google. There is a MOUNTAIN of information on using LaTeX online.

This paper is in the following e-collection/theme issue:

Published on 25.6.2024 in Vol 13 (2024)

Social Factors Associated With Nutrition Risk in Community-Dwelling Older Adults in High-Income Countries: Protocol for a Scoping Review

Authors of this article:

• Christine Marie Mills 1, 2 , BASc, MPH, PhD   ; 
• Liza Boyar 2 , BASc, MHSc   ; 
• Jessica A O’Flaherty 3 , BScFN   ; 
• Heather H Keller 1, 4 , BASc, MSc, PhD  

1 Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada

2 School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada

3 Mount Saint Vincent University, Halifax, NS, Canada

4 Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada

Corresponding Author:

Christine Marie Mills, BASc, MPH, PhD

Department of Kinesiology and Health Sciences

University of Waterloo

200 University Avenue West

Waterloo, ON, N2L 3G1

Phone: 1 5198884567

Email: [email protected]

Background: In high-income countries (HICs), between 65% and 70% of community-dwelling adults aged 65 and older are at high nutrition risk. Nutrition risk is the risk of poor dietary intake and nutritional status. Consequences of high nutrition risk include frailty, hospitalization, death, and reduced quality of life. Social factors (such as social support and commensality) are known to influence eating behavior in later life; however, to the authors’ knowledge, no reviews have been conducted examining how these social factors are associated with nutrition risk specifically.

Objective: The objective of this scoping review is to understand the extent and type of evidence concerning the relationship between social factors and nutrition risk among community-dwelling older adults in HICs and to identify social interventions that address nutrition risk in community-dwelling older adults in HICs.

Methods: This review will follow the scoping review methodology as outlined by the JBI Manual for Evidence Synthesis and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The search will include MEDLINE (Ovid), CINAHL, PsycINFO, and Web of Science. There will be no date limits placed on the search. However, only resources available in English will be included. EndNote (Clarivate Analytics) and Covidence (Veritas Health Innovation Ltd) will be used for reference management and removal of duplicate studies. Articles will be screened, and data will be extracted by at least 2 independent reviewers using Covidence. Data to be extracted will include study characteristics (country, methods, aims, design, and dates), participant characteristics (population description, inclusion and exclusion criteria, recruitment method, total number of participants, and demographics), how nutrition risk was measured (including the tool used to measure nutrition risk), social factors or interventions examined (including how these were measured or determined), the relationship between nutrition risk and the social factors examined, and the details of social interventions designed to address nutrition risk.

Results: The scoping review was started in October 2023 and will be finalized by August 2024. The findings will describe the social factors commonly examined in the nutrition risk literature, the relationship between these social factors and nutrition risk, the social factors that have an impact on nutrition risk, and social interventions designed to address nutrition risk. The results of the extracted data will be presented in the form of a narrative summary with accompanying tables.

Conclusions: Given the high prevalence of nutrition risk in community-dwelling older adults in HICs and the negative consequences of nutrition risk, it is essential to understand the social factors associated with nutrition risk. The results of the review are anticipated to aid in identifying individuals who should be screened proactively for nutrition risk and inform programs, policies, and interventions designed to reduce the prevalence of nutrition risk.

International Registered Report Identifier (IRRID): DERR1-10.2196/56714

Introduction

In high-income countries (HICs), between 65% and 70% of community-dwelling adults aged 65 years and older are at high nutrition risk [ 1 ]. In Canada, one-third of community-dwelling adults aged 60 and older are at increased nutrition risk [ 2 , 3 ]. While there is no universally agreed-upon definition of nutrition risk, 1 common definition is the risk of poor dietary intake and nutritional status [ 3 , 4 ]. Nutrition risk occurs when there are factors present that negatively affect food intake [ 5 ], and can lead to malnutrition if its causes are not addressed [ 3 ].

Many measures or instruments, commonly referred to as tools, are available to measure and screen for nutrition risk and malnutrition risk in community-dwelling older adults, such as Seniors in the Community Risk Evaluation for Eating and Nutrition and the Mini Nutritional Assessment [ 6 ]. Nutrition risk and malnutrition risk lie on a continuum between nutritional health and malnutrition [ 3 ]. Malnutrition is a clinical condition that occurs when there is unintentional weight loss, low body mass index, or reduced muscle mass, along with reduced food intake, reduced assimilation of food and nutrients, chronic disease, or inflammation related to acute disease or injury [ 7 ]. Malnutrition risk exists in clinical settings when individuals have 1 or more of these indicators [ 8 ]. In contrast, nutrition risk occurs earlier in the process. Nutrition risk “represents the determinants and risk factors that place an individual at risk for poor food intake and if not interrupted, can lead to malnutrition” [ 8 ]. However, in the literature, the terms nutrition risk and malnutrition risk are often used interchangeably, with nutrition risk sometimes referred to as early-stage malnutrition risk [ 9 ]. The following figure, adapted from Keller [ 8 ], illustrates the relationship between food intake, nutrition risk, and malnutrition ( Figure 1 ).

Individuals who are at nutrition risk are more likely to be hospitalized and have an increased risk of mortality, even when health status, health behaviors, and socioeconomic factors are considered [ 10 , 11 ]. Nutrition risk is also associated with early institutionalization [ 12 ], frailty [ 13 ], and poor quality of life [ 14 , 15 ].

Many social factors are associated with nutrition risk in older adults in the literature [ 16 , 17 ]. These include, but are not limited to, social network type (restricted, diverse, family-focused, friend-focused, etc), living arrangement (alone or with others), social support (emotional, informational, tangible, and affectionate support), social engagement (engagement in social activities with others), and social participation (participation in community activities) [ 3 , 17 - 19 ]. It is well-established that eating with others improves dietary intake and reduces nutrition risk [ 16 ], whereas eating alone is associated with high nutrition risk [ 16 , 20 ]. In many studies, social isolation is a significant factor leading to increased nutrition risk [ 3 , 11 ]. Social relationships may decrease nutrition risk by encouraging compliance with dietary norms [ 16 ], while eating with others may provide “social cues for when and what to eat” [ 16 ]. An individual’s social support system may also encourage healthy behaviors, such as consuming adequate amounts of nutrient-rich foods [ 21 ]. Studies have found that social support helps reduce nutrition risk [ 17 ], whereas low levels of social support are associated with increased nutrition risk [ 22 ]. Individuals with higher levels of social support may have greater assistance with food-related activities, such as meal preparation and grocery shopping [ 16 ]. Social interventions, such as congregate meal programs, have also been shown to improve nutrition risk scores in older adults. Despite the research showing that social factors are associated with nutrition risk, reviews in this area have not specifically focused on nutrition risk, but rather on eating behavior [ 16 ], dietary intake [ 23 ], food choice [ 24 ], or nutrition screening [ 25 ]. Although related to these concepts, nutrition risk is different, describing the presence of risk factors and determinants of food intake such as poor appetite, food insecurity, and low dietary intake [ 14 , 26 ].

To advance research on how social factors are associated with nutrition risk, it is essential to synthesize the available evidence. A scoping review was chosen as it is an appropriate method to understand and summarize the extent and type of evidence available [ 27 ]. It is important to understand the social factors associated with nutrition risk so that individuals who should be screened proactively for nutrition risk can be identified, and programs and policies designed to reduce the prevalence of nutrition risk can be appropriately developed and implemented. Understanding what types of social interventions have been shown to reduce the prevalence of nutrition risk can also help inform such policy and program development.

This review aims to examine the social factors associated with nutrition risk in community-dwelling older adults in HICs and to identify social interventions designed to address nutrition risk in community-dwelling older adults in HICs. A preliminary search was conducted in October 2023 to identify any existing systemic or scoping reviews on this topic. Searching PROSPERO, MEDLINE (Ovid), the Cochrane Database of Systematic Reviews, and JBI Evidence Synthesis identified no current or in-progress scoping reviews or systematic reviews on the topic. There have been reviews examining adjacent topics, for example, the social influences on eating behavior in later life [ 16 ], factors influencing food choice in older adults [ 24 ], and determinants of dietary intake in older people [ 23 ] although none of these have specifically examined the relationship between nutrition risk and social factors or examined social interventions designed to address nutrition risk.

The results of this scoping review will provide researchers and clinicians with knowledge of the social factors associated with nutrition risk in community-dwelling older adults in HICs. Identifying the social factors associated with nutrition risk can help inform future research into nutrition risk and guide program and policy development. Promising social interventions that can improve nutrition risk may also be identified. Additionally, the results of this review may help identify groups of individuals who should be screened for nutrition risk.

Scoping Review Methodology

The proposed scoping review will be conducted in accordance with the JBI methodology for scoping reviews [ 28 ] and in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews) [ 29 ] .

Research Questions

The research questions for this scoping review are as follows: (1) What social factors (including, but not limited to, social networks, social engagement, social support, and social participation) are associated with nutrition risk or malnutrition risk among community-dwelling adults aged 60 years and older living in HICs? (2) What social interventions improve nutrition risk or malnutrition risk in community-dwelling adults aged 60 years and older living in HICs?

Search Strategy

The search strategy was developed with the assistance of a university research librarian and will be conducted electronically. The search will aim to locate both published and unpublished studies and reviews. An initial limited search of MEDLINE and CINAHL was undertaken to identify articles on the topic. The initial search terms included “malnutrition,” “nutrition risk,” “older adults,” “social factors,” “social support,” “social engagement,” “social participation,” “social influence,” and “social networks.” The text words contained in the titles and abstracts of relevant articles and the index terms used to describe the articles were used to develop a full search strategy for MEDLINE, CINAHL, PsycINFO, and Web of Science. A sample search strategy for MEDLINE is available in Table 1 .

Search	Query	Records retrieved, n
#1	exp Malnutrition/ or exp Nutritional Status/ or nutrition risk.mp.	167,909
#2	undernutrition.mp.	8345
#3	poor dietary intake.mp.	227
#4	poor nutrition.mp. or exp Diet/	305,502
#5	1 or 2 or 3 or 4:	453,221
#6	exp Aged/ or exp Aging/ or older adults.mp.	3,506,670
#7	seniors.mp.	8211
#8	elderly.mp.	277,535
#9	6 or 7 or 8:	3,574,189
#10	social factors.mp. or exp Social Factors/	11,115
#11	social support.mp. or exp Social Support/	98,186
#12	social engagement.mp. or exp Social Participation/	4565
#13	social influence.mp. or exp Social Behavior/	276,421
#14	social networks.mp. or exp Social Networking/	14,147
#15	10 or 11 or 12 or 13 or 14:	383,726
#16	5 and 9 and 15:	874

The search strategy, including all identified keywords and index terms, will be adapted for each included database or information source. The reference lists of articles included in the review will be screened for additional studies. Only studies in the English language will be included, as there are limits to language proficiency within the research team. No date restrictions will be applied when conducting searches. As recommended by a research librarian, sources of unpublished studies or gray literature will be searched, including preprint servers such as medRxiv, ProQuest dissertations and theses, Open Grey, and Google Scholar. Both social factors associated with nutrition risk and social interventions designed to address nutrition risk will be searched for in the gray literature.

Study Selection

Inclusion and exclusion criteria have been developed according to the domains of participants, concept, context, and types of evidence sources, as recommended in the JBI Manual for Evidence Synthesis [ 28 ]. The inclusion and exclusion criteria ( Textbox 1 ) are described in detail.

Inclusion criteria

• Older adults (60 years of age and older)
• Community-dwelling
• High-income countries
• Social factors including social support, social engagement, social participation, social isolation, social inclusion, commensality (eating with others), and loneliness
• Social interventions such as congregate meals programs, group nutrition education programs, etc
• Nutrition risk, malnutrition risk, and risk of malnutrition

Exclusion criteria

• Age groups other than older adults (unless information for older adults available separately)
• Long-term care, care homes, hospital, institutionalized, and assisted living
• Low- or middle-income countries
• No social factors in relation to nutrition risk
• Not a social intervention
• Other nutritional factors such as risk of overnutrition, disease-related malnutrition, diet quality, diet patterns, nutrition risk in specific diseases (ie, diabetes, heart disease, kidney disease, dementia, cancer, and COVID-19)

Inclusion Criteria

Participants

This review will consider studies that include community-dwelling adults aged 60 years and older in HICs. The minimum participant age of 60 years is consistent with the United Nations’ definition of older persons [ 30 , 31 ]. Studies that include other age groups but present the results of adults aged 60 years and older as a subgroup will be included, whereas studies that do not separate this age group will not be included, as the causes of nutrition risk may differ in younger age groups. Similarly, studies that examine disease-related nutrition risk and malnutrition risk will be excluded from this review, as specific diseases affect nutrition risk and malnutrition risk in different ways.

