Prevalence of depression in retirees: a meta-analysis

heal hca e Re iew P e alence o Dep ession in Re i ees: A Me a-Analysis Manuel Pabón-Ca asco 1, Lucia Rami ez-Baena 1,* , Raúl López Sánchez 2, Isabel Rod íguez-Gallego 1, No a Suleiman-Ma os 3and JoséL. Gómez-U quiza 4 1Spanish Red C oss Nu sing School, Se illa Uni e si y, 41009 Se illa, Spain; mpabon@c uz oja.es (M.P.-C.); is oga@c uz oja.es (I.R.-G.) 2 In e nal Medicine, Hospi al Qui ó nsalud Ba celona, 08023 Ba celona, Spain; [email p o ec ed] 3Nu sing Depa men , Facul y o Heal h Sciences, Uni e si y o G anada, Campus Uni e si y o Ceu a, 51001 Ceu a, Spain; no asm@ug .es 4Facul y o Heal h Sciences, Uni e si y o G anada, 6018016 G anada, Spain; jlgu quiza@ug .es *Co espondence: lucia b@co eo.ug .es Recei ed: 30 June 2020; Accep ed: 2 Sep embe 2020; Published: 4 Sep embe 2020   Abs ac : Backg ound: Re i emen is a inal li e s age cha ac e ized by he ceasing o wo k and he loss o a ou ine, social ela ions, ole, s a us, accomplishmen s, and aspi a ions, e c. Many imes i is accompanied by nega i e eelings and can p o oke di e en psychoemo ional eac ions such as dep ession, among o he s. The aim o his s udy is o analyze he p e alence o dep ession, as well as i s psychoeduca ional app oach in e i ees. Me hods: A pai ed sys ema ic e iew wi h me a-analysis was conduc ed in di e en da abases—Medline, Scopus, CUIDEN, CINAHL, LILACS and PsycINFO. O iginal s udies we e included in English, Spanish and F ench ha we e published in he las 10 yea s, and which app oached dep ession in e i ees. Resul s: A o al o 11 a icles we e selec ed a e applying inclusion and exclusion c i e ia. The mean alue o he p e alence le els o dep ession in e i ees ob ained in he me a-analysis was 28%. Dep ession is mo e equen in e i ees, wi h manda o y e i emen , e i emen due o illness, and an icipa ed e i emen p esen ing highe le els o his disease. The heal h ole in he psychoeduca ional app oach is highligh ed in 41.6% (n=5). Conclusions: Wi h almos one- hi d o e i ees su e ing om dep ession, i is necessa y o implemen p e en ion and ea ly de ec ion measu es o app oach a public heal h p oblem. Keywo ds: aging; dep ession; e i emen ; heal h pe sonnel; nu sing 1. In oduc ion Acco ding o he Wo ld Heal h O ganiza ion (WHO), dep ession is a men al diso de ha mani es s i sel h ough sadness, ex eme apa hy, anhedonia, eelings o guil , low sel -es eem, sleep diso de s, appe i e, lack o concen a ion, and sensa ion o i edness [1]. The WHO es ima es ha dep ession a ec s mo e han 300 million people in he wo ld [ 2 ]. In i s mos se ious o m, his disease can lead o suicide, since 800,000 indi iduals commi suicide each yea in he wo ld, his being he second mos common cause o dea h in indi iduals be ween 15 and 29 yea s old [2]. E en so, dep ession a ec s all age anges, especially ulne able indi iduals such as e i ees. Re i emen is a ansi ion which occu s in he las s age o li e and is cha ac e ized by he ceasing o wo k and, wi h ha , he loss o a ou ine, social ela ions, ole, s a us, accomplishmen s, and aspi a ions, e c. [ 3 ]. This implies changing he li es yle adop ed du ing many yea s in he wo king s age and supposes a phenomenon ha can al e he psychosocial ealm o he e i ee [ 4 ]. Addi ionally, Heal hca e 2020,8, 321; doi:10.3390/heal hca e8030321 www.mdpi.com/jou nal/heal hca e Heal hca e 2020,8, 321 2 o 11 he aging p ocess supposes di e se changes in heal h and i would lead o he decline o indi iduals who su e i , al e ing hei sel -image, sel -es eem, au onomy, and unc ionali y [5]. The majo i y o indi iduals unde s and he ansi ion om being ac i e in wo king li e o e i emen as he p ocess by which hey s a o become old [ 3 ], which gene a es eelings o