This review will be restricted to HICs, given that there is a paucity of literature examining nutrition status specifically in older adults living in low- and middle-income countries (LMICs) [ 32 ], and that the causes of nutrition risk are likely different in LMICs compared with HICs [ 33 ]. In LMICs, food insecurity and rapid urbanization are the major contributors to malnutrition in older adults [ 32 ], and access to sufficient health care and welfare may not be adequate [ 34 ]. Moreover, adherence to the use of validated malnutrition risk screening and assessment tools is low in LMICs, rendering the prevalence of nutrition risk among older adults in these settings largely unquantified [ 32 ].

This review will consider studies that explore nutrition risk and malnutrition risk, in the community. While there is no universally agreed-upon definition of nutrition risk or malnutrition risk, 1 common definition is the risk of poor dietary intake and nutritional status that places an individual at risk of developing malnutrition if action is not taken to improve dietary intake [ 3 , 4 ]. Nutrition risk occurs when there are factors present that negatively affect food intake or nutrient metabolism [ 5 ].

This review will consider studies that examine social factors and social interventions. Social factors include, but are not limited to, social support, social networks, social engagement, and social participation. Social networks are “the web of social relationships that surround an individual and the characteristics of those ties” [ 35 ]. Social participation refers to participation in activities with friends and family or the community [ 36 ], whereas social engagement emphasizes meaningful engagement and desire for social change [ 37 ]. Social support includes “the functions that individuals in a person’s social network perform” [ 36 ]. The term “social factors” can be said to encompass these concepts.

Types of Evidence Sources

This scoping review will consider both experimental and quasi-experimental study designs, including randomized controlled trials that examine how social factors or social interventions affect nutrition risk, nonrandomized controlled trials, before and after studies, and interrupted time-series studies. In addition, analytical observational studies, including prospective and retrospective cohort studies, case-control studies, and analytical cross-sectional studies, will be considered for inclusion. This review will also consider descriptive observational study designs including case series, individual case reports, and descriptive cross-sectional studies for inclusion.

Qualitative studies will also be considered, including, but not limited to, designs such as phenomenology, grounded theory, ethnography, qualitative description, action research, and feminist research. In addition, systematic reviews, rapid reviews, and narrative reviews will be considered for inclusion in the proposed scoping review. Papers that are conference abstracts or letters to the editor will not be considered for inclusion in this scoping review.

Gray literature consisting of dissertations, theses, reports, or unpublished papers that examine how social factors affect nutrition risk or that describe social interventions designed to address nutrition risk will also be considered for inclusion.

Study or Source of Evidence Selection

Following the search, all identified citations will be collated and uploaded into EndNote 21 and duplicates will be removed. Citations will then be uploaded to Covidence. Following a pilot test, titles and abstracts will then be screened by 2 or more independent reviewers for assessment against the inclusion criteria for the review. Potentially relevant sources will be retrieved in full, and their full texts will be imported into Covidence. The full text of selected citations will be assessed in detail against the inclusion criteria by 2 independent reviewers. Reasons for the exclusion of sources of evidence in full text that do not meet the inclusion criteria will be recorded and reported in the scoping review. Any disagreements that arise between the reviewers at each stage of the selection process will be resolved through discussion, or with additional reviewers. The results of the search and the study inclusion process will completely be reported in the final scoping review and presented in the PRISMA-ScR flow diagram [ 29 ].

Data Extraction

Data will be extracted from sources of evidence included in the scoping review by 2 independent reviewers, using an adaptation of the Covidence data extraction tool as shown in Textbox 2 . The extraction tool is based on the JBI guidelines for data extraction and the default Covidence extraction tool. The data extracted will include specific details about the participants, concept, context, study methods, and key findings relevant to the review questions (social factors associated with nutrition risk). Data will be extracted verbatim from the included sources.

The data extraction tool will be further modified and revised, if necessary, during the process of extracting data from each included evidence source. Modifications will be detailed in the scoping review. Any disagreements that arise between the reviewers will be resolved through discussion, or with an additional reviewer. If appropriate, authors of papers will be contacted to request missing or additional data, where required.

General information

Study characteristics

• Study design
• Study methods
• Dates (start date, end date, and length of follow-up period for longitudinal studies)
• Study funding sources
• Possible conflicts of interest for study authors
• Population description
• Inclusion criteria for study
• Exclusion criteria for study
• Recruitment methods
• Total number of participants
• Baseline population characteristics

Main findings

• SCREEN-3 (Seniors in the Community Risk Evaluation for Eating and Nutrition-3)
• SCREEN-8 (Seniors in the Community Risk Evaluation for Eating and Nutrition-8, formerly SCREEN II AB)
• SCREEN-14 (Seniors in the Community Risk Evaluation for Eating and Nutrition-14, formerly SCREEN II)
• SCREEN/SCREEN I (Seniors in the Community Risk Evaluation for Eating and Nutrition/Seniors in the Community Risk Evaluation for Eating and Nutrition I)
• MNA (Mini Nutritional Assessment)
• MNA-SF (Mini Nutritional Assessment-Short Form)
• SGA (Subjective Global Assessment)
• DETERMINE (Determine your health checklist)
• SNAQ (Short Nutritional Assessment Questionnaire)
• MUST (Malnutrition Universal Screening Tool)
• Other (describe)
• Social support
• Social influence
• Social participation
• Commensality (eating with others)
• Living situation (alone or with others)
• Social networks or social network types
• Social capital
• Social standing
• Social isolation
• Measures of social factors (social factor and how it was measured)
• Found a relationship between social factors and malnutrition and nutrition risk (yes, no, or other)
• Description of the relationship between social factors and malnutrition and nutrition risk

Additional information for intervention studies

• Description of intervention
• Time points (number and time between time points)
• Outcomes at different time points

Additional information for trials

• Description of control group
• Comparison of intervention group to control group

Data Analysis and Presentation

Social factors associated with nutrition risk or malnutrition risk will be reported in the scoping review, as will any social interventions that affect nutrition risk or malnutrition risk. Data will be analyzed to identify the common social factors that have been examined in conjunction with nutrition risk and to identify which social factors and interventions have been found to affect nutrition risk. Similarities and differences between findings will be noted; for example, differences in the tools used to measure nutrition risk, differences in how the various social factors were measured, and whether a social factor was consistently associated with nutrition risk across all (or the majority of) studies. Data from studies included in this review will be presented as a narrative summary with the use of tables. The tables will be used to highlight central concepts described in the narrative summary.

The scoping review was started in October 2023 and will be finalized by August 2024. As of May 28, 2024, a total of 5064 studies have been identified through database searches and imported for title and abstract screening, and 293 duplicates have been removed (266 duplicates identified by Covidence and 27 duplicates identified manually). Title and abstract screening has been completed, resulting in 235 full-text studies ready to be assessed for eligibility. The results of this scoping review will provide a comprehensive understanding of the social factors associated with nutrition risk in community-dwelling older adults in HICs.

Expected Outcomes

This scoping review will identify which social factors have been examined concerning nutrition risk in the literature and which social factors have been shown to impact nutrition risk. It will also identify any social interventions that have successfully reduced the prevalence of nutrition risk. The results of the review are anticipated to aid in identifying individuals who should be screened proactively for nutrition risk by identifying the social factors associated with increased risk. If the literature shows that certain social factors are consistently associated with increased nutrition risk, then screening programs can target individuals who reflect those social factors, for example, individuals with low levels of social support [ 17 , 22 ], low levels of social participation [ 3 , 17 ], or those who are socially isolated [ 3 , 11 , 22 , 38 ].

The results of this review will also inform programs and policies designed to reduce the prevalence of nutrition risk and help guide the development of interventions aimed at reducing nutrition risk through the identification of interventions that have affected nutrition risk and social factors that impact nutrition risk.

Gaps in the literature exploring social factors associated with nutrition risk will also be identified by noting which social factors have not been well-studied in the literature. This will help inform future research into nutrition risk and social factors.

Strengths and Limitations

A strength of this scoping review is the use of the JBI methodology for scoping reviews [ 28 ], and the PRISMA-ScR [ 29 ]. All screening and data extraction will be completed by at least 2 reviewers, out of whom at least 1 is a registered dietitian with experience in working with older adults in the community. Any disagreements between the reviewers will be resolved through discussion or by a third reviewer.

Due to many different tools that can be used to measure nutrition risk in community-dwelling older adults and due to the many ways that social factors can be measured, it is anticipated that there will be significant heterogeneity between studies. This information will be captured in the data extraction tool and will be discussed in the scoping review.

Conclusions

With the high prevalence of nutrition risk in community-dwelling older adults in HICs and the negative consequences of nutrition risk, it is essential to understand the social factors associated with nutrition risk. The Canadian Malnutrition Task Force has identified that research into the root causes of nutrition risk in community-dwelling older adults is a priority [ 39 ], and this scoping review will help to identify the potential social factors that may be the root causes of nutrition risk among this demographic.

Conflicts of Interest

None declared.

• Borkent JW, Keller H, Wham C, Wijers F, de van der Schueren MAE. Cross-country differences and similarities in undernutrition prevalence and risk as measured by SCREEN II in community-dwelling older adults. Healthcare (Basel). 2020;8(2):151. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Morrison JM, Laur CV, Keller HH. SCREEN III: working towards a condensed screening tool to detect nutrition risk in community-dwelling older adults using CLSA data. Eur J Clin Nutr. 2019;73(9):1260-1269. [ CrossRef ] [ Medline ]
• Ramage-Morin PL, Garriguet D. Nutritional risk among older Canadians. Health Rep. 2013;24(3):3-13. [ FREE Full text ] [ Medline ]
• Ramage-Morin PL, Gilmour H, Rotermann M. Nutritional risk, hospitalization and mortality among community-dwelling Canadians aged 65 or older. Health Rep. 2017;28(9):17-27. [ FREE Full text ] [ Medline ]
• Keller HH. The SCREEN I (Seniors in the Community: Risk Evaluation for Eating and Nutrition) index adequately represents nutritional risk. J Clin Epidemiol. 2006;59(8):836-841. [ CrossRef ] [ Medline ]
• Power L, Mullally D, Gibney ER, Clarke M, Visser M, Volkert D, et al. MaNuEL Consortium. A review of the validity of malnutrition screening tools used in older adults in community and healthcare settings - A MaNuEL study. Clin Nutr ESPEN. 2018;24:1-13. [ CrossRef ] [ Medline ]
• Cederholm T, Jensen GL, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, et al. GLIM Core Leadership Committee‚ GLIM Working Group. GLIM criteria for the diagnosis of malnutrition - a consensus report from the global clinical nutrition community. J Cachexia Sarcopenia Muscle. 2019;10(1):207-217. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Keller HH. Using and scoring SCREEN. Older Adult Nutrition Screening. URL: https://olderadultnutritionscreening.com/faq/ [accessed 2022-10-11]
• de van der Schueren MAE, Jager-Wittenaar H. Malnutrition risk screening: new insights in a new era. Clin Nutr. 2022;41(10):2163-2168. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Lundin H, Sääf M, Strender LE, Mollasaraie HA, Salminen H. Mini nutritional assessment and 10-year mortality in free-living elderly women: a prospective cohort study with 10-year follow-up. Eur J Clin Nutr. 2012;66(9):1050-1053. [ CrossRef ] [ Medline ]
• Broeska VE, Lengyel CO, Tate RB. Nutritional risk and 5-year mortality of older community-dwelling Canadian men: the Manitoba follow-up study. J Nutr Gerontol Geriatr. 2013;32(4):317-329. [ CrossRef ] [ Medline ]
• Payette H, Coulombe C, Boutier V, Gray-Donald K. Nutrition risk factors for institutionalization in a free-living functionally dependent elderly population. J Clin Epidemiol. 2000;53(6):579-587. [ CrossRef ] [ Medline ]
• Dent E, Visvanathan R, Piantadosi C, Chapman I. Nutritional screening tools as predictors of mortality, functional decline, and move to higher level care in older people: a systematic review. J Nutr Gerontol Geriatr. 2012;31(2):97-145. [ CrossRef ] [ Medline ]
• Keller HH. Promoting food intake in older adults living in the community: a review. Appl Physiol Nutr Metab. 2007;32(6):991-1000. [ CrossRef ] [ Medline ]
• Keller HH, Østbye T, Goy R. Nutritional risk predicts quality of life in elderly community-living Canadians. J Gerontol A Biol Sci Med Sci. 2004;59(1):68-74. [ CrossRef ] [ Medline ]
• Vesnaver E, Keller HH. Social influences and eating behavior in later life: a review. J Nutr Gerontol Geriatr. 2011;30(1):2-23. [ CrossRef ] [ Medline ]
• Mills CM, Keller HH, DePaul VG, Donnelly C. Social network factors affect nutrition risk in middle-aged and older adults: results from the Canadian Longitudinal Study on aging. J Nutr Health Aging. 2022;27(1):46-58. [ CrossRef ]
• Johnson CSJ. Psychosocial correlates of nutritional risk in older adults. Can J Diet Pract Res. 2005;66(2):95-97. [ CrossRef ] [ Medline ]
• Mills CM, Keller HH, DePaul VG, Donnelly C. Nutrition risk varies according to social network type: data from the Canadian Longitudinal Study on aging. Fam Med Community Health. 2023;11(1):e002112. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Bloom I, Lawrence W, Barker M, Baird J, Dennison E, Sayer AA, et al. What influences diet quality in older people? a qualitative study among community-dwelling older adults from the Hertfordshire Cohort Study, UK. Public Health Nutr. 2017;20(15):2685-2693. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Locher JL, Sharkey JR. An ecological perspective on older adult eating behavior. In: Bales CW, Ritchie CS, editors. Handbook of Clinical Nutrition and Aging. Totowa, NJ. Humana Press; Feb 04, 2009.
• Locher JL, Ritchie CS, Roth DL, Baker PS, Bodner EV, Allman RM. Social isolation, support, and capital and nutritional risk in an older sample: ethnic and gender differences. Soc Sci Med. 2005;60(4):747-761. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Poggiogalle E, Kiesswetter E, Romano M, Saba A, Sinesio F, Polito A, et al. Psychosocial and cultural determinants of dietary intake in community-dwelling older adults: a determinants of diet and physical activity systematic literature review. Nutrition. 2021;85:111131. [ CrossRef ] [ Medline ]
• Host A, McMahon AT, Walton K, Charlton K. Factors influencing food choice for independently living older people-a systematic literature review. J Nutr Gerontol Geriatr. 2016;35(2):67-94. [ CrossRef ] [ Medline ]
• Phillips MB, Foley AL, Barnard R, Isenring EA, Miller MD. Nutritional screening in community-dwelling older adults: a systematic literature review. Asia Pac J Clin Nutr. 2010;19(3):440-449. [ FREE Full text ] [ Medline ]
• Teitelbaum D, Guenter P, Howell WH, Kochevar ME, Roth J, Seidner DL. Definition of terms, style, and conventions used in A.S.P.E.N. guidelines and standards. Nutr Clin Pract. 2005;20(2):281-285. [ CrossRef ] [ Medline ]
• Colquhoun HL, Levac D, O'Brien KK, Straus S, Tricco AC, Perrier L, et al. Scoping reviews: time for clarity in definition, methods, and reporting. J Clin Epidemiol. 2014;67(12):1291-1294. [ CrossRef ] [ Medline ]
• Peters M, Godfrey C, McInerney P, Munn Z, Tricco A, Khalil H. Scoping reviews (2020). JBI Manual for Evidence Synthesis. JBI; 2024. URL: https://synthesismanual.jbi.global/ [accessed 2023-12-05]
• Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-473. [ CrossRef ] [ Medline ]
• Larson JS. The World Health Organization's definition of health: social versus spiritual health. Soc Indic Res. 1996;38(2):181-192. [ CrossRef ]
• UN decade of healthy ageing: plan of action. World Health Organization. 2020. URL: https://www.who.int/publications/m/item/decade-of-healthy-ageing-plan-of-action [accessed 2023-12-05]
• Dent E, Wright ORL, Woo J, Hoogendijk EO. Malnutrition in older adults. Lancet. 2023;401(10380):951-966. [ CrossRef ] [ Medline ]
• Norman K, Haß U, Pirlich M. Malnutrition in older adults-recent advances and remaining challenges. Nutrients. 2021;13(8):2764. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Sudharsanan N, Bloom DE. The demography of aging in low- and middle-income countries: chronological versus functional perspectives. The Demography of Aging in Low- and Middle-Income Countries. Chronological versus Functional Perspectives. Future Dir Demogr Aging Proc Workshop National Academies Press (US); 2018. URL: https://www.ncbi.nlm.nih.gov/books/NBK513069/ [accessed 2023-12-05]
• Berkman LF, Glass T, Brissette I, Seeman TE. From social integration to health: Durkheim in the new millennium. Soc Sci Med. 2000;51(6):843-857. [ CrossRef ] [ Medline ]
• Harasemiw O, Newall N, Shooshtari S, Mackenzie C, Menec V. From social integration to social isolation: the relationship between social network types and perceived availability of social support in a national sample of older Canadians. Res Aging. 2018;40(8):715-739. [ CrossRef ] [ Medline ]
• Lévasseur M, Richard L, Gauvin L, Raymond E. Inventory and analysis of definitions of social participation found in the aging literature: proposed taxonomy of social activities. Soc Sci Med. 2010;71(12):2141-2149. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Keller HH, McKenzie JD. Nutritional risk in vulnerable community-living seniors. Can J Diet Pract Res. 2003;64(4):195-201. [ CrossRef ] [ Medline ]
• Keller H, Gramlich L, Davidson B, Trinca V, Laur C. Canadian malnutrition task force primary care working group. In: Canadian Malnutrition Primary Care Knowledge Exchange Report. Toronto, ON. Canadian Malnutrition Task Force; Jun 01, 2018:1-24.

Abbreviations

high-income country

low- and middle-income country

Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews

Edited by A Mavragani; submitted 24.01.24; peer-reviewed by P Voorheis, C Chan; comments to author 21.02.24; revised version received 10.03.24; accepted 02.04.24; published 25.06.24.

©Christine Marie Mills, Liza Boyar, Jessica A O’Flaherty, Heather H Keller. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 25.06.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.

This paper is in the following e-collection/theme issue:

Published on 25.6.2024 in Vol 26 (2024)

Effectiveness of Web-Based Mindfulness-Based Interventions for Patients With Cancer: Systematic Review and Meta-Analyses

Authors of this article:

• Ting Wang * , MNS   ; 
• Chulei Tang * , PhD   ; 
• Xiaoman Jiang, MSc   ; 
• Yinning Guo, MNS   ; 
• Shuqin Zhu, PhD   ; 
• Qin Xu, MM  

School of Nursing, Nanjing Medical University, Nanjing, China

*these authors contributed equally

Corresponding Author:

School of Nursing, Nanjing Medical University

101 Longmian Avenue, Jiangning District

Nanjing, 211166

Phone: 86 13601587208

Email: [email protected]

Background: Cancer has emerged as a considerable global health concern, contributing substantially to both morbidity and mortality. Recognizing the urgent need to enhance the overall well-being and quality of life (QOL) of cancer patients, a growing number of researchers have started using online mindfulness-based interventions (MBIs) in oncology. However, the effectiveness and optimal implementation methods of these interventions remain unknown.

Objective: This study evaluates the effectiveness of online MBIs, encompassing both app- and website-based MBIs, for patients with cancer and provides insights into the potential implementation and sustainability of these interventions in real-world settings.

Methods: Searches were conducted across 8 electronic databases, including the Cochrane Library, Web of Science, PubMed, Embase, SinoMed, CINAHL Complete, Scopus, and PsycINFO, until December 30, 2022. Randomized controlled trials involving cancer patients aged ≥18 years and using app- and website-based MBIs compared to standard care were included. Nonrandomized studies, interventions targeting health professionals or caregivers, and studies lacking sufficient data were excluded. Two independent authors screened articles, extracted data using standardized forms, and assessed the risk of bias in the studies using the Cochrane Bias Risk Assessment Tool. Meta-analyses were performed using Review Manager (version 5.4; The Cochrane Collaboration) and the meta package in R (R Foundation for Statistical Computing). Standardized mean differences (SMDs) were used to determine the effects of interventions. The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework was used to assess the potential implementation and sustainability of these interventions in real-world settings.

Results: Among 4349 articles screened, 15 (0.34%) were included. The total population comprised 1613 participants, of which 870 (53.9%) were in the experimental conditions and 743 (46.1%) were in the control conditions. The results of the meta-analysis showed that compared with the control group, the QOL (SMD 0.37, 95% CI 0.18-0.57; P <.001), sleep (SMD −0.36, 95% CI −0.71 to −0.01; P =.04), anxiety (SMD −0.48, 95% CI −0.75 to −0.20; P <.001), depression (SMD −0.36, 95% CI −0.61 to −0.11; P =.005), distress (SMD −0.50, 95% CI −0.75 to −0.26; P <.001), and perceived stress (SMD −0.89, 95% CI −1.33 to −0.45; P =.003) of the app- and website-based MBIs group in patients with cancer was significantly alleviated after the intervention. However, no significant differences were found in the fear of cancer recurrence (SMD −0.30, 95% CI −1.04 to 0.44; P =.39) and posttraumatic growth (SMD 0.08, 95% CI −0.26 to 0.42; P =.66). Most interventions were multicomponent, website-based health self-management programs, widely used by international and multilingual patients with cancer.

Conclusions: App- and website-based MBIs show promise for improving mental health and QOL outcomes in patients with cancer, and further research is needed to optimize and customize these interventions for individual physical and mental symptoms.

Trial Registration: PROSPERO CRD42022382219; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=382219

Introduction

The 2020 Global Cancer Statistics Report estimates that there are 19.3 million new cases of cancer worldwide and approximately 10 million cancer-related deaths [ 1 ]. The leading cause of disease and mortality among humans today is cancer [ 2 , 3 ]. The physical symptoms of patients with cancer have been alleviated because of the continuous advancement of medical technology, but the psychological problems of patients with cancer have not been adequately treated. The process of treating cancer is typically complex, with many patients experiencing negative side effects of cancer treatments, such as chemotherapy and radiation therapy, that may impact their mental health, quality of life (QOL), and sleep quality. Targeted interventions to address these cancer-related symptoms can reduce the psychological burden of cancer treatment and diagnosis, which is critical to improving patients’ QOL and promoting their health [ 4 ]. With an increasing number of patients with cancer and a desire for physical and mental health, cancer care research is focusing on identifying the psychological problems of patients with cancer and developing and implementing patient-centered psychological care plans [ 5 , 6 ]. Rehabilitation for patients with cancer increasingly uses mental health as a therapeutic strategy; however, effective psychological intervention strategies are still urgently needed to satisfy the demands of patients with cancer [ 7 ].

Mindfulness-based interventions (MBIs) have emerged as promising intervention techniques for patients with cancer. Mindfulness can be defined as the ability to observe thoughts, bodily sensations, or feelings in the present moment with an open and accepting orientation toward one’s experiences [ 8 ]. MBIs, which incorporate mindfulness practices into various therapies in mental health care, have been found to increase psychological flexibility and alleviate intense emotional states. MBIs can include additional mental training, such as mindfulness-based stress reduction (MBSR) [ 9 ], and acceptance and commitment therapy [ 10 ], which addresses psychological issues by increasing psychological flexibility [ 11 ]. Cognitive-behavioral therapy has been combined with MBSR, resulting in mindfulness-based cognitive therapy (MBCT) for preventing depression relapses [ 12 ]. Mindfulness-based cancer recovery (MBCR), an adaptation of MBSR, comprises contents tailored for patients with cancer [ 13 ]. Through facilitating awareness and nonjudgmental acceptance of moment-to-moment experiences, these MBIs are presumed to alleviate intense emotional states. Mindfulness interventions have been shown to improve the psychological status of patients with cancer [ 14 , 15 ].