uselessness, hus p edisposing hem o dep ession. Dep ession is one o he mos unde diagnosed diseases and, s ill in he 21 s cen u y, i is s ill being s igma ized o e en banalized, igno ing he esou ces, ea men s, and eco e y o his c uel disease [ 6 ]. Resea ch on he dep ession o e i ees is e y sca ce, and ew s udies di ec ly ela e dep ession wi h e i emen [ 7 ], despi e he g ea di e si y o published a icles on his disease [ 8 ]. Cu en ly, he publica ions on dep ession a e di ec ed o aluing di e en ea men s o de e mine i hey a e e ec i e such as, o example, he use o acupunc u e, music he apy, and he sea ch o he ideal an idep essan [9–11]. Al hough he cu en esea ch lines on he sea ch o e ec i e ea men s agains dep ession a e impo an , mo e s udies should be conduc ed on he di ec ela ion be ween e i emen and dep ession. I is also impo an o know he p e alence o dep ession and how heal h p o essionals, including nu ses, can collabo a e on a psychoeduca ional app oach o lowe he p e alence igu es. The ac is ha , bo h in heal h p e en ion and p omo ion, nu sing plays a e y p ominen ole o s op he p og ess o his disease [ 12 ]. Nu sing is e y impo an in ea ly de ec ion [ 7 ], apa om i s undamen al con ibu ion o he psychoeduca ional app oach [ 12 ]. These heal h p o essionals a e also in cha ge o main aining a close ela ionship wi h pa ien s and hei ela i es, so as o os e a good use o pha macological ea men s, inc easing adhe ence o hem [ 13 , 14 ] and hus p e en ing u u e elapses [7]. The e o e, he main aim o his pape is wo- old: (a) o analyze he p e alence o dep ession in e i ees; (b) o analyze he ole o he psychoeduca ional app oach o dep ession. 2. Me hodology 2.1. Da a Sou ces and Inclusion C i e ia A sys ema ic e iew wi h me a-analysis was conduc ed un il Ma ch 2020, ollowing he ecommenda ions o he P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-analyses (PRISMA) s a emen [ 15 ]. The ollowing scien i ic da abases we e consul ed: Medline, Scopus, CUIDEN, CINAHL, LILACS and PsycINFO. The inclusion c i e ia o he selec ion o s udies we e: o iginal s udies in English, Spanish and F ench; ime es ic ion o he las 10 yea s; a heme ela ed o e i emen and dep ession diagnosed by heal hca e p o essionals wi h he p e alence con i med by a alida ed scale, including all he modali ies o e i emen (an icipa ed, p e e i emen , due o disease, olun a y o manda o y) wi h no age limi in e i emen . The las 10 yea s we e ma ked o app ecia e he e ec o he global economic c isis in 2008. Many people had o ad ance hei e i emen age and i has been a pe iod o in e es a he social, heal h and economic le el. The exclusion c i e ia we e s udies no a ailable in ull ex , a manda o y e i emen whose cause was dep ession and a icles o low me hodological quali y, as well as e iews, clinical cases o expe opinions. 2.2. Sea ch S a egy The sea ch equa ion was elabo a ed by means o e ms (MeSH) used o iden i y he p ima y s udies: e i emen , dep ession, aged, nu sing and “heal h Pe sonnel”. Table 1shows he di e en sea ch equa ions conduc ed in each da abase, wi h he il e s used and he esul s ob ained in each o hem. Heal hca e 2020,8, 321 3 o 11 Table 1. Sea ch s a egies conduc ed in he di e en da abases. Da abases Sea ch S a egy Fil e s Resul s Medline ( e i emen OR pensions OR unemploymen ) AND (aged OR aging OR senescence OR elde ly) AND (dep ession OR “dep essi e symp oms” OR “emo ional dep ession” OR “dep essi e diso de ” OR “dep essi e synd ome” OR melancholia) AND (nu s* OR “heal h Pe sonnel”) (a) Time es ic ion: 10 yea s. (b) Languages: English, Spanish and F ench. 101 Scopus ( e i emen OR pensions OR unemploymen ) AND (aged OR aging OR senescence OR elde ly) AND (dep ession OR “dep essi e symp oms” OR “emo ional dep ession” OR “dep essi e diso de ” OR “dep essi e synd ome” OR melancholia) AND (nu s* OR “heal h Pe sonnel”) (a) Time es ic ion: 10 yea s. (b) Languages: English, Spanish and F ench 73 CUIDEN jubilación AND dep esión (a) Time es ic ion: 10 yea s. (b) Languages: English, Spanish and F ench 0 CINHAL ( e i emen OR pensions OR unemploymen ) AND (aged OR aging OR senescence OR elde ly) AND (dep ession OR “dep essi e symp oms” OR “emo ional dep ession” OR “dep essi e diso de ” OR “dep essi e synd ome” OR melancholia) AND (nu s* OR “heal h Pe sonnel”) (a) Time es ic ion: 10 yea s. (b) Languages: English, Spanish and F ench. 35 LILACS ( e i emen OR pensions OR unemploymen ) AND (aged OR aging OR senescence OR elde ly) AND (dep ession OR “dep essi e symp oms” OR “emo ional dep ession” OR “dep essi e diso de ” OR “dep essi e synd ome” OR melancholia) AND (nu s* OR “heal h Pe sonnel”) (a) Time es ic ion: 10 yea s. (b) Languages: English, Spanish and F ench. 43 PsycINFO ( e i emen OR pensions OR unemploymen ) AND (aged OR aging OR senescence OR elde ly) AND (dep ession OR “dep essi e symp oms” OR “emo ional dep ession” OR “dep essi e diso de ” OR “dep essi e synd ome” OR melancholia) AND (nu s* OR “heal h Pe sonnel”) (a) Time es ic ion: 10 yea s. (b) Languages: English, Spanish and F ench. 81 2.3. S udy Selec ion This manusc ip is egis e ed in PROSPERO wi h he ollowing e e ence code: CRD42020163979. A p eselec ion was conduc ed by pai s, whe e he esul s we e sc eened based on he inclusion c i e ia. Subsequen ly, he ull ex was ead and hen a c i ical eading was conduc ed o e alua e he alidi y o he s udy ollowing he ecommenda ions o Coope , Hedges and Valen ine [16]. Fo each selec ed s udy, a back-and- o h sea ch was pe o med o loca e mo e esea ch s udies ela ed o he heme o in e es . In case o a disag eemen be ween he wo eam membe s, a hi d esea che was consul ed, blinded o his pee s’ decision and who ollowed he same sea ch c i e ion p o ocol [ 17 ]. Finally, a c i ical eading was pe o med o he chosen a icles o e alua e possible biases in he me hodology [ 16 ]. Apa om ha , a sea ch was pe o med by an expe in he g ey li e a u e o iden i y po en ially alid a icles. Heal hca e 2020,8, 321 4 o 11 S a ing om an ini ial sea ch o 556 a icles, 179 we e selec ed a e elimina ing duplica es using he Mendeley ® bibliog aphical manage and applying he inclusion c i e ia. A e eading i les and abs ac s, 148 a icles we e dele ed, wi h a o al o 31 a icles emaining. A ull ex eading o hese 31 a icles was pe o med, a e which a se ies o a icles was dele ed acco ding o he inclusion c i e ia, as can be seen in Figu e 1, hus ob aining a inal sample o n=11. An analysis o he biases was ca ied ou using he STROBE, CONSORT and CASPE ools (Table S1). Fo he assessmen o he me hodological quali y o he obse a ional s udies, he STROBE s a emen was used. All s udies abo e 11 o he 22 i ems we e conside ed alid. CONSORT was used o he e alua ion o clinical ials. I was es ima ed as a cu sco e o 13/25. CASPE was used o quali a i e s udies oo. The selec ion p ocess was assessed by wo in es iga o s independen ly and in case o a disc epancy a hi d decided. A Kappa indic was ob ained om 0.91. Figu e 1. Flow diag am in he selec ion o a icles acco ding o P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-analyses (PRISMA). 