The rapid development of information technologies has led to the delivery of MBIs via the internet, which is more practical than face-to-face interaction and can overcome time and geographic barriers, and it has been established that online MBIs are more suitable for people with psychological and physical symptoms [ 16 ]. Implementing psychological interventions through online or remote health can be a potential cost benefit for current referral pathways and treatment models [ 17 ]. online MBIs can be used as the adjunctive therapy in patients with cancer to manage cancer-related symptoms [ 18 ].

Despite the increasing popularity of online mindfulness-based therapies for patients with cancer and the growing number of randomized controlled trials (RCTs) examining such programs, there has not been a systematic review of these studies and their descriptions of the interventions regarding their characteristics (eg, delivery mode and approach). To date, only 2 systematic reviews addressing the impact of online interventions on health outcomes in patients with cancer have been published. However, these reviews have notable limitations. The first review [ 19 ] only searched 4 databases, potentially leading to publication bias and compromising the reliability of the findings. Furthermore, this systematic review did not conduct sensitivity, subgroup, or meta-analyses. The second review [ 20 ] evaluated the validity of online MBIs on only 4 health outcomes: anxiety, depression, QOL, and mindfulness. However, the restricted quantity of RCTs and papers within each subgroup analysis poses a challenge in reaching definitive conclusions. In addition, the external validity (eg, generalizability or applicability) based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework has not been examined in online MBIs for patients with cancer. Thus, attempts to synthesize the literature on the impact of online MBIs on the health of patients with cancer are limited, and there is a lack of analysis of the barriers and facilitators to the development of current online MBIs.

This systematic review aims to synthesize the effectiveness of online MBIs, encompassing both app- and website-based MBIs, for patients with cancer, comprehensively assessing a wide range of outcomes, including psychological, physiological, and QOL aspects. We conducted a comprehensive search to evaluate the validity of app- and website-based MBIs on psychological outcomes in patients with cancer, using high-quality RCTs to assess many health outcomes before and after treatment. Moreover, this study aims to provide an overview of the outcomes related to the interventions, including their effectiveness and potential for implementation and sustainability in real-world settings. We used the RE-AIM framework [ 21 ] to evaluate the potential for implementation and sustainability of these interventions in real-world settings. Using this framework, we can provide a comprehensive evaluation of an intervention’s potential impact and identify common traits of effective interventions. Overall, this study fills gaps in the literature by comprehensively evaluating the effectiveness and potential for implementation and sustainability of app- and website-based MBIs for patients with cancer.

Search Strategy

The protocol of this review was registered in PROSPERO (CRD42022382219) and written following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guideline. The methods outlined in the protocol were strictly adhered to throughout the experimental procedures. The databases were searched until December 30, 2022. To identify relevant studies for inclusion in our systematic reviews, we developed comprehensive search strategies and used 8 databases: Cochrane Library, Web of Science, PubMed, Embase, SinoMed, CINAHL Complete, Scopus, and PsycINFO. The literature search language was limited to Chinese and English. The search strategies used a combination of subject headings (eg, Medical Subject Headings in PubMed) and keywords for the following 5 concepts: mindfulness, carcinoma, intervention, telemedicine, and randomly. Multimedia Appendix 1 shows detailed database search strategies. Reference lists of included studies and relevant systematic reviews were also manually searched for additional relevant studies. Search results were captured using citation management software, and duplicates were removed.

Inclusion and Exclusion Criteria

Because of the explorative nature of this meta-analysis, we opted for rather broad inclusion criteria. The inclusion criteria were as follows: (1) studies that included patients with cancer (aged ≥18 years) with any cancer type and stage, including those receiving anticancer treatment, those in remission, those considered cured, and those in the terminal phases of the disease; (2) studies that used MBIs (including MBSR, MBCT, and MBCR) and administered the MBI via the internet (including websites, web conferencing, web-based games, and web-based video) or a smartphone app; (3) studies in which eligible controls were required to receive standard care or usual care; (4) studies were eligible if a mental health outcome (eg, fear of cancer recurrence [FCR] as measured with the Fear of Cancer Recurrence Inventory [FCRI] and posttraumatic growth [PTG] as measured with the Posttraumatic Growth Inventory), anxiety, depression, distress, stress, and sleep) or QOL was assessed; and (5) the RCT was published in English or Chinese.

Exclusion criteria were (1) other types of studies (eg, observational, review, protocol, and case report); (2) studies of health professionals, caregivers, or mixed populations in which outcomes for survivors of cancer could not be extracted; and (3) insufficient information to calculate an effect size or determine eligibility.

Screening and Data Extraction

Two reviewers independently screened all titles and abstracts; then, they independently screened full-text articles, and conflicts were resolved by consensus. Data were independently extracted by 2 reviewers using a data extraction form adapted from the Cochrane Handbook [ 22 ] and reported using PRISMA guidelines [ 23 ]. We extracted data from included trials using standardized data extraction forms. Study-level variables included the year of publication, country of study, age of participants, cancer diagnosis, delivery mode, reminder, cancer-adapted MBIs, primary and secondary outcomes, intervention and follow-up durations, intervention and control group details, outcome measurement metrics, and outcomes scores up to postintervention. Any discrepancy or uncertainties were resolved through regular meetings and discussion among the research team.

Risk-of-Bias Assessment

The risk of bias was independently assessed by 2 reviewers using the Cochrane Risk-of-Bias tool, with differences reconciled through discussion [ 24 ]. A total of 6 domains encompassed random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, and selective outcome reporting. Each domain was judged as low, high, or unclear risk. Discrepancies in assessments between the 2 reviewers were resolved by consensus or by a third reviewer as required.

Meta-Analytic Method

This study conducted a meta-analysis using Review Manager (version 5.4; The Cochrane Collaboration) and the meta package in R (R Foundation for Statistical Computing). The primary and secondary outcome mean and SD values at postintervention follow-up for intervention and control groups were converted to standardized mean difference (SMD), using Hedges g . The value of SMD <0.5 would be interpreted as small, SMD ≥0.5 as medium, and SMD ≥0.8 as large effect size [ 25 ]. Authors of studies with missing data were contacted through email. However, if no data were provided, a narrative synthesis would be conducted. The I 2 statistic was used to estimate the percentage of heterogeneity across the primary studies not attributable to random sample error alone. A value of 0% indicated no heterogeneity, and values of 25%, 50%, and 75% reflected low, moderate, and high degrees of heterogeneity, respectively [ 26 ]. Acknowledging differences across studies because of the varied population, length of intervention, and length of follow-up, meta-analyses were performed fitting random effects models [ 27 ]. In addition, subgroup analyses were conducted to examine effect sizes across different subgroups; the specific moderating variables included technology, sex, intervention type, intervention duration, study quality, and scale.

RE-AIM Framework

The RE-AIM framework is a valuable tool for evaluating interventions in health care [ 28 ]. Its 5 dimensions assess an intervention’s potential for large-scale adoption, implementation, and sustainability, providing a comprehensive evaluation of its real-world efficacy and viability [ 29 ]. Reach refers to the extent of successfully targeting and engaging the intended audience, evaluated using the percentage of eligible patients enrolled in the study (n enrolled/n eligible). Efficacy measures the effect on outcomes such as mental health and QOL. Effect sizes (95% CIs) for the primary outcome were used to assess efficacy. Adoption measures the extent to which organizations or health care providers are willing and able to offer the intervention to their patients or clients, and barriers to adoption are evaluated by who recruited participants and where the intervention was offered. Implementation evaluates how effectively the intervention is delivered and received by patients, including factors such as adherence and fidelity, and is evaluated by measures such as adherence to the intervention, percentage of dropouts of the most complex intervention (n postintervention follow-up/n baseline×100), intervention cost, and author-reported plans to upscale or implement. Maintenance measures the extent to which the intervention can be sustained over time and integrated into routine care, and it is evaluated by the duration of results and the author-reported availability of the intervention [ 30 ].

Description of Studies

The systematic search revealed 4349 original articles, of which 54 (0.12%) were assessed at full-text level, and 15 (0.03%) studies were included in the final synthesis. Figure 1 displays the study flowchart of the search results and Table 1 presents the characteristics extracted from the included literature in the study. The total population comprised 1613 participants, of which 870 (53.94%) and 743 (46.06%) were in the experimental and control conditions, respectively. In most (13/15, 87%) studies, the majority of participants were women. Participants were aged from 41.84 to 66.45 years. Four studies were based on MBCR, 3 on MBCT, 2 on MBSR, and 6 on mindfulness-based programs. The 6 studies included interventions that were indeed rooted in mindfulness practices; however, they did not strictly adhere to the conventional frameworks of MBCT, MBCR, or MBSR. Instead, they used a variety of mindfulness-based approaches tailored to their respective study populations.

Furthermore, these studies did not specify the exact intervention methods used but were categorized as mindfulness-based programs . Because of the unique nature of these interventions, we cannot determine whether they belong to MBCT, MBCR, or MBSR interventions; we have categorized them as mindfulness-based programs , encompassing diverse methodologies beyond the traditional MBCT, MBCR, or MBSR frameworks. Trials used usual care (8 trials) and waitlists (7 trials) equally as comparators. Six studies had participants with breast cancer, 7 with mixed cancer types, and 2 with other cancer types. Five studies were conducted in China; 5 in the United States; and 1 each in the Netherlands, Denmark, Iran, Australia, and Canada.

Study; country	Cancer type; age (y), mean (SD); gender (female; %)	Intervention (n); delivery mode	Reminders	Intervention duration, number of sessions; intervention dose	Cancer adapted	Technology	Control group (n)	Measurements	Outcomes: measure instrument
Chang et al [ ], 2022; China	Breast; 49.6 (12.0); 100	MBSR (41); web-based software and digital interactive whiteboard	—	6 wk, 6 sessions; 2 h/wk	—	Website	Waitlist (26)	Pre and post	Depression, anxiety, and stress: DASS-21
Compen et al [ ], 2018; Netherlands	Mixed; 51.7 (10.7); 85	MBCT (90); email, meditation audio file, and written feedback	—	8 wk; 40-45 min/d twice daily	—	Website	Usual care (78)	Pre and post	Distress: HADS , FCR : FCRI , and QOL : SF-12
Kubo et al [ ], 2019; US	Mixed; 58.2 (14.4); 68	MBP (54); audio instruction, lecture videos, and foundation course	Study staff made phone calls if an intervention participant completed <3	8 wk, 2 h/wk	Specifically for individuals affected by cancer	App	Usual care (43)	Pre and post	Distress: NCCN , anxiety and depression: HADS, PTG : PTGI , sleep: PROMIS , and QOL:FACT-G
Kubo et al [ ], 2018; US	Mixed; 66.5 (9.7); 69	MBP (52); online classroom and manual	The app can send reminders using push notifications; study staff made phone calls if an intervention participant completed <3	6 wk; 2 h/wk	Cancer pack, which was designed specifically for individuals affected by cancer	App	Usual care (51)	Pre and post	QOL: FACIT−Pal , distress: NCCN, and anxiety and depression: HADS
Liu et al [ ], 2022; China	HCC ; 55.7 (8); 22	MBCT (61); WeChat audio and online platforms	Every day (texting)	6 wk, 20 min/d for 5 d/wk	Adoption of the main issues and needs of patients with HCC	App	Waitlist (61)	Pre, post, 1 mo FU , 3 mo FU	Distress: HADS, sleep: PSQI , QOL: FACT-hep , and stress: PSS
Messer et al [ ], 2020; US	Mixed; 51 (10.6); 76	MBSR (11); guided meditation audio clips and brief textual lessons	—	6 wk; mean duration of 12 min/session	—	Website	Usual care (10)	Pre and post	Distress: HADS, QOL: POMS-SF , and sleep: PSQI
Nissen et al [ ], 2018; Denmark	Breast and prostate; 55.9 (12.1); 91	MBCT (104); website written material, audio exercises, writing tasks, and videos	—	10 wk, 10 sessions; 2 h/wk for 45 min/d	Program adjustments to meet the needs of survivors of cancer	Website	Waitlist (46)	Pre, post, and 6 mo FU	Anxiety: STAI‐Y , depression: BDI‐II , stress: PSS‐10, and sleep: ISI
Peng et al [ ], 2022; China	Breast; 41.8 (2.9); 100	MBP (30); website meeting 5P medicine approach	—	6 wk, 6 sessions; 1.5 h/wk	On the basis of specific considerations for survivors of cancer	App	Usual care (30)	Pre, post, and 1 mo FU	FCR: FCRI-SF and QOL: Eortc-Qlq-C30
Rosen [ ], 2017; US	Breast; 53 (10.3); 100	MBP (48); app-based courses include audio and video	General weekly check-in emails	9 wk	—	App	Waitlist (47)	Pre, wk 5, wk 9, and wk 4 FU	QOL: FACT-B
Rosen et al [ ], 2018; US	Breast; 51.6 (10.3); 100	MBP (57); app-based audio and animated video	Weekly check-in email	9 wk	—	App	Waitlist (55)	Pre, post, and 1 mo FU	QOL: FACT‐B
Russell et al [ ], 2019; Australia	Melanoma; 53.4 (13.1); 54	MBP (46); embedded short videos, PDF transcript of the videos, and MP3 audio email	Automatically generated email reminders twice daily	6 wk	Survey to understand the knowledge of meditation among people with melanoma	Website	Waitlist (23)	Pre and post	FCR: FCRI and stress: PSS-10
Shen et al [ ], 2021; China	Breast; 47.4 (7.5); 100	MBCR (37); online course, WeChat group, audio-video materials, and pictures	Every day (texting)	8 wk, 8 sessions; 15 min/d for 6 d/wk	Combine rich experience in rehabilitation psychotherapy of breast cancer	App	Usual care (40)	Pre and post	Stress: CPSS and anxiety: SAS
Wang [ ], 2022; China	Breast; 46.8 (7.9); 100	MBCR (51); web-based courses and intervention materials	—	4 wk, 4 sessions; 1.5 h/wk and 30 min daily	On the basis of the problems in the pilot study and participant feedback, adjusted internet-delivered MBCR program	Website	Usual care (52)	Pre and post	QOL: FACT-B
Yousefi et al [ ], 2022; Iran	Colorectal and stomach; 54.9 (6.6); 42	MBCR (25); web-based session	An alert reminder message was sent 2 h before each session	9 wk, 9 sessions; 90 min/wk	Cancer-specific MBSR program was used in the study	Website	Usual care (25)	Pre, post, and 2 mo FU	Stress: DASS‐21 and sleep: ISI
Zernicke et al [ ], 2014; Canada	Mixed; 58 (10.7); 72	MBCR (30); web-based classroom, guided meditation recordings, and videos	—	8 wk, 8 sessions; 45 min/d	Cancer-adapted MBSR	Website	Waitlist (32)	Pre and post	Depression and anxiety: POMS , stress: CSOSI , PTG: PTGI

a MBSR: mindfulness-based stress reduction.

b Not applicable.

c DASS-21: Depression, Anxiety, and Stress Scale-21.

d MBCT: mindfulness-based cognitive therapy.

e HADS: Hospital Anxiety and Depression Scale.

f FCR: fear of cancer recurrence.

g FCRI: Fear of Cancer Recurrence Inventory.

h QOL: quality of life.

i SF-12: 12-item Short-Form health survey.

j MBP: mindfulness-based program.

k NCCN: National Comprehensive Cancer Network Distress Thermometer.

l PTG: posttraumatic growth.

m PTGI: 21-item Posttraumatic Growth Inventory.

n PROMIS: 8-item PROMIS Sleep Disturbance scale.

o FACT-G: 27-item Functional Assessment of Cancer Therapy General Scale.

p FACIT‐Pal: 46-item Functional Assessment of Chronic Illness Therapy—Palliative Care.

q HCC: hepatocellular carcinoma.

r FU: follow-up.

s PSQI: Pittsburgh Sleep Quality Index.

t FACT-Hep: Functional Assessment of Cancer Therapy-Hepatobiliary Carcinoma.

u PSS: Perceived Stress Scale.

v POMS-SF: Profile of Mood States-Short Form.

w STAI‐Y: State-Trait Anxiety Inventory Y-Form.

x BDI‐II: Beck Depression Inventory.

y ISI: Insomnia Severity Index.

z 5P: The specific name of an application designed to promote mind and brain health and cultivate happiness.

aa FCRI-SF: Fear of Cancer Recurrence Inventory-Short Form.

ab Eortc-Qlq-C30: European Organization for Research and Treatment of Cancer questionnaire.

ac FACT-B: Functional Assessment of Cancer Therapy-Breast version 4.

ad MBCR: Mindfulness-based cancer recovery.

ae CPSS: Chinese version of the Perceived Stress Scale.

af SAS: Self-Rating Anxiety Scale.

ag POMS: Profile of Mood States.

ah CSOSI: Calgary Symptoms of Stress Inventory.

Risk of Bias

The risk-of-bias assessment is presented in Multimedia Appendix 2 [ 31 - 45 ]. Most studies (9/15, 60%) adequately generated and concealed allocation ( Figure 2 ). In most studies (14/15, 93%), patient blinding was not possible because of the nature of online MBIs and was not considered to increase the risk of bias. However, of the 15 studies, 8 (53%) [ 31 , 33 , 37 - 40 , 42 , 44 ] presented insufficient information regarding researcher and outcome assessor blinding, whereas 7 (47%) reported blinding researchers [ 32 , 34 - 36 , 41 , 43 , 45 ] (low risk). A total of 14 studies reported complete outcome data (low risk), and 1 study had insufficient detail [ 44 ] (unclear risk). In 1 study [ 40 ], attrition was high and comparisons or reasons for attrition were not provided. Finally, 66% (10/15) of the studies did not reference a protocol or trial registration (unclear risk).

Meta-Analysis

Effects on qol.

A total of 8 studies reported the effects of app- and website-based MBIs on QOL among patients with cancer. To measure QOL in patients with cancer, 4 health-related QOL measures were used, including the Functional Assessment of Chronic Illness Therapy [ 34 ], the Functional Assessment of Cancer Therapy [ 33 , 35 , 39 , 40 , 43 ], the Short-Form 12 [ 32 ], and the European Organization for Research and Treatment of Cancer questionnaire [ 38 ], all of which have been validated in this patient population. Higher scores reflected a higher QOL. Because the physical and psychological components of the scale were measured separately and it was not possible to determine the overall change in the QOL, the data from 1 study [ 32 ] were not summarized. A total of 7 studies including 569 participants were evaluated in the meta-analysis. No significant heterogeneity was found between studies ( I 2 =26%; P =.23; Figure 3 [ 33 - 41 , 43 - 45 ]). The intervention group had a significant QOL improvement compared to the control group (SMD 0.37, 95% CI 0.18-0.57; P <.001). In addition, the exclusion of any single study at one time did not change the pooled results markedly.

Effects on Sleep

Five studies investigated the impact of app- and website-based MBIs on sleep quality using 3 assessment tools: the 8-item PROMIS Sleep Disturbance scale [ 33 ], the Insomnia Severity Index [ 37 , 44 ], and the Pittsburgh Sleep Quality Index [ 35 , 36 ]. A higher score indicated a worse sleep quality. Moderate heterogeneity of effect sizes was observed ( I ²=58%; P =.05; Figure 3 ). Grouping the studies by type of technology, scale, and intervention type did not resolve heterogeneity, so a random effects model was chosen to pool the results. The result revealed that app- and website-based MBIs could alleviate patients’ sleep issues, with a statistical difference (SMD −0.36, 95% CI −0.72 to −0.01; P =.04). Only 1 outlier was detected [ 36 ]. After omitting the studies from the analysis, the effect size dropped to an SMD of −0.25 (95% CI −0.54 to 0.04; P =.09), and heterogeneity reduced substantially ( I 2 =38%). The possible reason for this change may be attributed to the fact that small sample sizes tend to yield more pronounced effects.

Effects on FCR

A total of 3 studies measured FCR; the pooled data included 224 participants. Two FCR measures were used: FCRI [ 32 , 41 ] and the Short-Form FCRI [ 38 ]. A higher score indicated a higher level of FCR. There is great heterogeneity among the studies ( I 2 =86%; P =.009; Figure 3 ). After the data of the study by Russell et al [ 41 ] are eliminated by the method of eliminating one by one, there is significantly lower heterogeneity ( I 2 =0%; P =.70). This may be due to Russell et al [ 41 ] presurveying patients with cancer so that the intervention on FCR was more effective. The results showed that the difference between the network-based MBIs and the control group was not statistically significant (SMD −0.30, 95% CI −1.04 to 0.44; P =.39).

Effects on PTG

Two studies examined the effect of app- and website-based MBIs on PTG, with a total of 134 participants. The measurement tool exclusively used across 2 studies to assess PTG was the Posttraumatic Growth Inventory [ 33 , 45 ]. Higher scores indicated greater PTG. No significant heterogeneity was found between studies ( I 2 =0%; P =.38; Figure 3 ). We found that app- and website-based MBIs did not lead to a significant increase in PTG score (SMD 0.08, 95% CI −0.26 to 0.42; P =.66).

Effects on Anxiety

Anxiety levels were assessed in 6 studies using 5 validated scales. These scales include the Hospital Anxiety and Depression Scale (HADS) [ 33 , 34 ], the Depression Anxiety Stress Scale Depression Inventory [ 31 ], the State-Trait Anxiety Inventory Y-Form [ 37 ], the Self-Rating Anxiety Scale [ 42 ], and the Profile of Mood States [ 45 ]. Higher scores on these scales indicated elevated levels of anxiety. Meta-analysis showed that app- and website-based MBIs lead to a significant reduction in anxiety (SMD −0.48, 95% CI −0.75 to −0.20; P <.001; Figure 4 [ 31 - 37 , 41 , 42 , 44 , 45 ]). Moderate heterogeneity was found between studies ( I 2 =52%; P =.07). Grouping the studies by type of technology and intervention duration did not resolve heterogeneity ( Table 2 ). Furthermore, when we examined subgroups based on sex, we found that studies including female participants had a significantly larger pooled effect size (SMD −0.67, 95% CI −1.01 to −0.33; P <.001) than the studies including both male and female participants (referred to as the mixed-gender subgroup; SMD −0.39, 95% CI −0.76 to −0.02; P =.04; Figure 4 ). The differences across these 2 subgroups were statistically nonsignificant (χ 2 1 =1.2; P =.28).

Subgroup and stratification				Studies, n (%)		SMD (95% CI)		value for heterogeneity				value for pooled results		value for interaction
															.54
		Website	3 (50)		−0.57 (−0.82 to −0.31)		.47		0		.0001
		App	3 (50)		−0.38 (−0.93 to 0.18)		.02		74		.18
															.43
		<8 wk	2 (33)		−0.62 (−0.97 to−0.27)		.57		0		<.001
		≥8 wk	4 (67)		−0.41 (−0.81 to −0.01)		.03		67		.04
															.28
		Female	2 (33)		−0.67 (−1.01 to −0.33)		.41		0		<.001
		Mixed	4 (67)		−0.39 (−0.76 to −0.02)		.05		62		.04
															.67
		MBCR	2 (33)		−0.70 (−0.05 to −0.36)		.55		0		<.001
		MBCT	1 (17)		−0.43 (−0.82 to 0.03)		—		—		.04
		MBIs	2 (33)		−0.28 (−1.14 to 0.59)		.01		85		.53
		MBSR	1 (17)		−0.52(−1.02 to −0.02)		—		—		.04
															.07
		Unclear risk	5 (83)		−0.43 (−0.74 to −0.12)		.06		56		.007
		High risk	1 (17)		−0.72 (−1.20 to −0.24)		—		—		.004
															.68
		Website	4 (80)		−0.87 (−1.44 to −0.29)		.002		80		.003
		App	1 (20)		−1.02 (−1.50 to −0.55)		—		—		<.001
															<.001
		MBCR	3 (60)		−0.96 (−1.27 to−0.66)		.39		0		<.001
		MBCT	1 (20)		−0.21 (-0.61 to 0.18)		—		—		.29
		MBIs	1 (20)		−1.41 (−1.97 to −0.86)		—		—		<.001
															.33
		PROMs	1 (20)		−0.09 (−0.55 to 0.38)		—		—		.72
		PSQI	2 (40)		−0.78 (−1.58 to 0.02)		.11		60		.05
		ISI	2 (40)		−0.23 (−0.83 to 0.36)		.09		65		.44
															.20
		Website	3 (60)		−0.52 (−1.22 to 0.19)		.02		75		.15
		App	2 (40)		−0.02 (−0.32 to 0.28)		.70		0		.91
															.16
		<8 wk	2 (40)		−0.78 (−1.58 to −0.02)		.11		60		.05
		≥8 wk	3 (60)		−0.16 (−0.49 to 0.17)		.23		32		.35
															.11
		Unclear risk	4 (80)		−2.03 (−2.93 to −1.13)		.12		49		<.001
		High risk	1 (20)		0.20 (−2.93 to 2.79)		—		—		.88

a SMD: standardized mean difference.

b MBCR: mindfulness-based cancer recovery.

c MBCT: mindfulness-based cognitive therapy.

d Not applicable.

e MBI: mindfulness-based intervention.

f MBSR: mindfulness-based stress reduction.

g Unclear risk: unclear risk of bias for one or more key domains.

h High risk: high risk of bias for one or more key domains.

i PROM: patient‐reported outcome measure.

j PSQI: Pittsburgh Sleep Quality Index.

k ISI: Insomnia Severity Index.

Effects on Depression

Depression was assessed across 5 studies using various standardized instruments. These included the Depression Anxiety Stress Scale-21 [ 31 ], HADS [ 33 , 34 ], Beck Depression Inventory [ 37 ], and Profile of Mood States [ 45 ]. Elevated levels of depression were indicated by higher scores on these scales. The pooled data included 384 participants and showed a significant difference in improvement between the intervention and control groups (SMD −0.36, 95% CI −0.61 to −0.11; P =.005; Figure 4 ). Moderate heterogeneity of effect sizes was observed ( I 2 =31%; P =.21). In the sensitivity analysis using the one-study-out method, we found that the pooled estimates were not significantly altered when any 1 study was omitted in turn. The range of P values obtained varied from .0001 to .03, indicating that the summary effect size is robust.

Effects on Perceived Stress

A total of studies investigated the effects of app- and website-based MBIs on stress. Four distress measures were used: the Perceived Stress Scale [ 35 , 37 , 41 ], the Chinese version of the Perceived Stress Scale [ 42 ], the Depression and Stress Scale [ 44 ], and the Calgary Symptoms of Stress Inventory [ 45 ]. A total of 5 studies including 366 participants were evaluated in the meta-analysis. The data from 1 study was not pooled because the mean values and SD of outcomes were not reported [ 35 ], and between-study heterogeneity was found ( I 2 =75%; P =.003; Figure 4 ). This meta-analysis revealed a reduction in stress of −0.89 (95% CI −1.33 to −0.45) when comparing the intervention group to the control group at the postintervention stage.

To further explore the potential sources of heterogeneity, we conducted subgroup analyses by type of technology and intervention type ( Table 2 ). The 2 studies using apps (SMD −1.02, 95% CI −1.50 to −0.55; I 2 =0) were found to have low heterogeneity, whereas the 3 studies based on website-based technologies (SMD −0.87, 95% CI −1.44 to −0.29; P =.002) exhibited higher heterogeneity. After conducting sensitivity analysis and eliminating 1 study at a time, the exclusion of the study by Nissen et al [ 37 ] resulted in significantly lower heterogeneity (I 2 =21%; P =.28). One possible reason is that the study by Nissen et al [ 37 ], which offered internet-delivered MBCT as a routine based on a screening procedure, may have included less motivated participants compared to studies with self-referral. In addition, Nissen et al [ 37 ] used a lower cutoff value for screening the study population, which could have resulted in a floor effect.

Effects on Distress

In the analysis of distress (involving 5 studies), HADS [ 32 , 35 , 36 ] and the National Comprehensive Cancer Network Distress Thermometer [ 33 , 34 ] were used to assess the current distress level. Low heterogeneity was found between studies ( I 2 =30%; P =.22; Figure 4 ), and the random effects model indicated that app- and website-based MBIs were associated with reduced distress levels in patients with cancer (SMD −0.50, 95% CI −0.75 to −0.26; P <.001).

Subgroup Analysis

Table 2 displays the results of subgroup analyses that were conducted to investigate the heterogeneity in the association between anxiety, perceived stress, and sleep in the context of MBIs. To explain the variability in the effects of mindfulness, we examined various moderating variables, such as technology, sex, intervention type, intervention duration, study quality, and scale. No statistically significant variables were found in the subgroup analysis of anxiety and sleep, whereas the type of intervention ( P <.001) was a significant moderating variable for perceived stress

Publication Bias

Funnel plots and statistical tests were not performed as any of the outcomes had at least 10 studies to ensure sufficient power in detecting asymmetry [ 46 ]. However, we reduced the possibility of publication bias by conducting a thorough search across multiple databases to identify published studies [ 47 ].

Details of the RE-AIM Framework assessment are presented in Multimedia Appendix 3 [ 31 - 45 ]. Of the 15 studies, 14 (93%) reported 13% to 92% of eligible patients. Efficacy (effect size and 95% CI of primary outcome) was reported in 33% (5/15) of the studies [ 33 , 35 , 37 , 39 , 40 ] (Cohen d or η 2 ). For adoption barriers, health professionals or researchers conducted recruitment for all studies, and 53% (8/15) of the studies [ 35 - 38 , 41 - 44 ] recruited participants in person (hospital and cancer center). For implementation, intervention adherence ranged from 59% to 100% of participants completing all scheduled components. Dropouts of most complex interventions ranged from 0% to 48%, with 40% (6/15) of the studies [ 31 , 38 - 40 , 42 , 45 ] having <10% dropouts. The cost was reported in 4 studies [ 33 , 34 , 39 , 40 ], including the paid app (priced at US $77 for 6 months and US $69.99 for 12 months) and the app already publicly available. In total, 46% (7/15) of the studies [ 35 , 37 - 40 , 43 , 44 ] reported maintenance of results, and 46% (7/15) of the studies [ 35 , 37 - 40 , 43 , 44 ] sustained results for 1 to 9 months. Four studies [ 33 , 34 , 39 , 40 ] explicitly reported on the potential for the interventions to remain accessible or whether there were plans for their continued implementation.

Principal Findings

The objective of this study is to assess the effectiveness of MBIs in improving the mental health and QOL of patients with cancer. We discovered that patients’ QOL can be greatly enhanced by app- and website-based MBIs, which also significantly lowers psychological distress, sleep problems, anxiety, depression, and perceived stress. This systematic review of meta-analyses and the RE-AIM framework demonstrate that app- and website-based interventions have a wide range of effects and are highly used by different (international and multilingual) patients with cancer. However, the use and accessibility of app- and website-based MBIs for patients with cancer have been constrained because of service fees and patient mobility limitations [ 48 ]; app- and website-based MBIs are mainly conducted in high-income countries. The possible explanation is the distinction between communication and economy; some high-income countries may have national health services in place to promote app- and website-based MBIs, whereas developing nations may not. Study shows that in many low- and middle-income countries, the accessibility of evidence-based mental health treatments remains limited [ 49 ]. The time commitment, teacher shortage, and high cost of classic mindfulness interventions may have hindered efforts to spread the associated benefits to individuals in developing countries [ 50 ]. For instance, Indonesia has yet to implement evidence-based internet-based mindfulness therapy, emphasizing the need for expanding evidence-based mental health interventions in resource-constrained settings.

The results of this study suggest that app- and website-based MBIs are effective in improving QOL and reducing anxiety and depressive symptoms in patients with cancer, which is consistent with previous meta-analyses [ 18 , 20 ]. A possible explanation for this is that app- and website-based MBIs can alleviate negative emotions, enhance positive emotions, and increase mindfulness skills among patients with cancer, as elaborated by previous research [ 51 ]. Moreover, the sleep quality of patients with cancer also improved after MBIs. This outcome may be attributed to the inclusion of techniques in the program that target sleep difficulties [ 7 ] and the nonjudging aspect of mindfulness, which can enhance sleep quality by mitigating stress and everyday tensions. Previous studies [ 52 ] have confirmed the moderate effect of mindfulness interventions on sleep quality, which suggests that the use of app- and website-based MBIs to manage QOL and sleep in patients with cancer should be further supported.

App- and website-based MBIs have shown potential in helping patients with cancer develop emotional regulation skills and cope with the distress associated with diagnosis and treatment [ 53 ]. It makes patients feel better emotionally and physically and helps patients with cancer reduce their psychological distress [ 54 ]. Incorporating MBIs into oncological treatment can promote emotional and physical well-being and alleviate psychological distress [ 55 ]. MBIs have been found to regulate biological variables associated with stress [ 56 ], such as immune function, hypothalamic-pituitary-adrenal regulation, and autonomic nervous system activity, thereby reducing pressure on patients. The data from this review showed that MBCR appeared to be particularly effective in reducing perceived stress, whereas MBCT was not effective in reducing stress after the intervention [ 51 ]. This finding was unexpected, given that many previous studies have suggested the effectiveness of MBCT in reducing stress [ 57 ]. However, because of the limited number of included studies, it is difficult to draw definitive conclusions regarding the comparative effectiveness of different MBIs.

However, although not statistically significant, app- and website-based MBIs can improve the level of PTG and FCR in patients with cancer. FCR is one of the most common problems of survivors of cancer, and it has been known that FCR can persist throughout the treatment and survival trajectory [ 58 ]; thus, specific intervention is needed for survivors of cancer who have clinically significant FCR. Previous meta-analysis showed that cognitive therapy and mindfulness exercises are very suitable for combating FCR [ 59 ]. Numerous psychological and behavioral mechanisms of change within mindfulness interventions have been suggested, encompassing acceptance, emotion regulation skills, and the reduction of ruminative thoughts [ 60 ]. The meta-analysis by Gu et al [ 61 ] provided empirical confirmation that rumination significantly mediates the impact of MBIs on mental health outcomes. In addition, the study by Butow et al [ 62 ] identified rumination as a crucial psychological mechanism associated with FCR. Therefore, the study suggests that the effectiveness of mindfulness interventions in addressing the FCR may be attributed to their potential to improve patients’ levels of rumination. The improved PTG observed in this study may be explained by the systematic training in moment-by-moment awareness, and MBIs focus on viewing thoughts and feelings as mental events [ 63 ]. Such a decentered relationship enables a perception of mental events as aspects of experience moving through awareness, showing that mindfulness practice supports personal growth and transformation.

In this study, it was observed that short-term MBIs with a duration of <8 weeks exhibited a larger effect size concerning the outcomes of anxiety and sleep. In the study by Wang et al [ 43 ], short-term MBIs were found to be more effective in improving physical health compared to long-term MBIs, and interventions lasting <8 weeks demonstrated a greater effect size, possibly attributed to the increased participant engagement resulting from the shorter intervention duration and simplified intervention complexity. Shorter interventions may be more feasible and acceptable for patients with cancer who are dealing with a range of physical and emotional challenges [ 64 ]. Future research should aim to replicate and expand on these results, including investigating the optimal duration and timing of app- and website-based MBIs for patients with cancer.

Recommendations for Future Research

To the best of our knowledge, this study represents the first meta-analysis using the RE-AIM framework, systematically reviewing and synthesizing the effectiveness of MBIs for patients with cancer across various types of interventions. By accurately reporting the RE-AIM dimensions, this study seeks to enhance the replicability and universality of mindfulness interventions in oncology settings. Our assessment of app- and website-based MBIs for patients with cancer, conducted within the framework of RE-AIM, reveals that the participation rates of eligible patients range from 13% to 92%. The calculated median participation rate, at 67% (IQR 47.5%-82%), emphasizes the effectiveness of the interventions in reaching a substantial portion of the target population. However, only a minority of studies reported on efficacy, which limited our ability to draw conclusions on overall effectiveness. Recruitment was primarily conducted by health professionals or researchers, and more than half of the studies (8/15, 53%) recruited participants in person, potentially limiting generalizability. Intervention adherence was generally high, but dropout rates varied widely, indicating that certain interventions may be more challenging for some patients. Cost was reported in only a few studies (4/15, 27%), with implications for accessibility. Long-term effects were reported in more than half of the studies (7/15, 47%), highlighting the need for further research. This study underscores the importance of considering the RE-AIM framework in the implementation and evaluation of these interventions. Further research is needed to fully understand their potential benefits and limitations in real-world settings.

Internet-based interventions have previously been shown to be effective for anxiety disorders and fear-related disorders and have achieved the same effect as face-to-face treatment [ 65 ]. Consistent with the results of this study, delivery via the internet, group, or app is feasible and effective. Our results suggest that among forms of online MBIs for patients with cancer, the most widely studied type was website-based interventions. This observation is in line with an analysis conducted in recent years [ 66 ], which indicated that the most widely studied type of telehealth for patients with breast cancer was website-based interventions. Website-based MBIs may offer more content, functionality, and instruction than app-based interventions, which may enhance user engagement, learning, and practice of positive thinking skills [ 67 , 68 ]. Website-based MBIs had higher completion rates and lower attrition rates compared to app-based interventions, which may be due to factors such as convenience, accessibility, engagement, and personalization [ 69 ]. Finally, in our review, a website-based study [ 41 ] that greatly improved FCR and stress highlighted the sustainability and self-management of the intervention and enabled flexible navigation by accessing website content according to user preferences. Therefore, website-based MBIs may offer more opportunities for personalization and tailoring interventions to individual needs.

In our analysis, 53% (8/15) of the studies implemented a weekly or daily reminder system through various channels, such as email, text messages, apps, or smartphone notifications, to facilitate app- and website-based MBIs. However, the prevalence of reminder systems in the studies under review is relatively limited (7/15, 47%), a finding consistent with the investigation by Matis et al [ 19 ]. Matis et al conducted a systematic evaluation in this field, discussing the limited prevalence of reminder systems in reviewed studies and highlighting the current lack of direct comparisons between interventions with and without reminders. In addition, the study found that the frequency of reminders was positively associated with the magnitude of the intervention effect [ 70 ]. Consequently, to promote patient involvement in app- and website-based MBIs, it is vital to set reminders [ 67 ]. Some studies have also set up expert feedback, answers, and a variety of supervision methods to avoid reduced patient compliance. Therefore, app- and website-based MBIs can enhance engagement using features such as reminders, feedback, personalization, and facilitator-led components. However, it is important to note that the specific frequency, timing, and content of the reminders may vary depending on the individual and the context of the intervention. Our study results reveal heterogeneity in the types, frequencies, and content of reminder systems, preventing the establishment of specific standards for their effectiveness. Despite the evident practicality of reminder systems, a more comprehensive investigation into their types, frequencies, and effectiveness is imperative within the context of app- and website-based MBIs.

This systematic review found that most app- and website-based interventions have adopted online classrooms; application-based measures to implement mindfulness interventions; and multicomponent interventions that include audio, video, and documents. However, the study did not clarify which factors affect behavioral changes. Despite these differences, 67% (10/15) of the interventions are designed specifically for the cancer population and provide customizable interventions. For example, as demonstrated by Wang et al [ 43 ], a pilot website-based MBIs was conducted for patients with cancer; this is an adapted version of MBSR specifically tailored for individuals dealing with cancer-related stressors. The MBCR program retains the core principles and practices of MBSR while integrating specific intervention materials to address challenges associated with cancer, such as common experiences related to cancer, sleep issues, pain, and FCR, which is greatly beneficial for improving the physical and mental symptoms of patients with cancer. MBCR will provide a platform for patients with cancer to engage in discussions and address challenges related to cancer. Future app- and website-based MBIs should take into account the characteristics of patients and determine which intervention plan is most suitable for patients with cancer, emphasizing feedback sessions and communication with therapists to enable patients to learn self-management and make intervention plans sustainable.

Limitations

Although this review summarizes international RCTs for various outcomes, there are limitations. First, because the research results are measured by various tools, it may hinder the comparability of research outcomes. Second, in the 15 trials, there are differences in the personnel, duration, and methods of app- and website-based MBIs in various studies. Patients included in these studies have different characteristics. Third, The inability to access or adequately translate studies in languages other than English and Chinese may introduce bias into the selection process, potentially limiting the comprehensiveness of the findings. Finally, in the subgroup analysis, the study of each subgroup is limited, which may reduce the ability to draw conclusions on the differences in the consistency of intervention effects between subgroups. The abovementioned factors may lead to heterogeneity between studies, which is closely related to the summary results, so these results need to be interpreted carefully. Nevertheless, the meta-analysis included RCTs only and used a random effect model to pool results to give the most conservative estimates. In addition, subgroup analysis and sensitivity analysis were conducted and showed that the pooled estimations were relatively robust.

Conclusions

This meta-analysis provides definite evidence regarding the efficacy of app- and website-based MBIs for patients with cancer. Our findings suggest that app- and website-based MBIs can be effective in improving OL, sleep, and mental health and can be integrated into stepped care in clinical practice. Future experiments should pay more attention to the development of intervention programs based on the wishes and characteristics of patients with cancer and study how to optimize interventions further and customize interventions based on individual physical and mental symptoms.

Acknowledgments

This study was supported by the Exploration of Trajectories and Intervention Program of Frailty for Gastric Cancer Survivors Based on the Health Ecology Theory project supported by the National Natural Science Foundation of China (number 82073407), the Studies on Construction of Core Competency Model and Development of Assessment Tool for Nurses of Hospice Care project supported by the National Natural Science Foundation of China (number 72004099), and the Basic Science (Natural Science) Foundation of Higher Education Institutions of Jiangsu Province (project number 22KJB320013).

Data Availability

All data generated or analyzed during this study are included in this published article and its supplementary information files.

Authors' Contributions

TW and XJ developed the key ideas for the manuscript and the hypotheses. TW developed the search strategy and conducted the literature searches. YG, XJ, and CT conducted screening and coding. QX, CT, and SZ contributed to manuscript review and editing. TW conducted the statistical analyses, summarized the findings, and prepared the initial draft of the manuscript. All authors contributed to and approved the final manuscript.

Conflicts of Interest

None declared.

Search strategy.

Summary of the risk of bias of studies included in the systematic review.

RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.

• Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. May 2021;71(3):209-249. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Choi HC, Lam KO, Pang HH, Tsang SK, Ngan RK, Lee AW. Global comparison of cancer outcomes: standardization and correlation with healthcare expenditures. BMC Public Health. Aug 07, 2019;19(1):1065. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. Jan 2023;73(1):17-48. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Wei X, Yuan R, Yang J, Zheng W, Jin Y, Wang M, et al. Effects of Baduanjin exercise on cognitive function and cancer-related symptoms in women with breast cancer receiving chemotherapy: a randomized controlled trial. Support Care Cancer. Jul 2022;30(7):6079-6091. [ CrossRef ] [ Medline ]
• Mead KH, Raskin S, Willis A, Arem H, Murtaza S, Charney L, et al. Identifying patients' priorities for quality survivorship: conceptualizing a patient-centered approach to survivorship care. J Cancer Surviv. Dec 2020;14(6):939-958. [ CrossRef ] [ Medline ]
• Nekhlyudov L, Mollica MA, Jacobsen PB, Mayer DK, Shulman LN, Geiger AM. Developing a quality of cancer survivorship care framework: implications for clinical care, research, and policy. J Natl Cancer Inst. Nov 01, 2019;111(11):1120-1130. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Schell LK, Monsef I, Wöckel A, Skoetz N. Mindfulness-based stress reduction for women diagnosed with breast cancer. Cochrane Database Syst Rev. Mar 27, 2019;3(3):CD011518. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Hadash Y, Bernstein A. Behavioral assessment of mindfulness: defining features, organizing framework, and review of emerging methods. Curr Opin Psychol. Aug 2019;28:229-237. [ CrossRef ] [ Medline ]
• Forte P, Abate V, Bolognini I, Mazzoni O, Quagliariello V, Maurea N, et al. Mindfulness-based stress reduction in cancer patients: impact on overall survival, quality of life and risk factor. Eur Rev Med Pharmacol Sci. Sep 2023;27(17):8190-8197. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Mathew A, Doorenbos AZ, Jang MK, Hershberger PE. Acceptance and commitment therapy in adult cancer survivors: a systematic review and conceptual model. J Cancer Surviv. Jun 2021;15(3):427-451. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Zhang D, Lee EK, Mak EC, Ho CY, Wong SY. Mindfulness-based interventions: an overall review. Br Med Bull. Jun 10, 2021;138(1):41-57. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Segal Z, Dimidjian S, Vanderkruik R, Levy J. A maturing mindfulness-based cognitive therapy reflects on two critical issues. Curr Opin Psychol. Aug 2019;28:218-222. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Schellekens MP, Tamagawa R, Labelle LE, Speca M, Stephen J, Drysdale E, et al. Mindfulness-Based Cancer Recovery (MBCR) versus Supportive Expressive Group Therapy (SET) for distressed breast cancer survivors: evaluating mindfulness and social support as mediators. J Behav Med. Jun 2017;40(3):414-422. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Johns SA, Tarver WL, Secinti E, Mosher CE, Stutz PV, Carnahan JL, et al. Effects of mindfulness-based interventions on fatigue in cancer survivors: a systematic review and meta-analysis of randomized controlled trials. Crit Rev Oncol Hematol. Apr 2021;160:103290. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Park S, Sato Y, Takita Y, Tamura N, Ninomiya A, Kosugi T, et al. Mindfulness-based cognitive therapy for psychological distress, fear of cancer recurrence, fatigue, spiritual well-being, and quality of life in patients with breast cancer-a randomized controlled trial. J Pain Symptom Manage. Aug 2020;60(2):381-389. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Toivonen KI, Zernicke K, Carlson LE. Web-based mindfulness interventions for people with physical health conditions: systematic review. J Med Internet Res. Aug 31, 2017;19(8):e303. [ FREE Full text ] [ CrossRef ] [ Medline ]
• van Agteren J, Iasiello M, Lo L, Bartholomaeus J, Kopsaftis Z, Carey M, et al. A systematic review and meta-analysis of psychological interventions to improve mental wellbeing. Nat Hum Behav. May 2021;5(5):631-652. [ CrossRef ] [ Medline ]
• Xunlin NG, Lau Y, Klainin-Yobas P. The effectiveness of mindfulness-based interventions among cancer patients and survivors: a systematic review and meta-analysis. Support Care Cancer. Apr 2020;28(4):1563-1578. [ CrossRef ] [ Medline ]
• Matis J, Svetlak M, Slezackova A, Svoboda M, Šumec R. Mindfulness-based programs for patients with cancer via ehealth and mobile health: systematic review and synthesis of quantitative research. J Med Internet Res. Nov 16, 2020;22(11):e20709. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Fung JY, Lim H, Vongsirimas N, Klainin-Yobas P. Effectiveness of eHealth mindfulness-based interventions on cancer-related symptoms among cancer patients and survivors: a systematic review and meta-analysis. J Telemed Telecare. Apr 2024;30(3):451-465. [ CrossRef ] [ Medline ]
• Bu S, Smith A, Janssen A, Donnelly C, Dadich A, Mackenzie LJ, et al. Optimising implementation of telehealth in oncology: a systematic review examining barriers and enablers using the RE-AIM planning and evaluation framework. Crit Rev Oncol Hematol. Dec 2022;180:103869. [ CrossRef ] [ Medline ]
• Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev. Oct 03, 2019;10(10):ED000142. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. Mar 29, 2021;372:n71. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Page MJ, Li T, Cumpston M, Welch VA, Higgins JP, Thomas J, et al. Cochrane Handbook for Systematic Reviews of Interventions, Second Edition. London, UK. The Cochrane Collaboration; 2019.
• Andrade C. Mean difference, standardized mean difference (SMD), and their use in meta-analysis: as simple as it gets. J Clin Psychiatry. Sep 22, 2020;81(5):20f13681. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. Jun 15, 2002;21(11):1539-1558. [ CrossRef ] [ Medline ]
• Borenstein M, Hedges LV, Higgins JP, Rothstein HR. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods. Apr 2010;1(2):97-111. [ CrossRef ] [ Medline ]
• Hodgson W, Kirk A, Lennon M, Janssen X, Russell E, Wani C, et al. RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) evaluation of the use of activity trackers in the clinical care of adults diagnosed with a chronic disease: integrative systematic review. J Med Internet Res. Nov 13, 2023;25:e44919. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Glasgow RE, Harden SM, Gaglio B, Rabin B, Smith ML, Porter GC, et al. RE-AIM planning and evaluation framework: adapting to new science and practice with a 20-year review. Front Public Health. Mar 29, 2019;7:64. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Singleton AC, Raeside R, Hyun KK, Partridge SR, Di Tanna GL, Hafiz N, et al. Electronic health interventions for patients with breast cancer: systematic review and meta-analyses. J Clin Oncol. Jul 10, 2022;40(20):2257-2270. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Chang YC, Chiu CF, Wang CK, Wu CT, Liu LC, Wu YC. Short-term effect of internet-delivered mindfulness-based stress reduction on mental health, self-efficacy, and body image among women with breast cancer during the COVID-19 pandemic. Front Psychol. Oct 25, 2022;13:949446. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Compen F, Bisseling E, Schellekens M, Donders R, Carlson L, van der Lee M, et al. Face-to-face and internet-based mindfulness-based cognitive therapy compared with treatment as usual in reducing psychological distress in patients with cancer: a multicenter randomized controlled trial. J Clin Oncol. Aug 10, 2018;36(23):2413-2421. [ CrossRef ]
• Kubo A, Kurtovich E, McGinnis M, Aghaee S, Altschuler A, Quesenberry CJ, et al. A randomized controlled trial of mHealth mindfulness intervention for cancer patients and informal cancer caregivers: a feasibility study within an integrated health care delivery system. Integr Cancer Ther. May 16, 2019;18:1534735419850634. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Kubo A, Kurtovich E, McGinnis M, Aghaee S, Altschuler A, Quesenberry CJ, et al. Pilot pragmatic randomized trial of mHealth mindfulness-based intervention for advanced cancer patients and their informal caregivers. Psychooncology. Feb 2024;33(2):e5557. [ CrossRef ] [ Medline ]
• Liu Z, Li M, Jia Y, Wang S, Zheng L, Wang C, et al. A randomized clinical trial of guided self-help intervention based on mindfulness for patients with hepatocellular carcinoma: effects and mechanisms. Jpn J Clin Oncol. Mar 03, 2022;52(3):227-236. [ CrossRef ] [ Medline ]
• Messer D, Horan JJ, Larkey LK, Shanholtz CE. Effects of internet training in mindfulness meditation on variables related to cancer recovery. Mindfulness. Jun 4, 2019;10(10):2143-2151. [ CrossRef ]
• Nissen ER, O'Connor M, Kaldo V, Højris I, Borre M, Zachariae R, et al. Internet-delivered mindfulness-based cognitive therapy for anxiety and depression in cancer survivors: a randomized controlled trial. Psychooncology. Jan 18, 2020;29(1):68-75. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Peng L, Yang Y, Chen M, Xu C, Chen Y, Liu R, et al. Effects of an online mindfulness-based intervention on Fear of Cancer Recurrence and quality of life among Chinese breast cancer survivors. Complement Ther Clin Pract. Nov 2022;49:101686. [ CrossRef ] [ Medline ]
• Rosen KD. Is there an app for that? An exploratory randomized controlled trial of app-based mindfulness training for women with breast cancer. The University of Texas at San Antonio. 2016. URL: https://www.proquest.com/openview/025a3306918540d35302bcee3e4ac77b/1?pq-origsite=gscholar&cbl=18750 [accessed 2024-06-04]
• Rosen KD, Paniagua SM, Kazanis W, Jones S, Potter JS. Quality of life among women diagnosed with breast cancer: a randomized waitlist controlled trial of commercially available mobile app-delivered mindfulness training. Psychooncology. Aug 01, 2018;27(8):2023-2030. [ CrossRef ] [ Medline ]
• Russell L, Ugalde A, Orellana L, Milne D, Krishnasamy M, Chambers R, et al. A pilot randomised controlled trial of an online mindfulness-based program for people diagnosed with melanoma. Support Care Cancer. Jul 30, 2019;27(7):2735-2746. [ CrossRef ] [ Medline ]
• Shen A, Qiang W, Wang Q, Zhao Z, Wang S. Effects of online mindfulness-based cancer rehabilitation on perceived stress, fatigue, and anxiety in transitional breast cancer survivors. J Nurs Train. 2021;36(23):2123. [ CrossRef ]
• Wang L, Chen X, Peng Y, Zhang K, Ma J, Xu L, et al. Effect of a 4-week internet-delivered mindfulness-based cancer recovery intervention on the symptom burden and quality of life of patients with breast cancer: randomized controlled trial. J Med Internet Res. Nov 22, 2022;24(11):e40059. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Yousefi A, Arani AM, Ghadiany M, Jafari M, Lighvan MA, Asanjarani B, et al. The effectiveness of online mindfulness-based cancer recovery program on psychological variables of colorectal and stomach cancer patients: a randomized control trial. Med Sci. Feb 2022;26(120). [ CrossRef ]
• Zernicke KA, Campbell TS, Speca M, McCabe-Ruff K, Flowers S, Carlson LE. A randomized wait-list controlled trial of feasibility and efficacy of an online mindfulness-based cancer recovery program: the eTherapy for cancer applying mindfulness trial. Psychosom Med. May 2014;76(4):257-267. [ CrossRef ] [ Medline ]
• Drucker AM, Fleming P, Chan AW. Research techniques made simple: assessing risk of bias in systematic reviews. J Invest Dermatol. Nov 2016;136(11):e109-e114. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Oberoi S, Yang J, Woodgate RL, Niraula S, Banerji S, Israels SJ, et al. Association of mindfulness-based interventions with anxiety severity in adults with cancer: a systematic review and meta-analysis. JAMA Netw Open. Aug 03, 2020;3(8):e2012598. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Vrontaras N, Koulierakis G, Ntourou I, Karakatsoulis G, Sergentanis TN, Kyrou D, et al. Psychosocial interventions on the posttraumatic growth of adults with cancer: a systematic review and meta-analysis of clinical trials. Psychooncology. Dec 2023;32(12):1798-1826. [ CrossRef ] [ Medline ]
• Listiyandini RA, Andriani A, Kusristanti C, Moulds M, Mahoney A, Newby JM. Culturally adapting an internet-delivered mindfulness intervention for Indonesian university students experiencing psychological distress: mixed methods study. JMIR Form Res. Aug 31, 2023;7:e47126. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Wu R, Liu LL, Zhu H, Su WJ, Cao ZY, Zhong SY, et al. Brief mindfulness meditation improves emotion processing. Front Neurosci. 2019;13:1074. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Cillessen L, van de Ven MO, Compen FR, Bisseling EM, van der Lee ML, Speckens AE. Predictors and effects of usage of an online mindfulness intervention for distressed cancer patients: usability study. J Med Internet Res. Oct 02, 2020;22(10):e17526. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Burrowes SA, Goloubeva O, Stafford K, McArdle PF, Goyal M, Peterlin BL, et al. Enhanced mindfulness-based stress reduction in episodic migraine-effects on sleep quality, anxiety, stress, and depression: a secondary analysis of a randomized clinical trial. Pain. Mar 01, 2022;163(3):436-444. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Glynn BA, Khoo EL, MacLeay HM, Duong A, Cantave R, Poulin PA. Exploring cancer patients' experiences of an online mindfulness-based program: a qualitative investigation. Mindfulness (N Y). 2020;11(7):1666-1677. [ FREE Full text ] [ CrossRef ] [ Medline ]
• King K. How ‘mindfulness’ can improve mental focus and help you feel better emotionally and physically. WTOP News. Jul 28, 2020. URL: https:/​/wtop.​com/​health-fitness/​2020/​07/​how-mindfulness-can-improve-mental-focus-and-help-you-feel-better-emotionally-and-physically/​ [accessed 2024-06-04]
• Cillessen L, Johannsen M, Speckens AE, Zachariae R. Mindfulness-based interventions for psychological and physical health outcomes in cancer patients and survivors: a systematic review and meta-analysis of randomized controlled trials. Psychooncology. Dec 2019;28(12):2257-2269. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Witek Janusek L, Tell D, Mathews HL. Mindfulness based stress reduction provides psychological benefit and restores immune function of women newly diagnosed with breast cancer: a randomized trial with active control. Brain Behav Immun. Aug 2019;80:358-373. [ CrossRef ] [ Medline ]
• Pedro J, Monteiro-Reis S, Carvalho-Maia C, Henrique R, Jerónimo C, Silva ER. Evidence of psychological and biological effects of structured Mindfulness-Based Interventions for cancer patients and survivors: a meta-review. Psychooncology. Nov 2021;30(11):1836-1848. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Tauber NM, O'Toole MS, Dinkel A, Galica J, Humphris G, Lebel S, et al. Effect of psychological intervention on fear of cancer recurrence: a systematic review and meta-analysis. J Clin Oncol. Nov 01, 2019;37(31):2899-2915. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Hall DL, Luberto CM, Philpotts LL, Song R, Park ER, Yeh GY. Mind-body interventions for fear of cancer recurrence: a systematic review and meta-analysis. Psychooncology. Nov 2018;27(11):2546-2558. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Jain S, Shapiro SL, Swanick S, Roesch SC, Mills PJ, Bell I, et al. A randomized controlled trial of mindfulness meditation versus relaxation training: effects on distress, positive states of mind, rumination, and distraction. Ann Behav Med. Feb 2007;33(1):11-21. [ CrossRef ] [ Medline ]
• Gu J, Strauss C, Bond R, Cavanagh K. How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clin Psychol Rev. Apr 2015;37:1-12. [ CrossRef ] [ Medline ]
• Butow PN, Turner J, Gilchrist J, Sharpe L, Smith AB, Fardell JE, et al. Randomized trial of ConquerFear: a novel, theoretically based psychosocial intervention for fear of cancer recurrence. J Clin Oncol. Dec 20, 2017;35(36):4066-4077. [ CrossRef ]
• Britton WB. Can mindfulness be too much of a good thing? The value of a middle way. Curr Opin Psychol. Aug 2019;28:159-165. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Li J, Li C, Puts M, Wu YC, Lyu MM, Yuan B, et al. Effectiveness of mindfulness-based interventions on anxiety, depression, and fatigue in people with lung cancer: a systematic review and meta-analysis. Int J Nurs Stud. Apr 2023;140:104447. [ CrossRef ] [ Medline ]
• Domhardt M, Geßlein H, von Rezori RE, Baumeister H. Internet- and mobile-based interventions for anxiety disorders: a meta-analytic review of intervention components. Depress Anxiety. Mar 2019;36(3):213-224. [ CrossRef ] [ Medline ]
• Chen YY, Guan BS, Li ZK, Li XY. Effect of telehealth intervention on breast cancer patients' quality of life and psychological outcomes: a meta-analysis. J Telemed Telecare. Apr 2018;24(3):157-167. [ CrossRef ] [ Medline ]
• Winter N, Russell L, Ugalde A, White V, Livingston P. Engagement strategies to improve adherence and retention in web-based mindfulness programs: systematic review. J Med Internet Res. Jan 12, 2022;24(1):e30026. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Goldberg SB, Lam SU, Simonsson O, Torous J, Sun S. Mobile phone-based interventions for mental health: a systematic meta-review of 14 meta-analyses of randomized controlled trials. PLOS Digit Health. 2022;1(1):e0000002. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Sylvia LG, Lunn MR, Obedin-Maliver J, McBurney RN, Nowell WB, Nosheny RL, et al. Web-based mindfulness-based interventions for well-being: randomized comparative effectiveness trial. J Med Internet Res. Sep 12, 2022;24(9):e35620. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Mrazek AJ, Mrazek MD, Cherolini CM, Cloughesy JN, Cynman DJ, Gougis LJ, et al. The future of mindfulness training is digital, and the future is now. Curr Opin Psychol. Aug 2019;28:81-86. [ CrossRef ] [ Medline ]

Abbreviations

fear of cancer recurrence

Fear of Cancer Recurrence Inventory

Hospital Anxiety and Depression Scale

mindfulness-based cognitive therapy

mindfulness-based intervention

mindfulness-based stress reduction

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

posttraumatic growth

quality of life

randomized controlled trial

Reach, Effectiveness, Adoption, Implementation, and Maintenance

standardized mean difference

Edited by T de Azevedo Cardoso; submitted 30.03.23; peer-reviewed by J Luo, K Kershner, F Chio; comments to author 31.12.23; revised version received 26.03.24; accepted 23.04.24; published 25.06.24.

©Ting Wang, Chulei Tang, Xiaoman Jiang, Yinning Guo, Shuqin Zhu, Qin Xu. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 25.06.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research (ISSN 1438-8871), is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.