2.4. Da a Coding A da a coding handbook was used. The ollowing a iables we e ex ac ed om each s udy: (a) name o he lead au ho ; (b) yea o publica ion; (c) language o he publica ion (English–Spanish–F ench); (d) coun y whe e he s udy was conduc ed; (e) ype o s udy design; ( ) o al o he sample o e i ees o indi iduals o e i emen age in each s udy; (g) dep ession scale used in he s udy; (h) p e alence o s udy pa icipan s su e ing om dep ession; (i) main esul s; (j) psychoeduca ional app oach. The p e alence a es o he numbe o e i ees su e ing om dep ession we e ob ained di ec ly om each s udy ( o al sample o he s udy and sample wi h he diagnosis). The in e - esea che eliabili y o he da a coding p ocess was e i ied by calcula ing he in aclass co ela ion coe icien . Heal hca e 2020,8, 321 5 o 11 2.5. Da a Analysis The da a analysis was pe o med by means o he S a sDi ec ® me a-analysis so wa e package (S a sDi ec L d., Camb idge, UK). Fi s a sensi i i y analysis was conduc ed o de e mine i excluding any o he included s udies p oduced signi ican changes o he esul s. Apa om ha , he publica ion bias was e alua ed by using Egge ’s eg ession es . The p e alence and he con idence in e als we e calcula ed by me a-analyzing andom e ec s. The he e ogenei y o he sample was de e mined by he I2index [18]. 3. Resul s 3.1. Cha ac e is ics o he S udy Sample A o al o 11 a icles we e inally selec ed, 18.1% (n=2) o which we e published in 2018, he same numbe in 2017, 2015, 2013, and 2009, and 9.1% (n=1) in 2012. The language o he publica ions was mos ly English, wi h 90.1% (n=10) o he sample in ha language, e sus one a icle published in Spanish (8.3%). The coun ies whe e he s udies we e published we e mainly he Uni ed S a es, wi h 27.2% o he sample (n=3), ollowed by G eece (n=2) and Aus alia (n=2), bo h wi h 18.1%, whe eas Singapo e, Spain, F ance and Canada we e ep esen ed by one wi h 9.1% (n=1) each. Rega ding he ype o design, c oss-sec ional desc ip i e coho s udies p edomina e wi h 45.4% o he sample (n=5), ollowed by coho s udies wi h 27.3% (n=3), non andomized clinical ials wi h 18.8% (n=2) and, inally, a mixed s udy (quali-quan i a i e) wi h 9.1%, as shown in Table S1. Table 2shows he desc ip i e da a o he sample o e i ees included in each o he s udies (gende dis ibu ion, mean age o e i emen , mean ime om e i emen and he diagnos ic o dep ession). Table 2. P e alence o dep ession in e i ees. Au ho s and Yea Gende Dis ibu ion Mean Age o Re i emen (Yea s) Mean Time om Re i emen (Yea s) Diagnos ic o Dep ession Cla k e al., 2018 [19] Female n=2 (4%) M=76.8 SD =7.42 R=64–88 ————- Scale =GDS Diagnosed by =Ge ia ician Hebe e al., 2018 [20] Female n=80 (100%) Ages 55 and olde ————- Scale =Ad-hoc Diagnosed by =—————– Ge ogianni e al., 2017 [21] Female n=152 (36.7%) M=63.54 R=54–72 M=1.5 Scale =BDI-II and HADS Diagnosed by =PCP Kyp aiou e al., 2017 [22] Female n=27 (5.4%) M=54.1 SD =7.4 M=6.1 SD =5.6 Scale =BDI-II Diagnosed by =PCP Culph e al., 2015 [23] Male n=12 (100%) M=67.4 R=52–77 ————- Scale =BDI-II Diagnosed by =PCP S ancli e e al., 2015 [24] Female n=16 (29%) M=55.6 SD =6.6 R=44–72 ————- Scale =GDS-G and Mini PASS-ADD Diagnosed by =PCP Zi in e al., 2013 [25] Female n=4195 (51.4%) M=63.8 SD =8.3 ————- Scale =CES-D Diagnosed by =—————— Oli e e al., 2013 [26] Male n=30 (100%) M=67.8 R=55-82 ————- Scale =BDI-II Diagnosed by =sel -iden i ied (n=10); o mally diagnosed by a physician (n=20) Pé ès e al., 2012 [27] Female n=401 (40%) M=75.1 SD =6.6 ————- Scale =CES-D Diagnosed by =Neu opsychologis In e iew Heal hca e 2020,8, 321 6 o 11 Table 2. Con . Au ho s and Yea Gende Dis ibu ion Mean Age o Re i emen (Yea s) Mean Time om Re i emen (Yea s) Diagnos ic o Dep ession Lizaso e al., 2009 [28] Female n=37 (31.9%) M=66.5 SD =5.60 n=99 (83.2%) be o e 65 n=20 (16.8%) a e 65 Scale =GADS Diagnosed by =Psychia is Schwingel e al., 2009 [29] Female n=1159 (66.1%) M=66.9 SD =7.8 ————- Scale =GDS Diagnosed by =Ge ia ician No e: BDI-II =Beck’s Dep ession In en o y, 2nd Edi ion; CES-D =Cen e o Epidemiological S udies-Dep ession scale; GADS =Goldbe g’s anxie y and dep ession scale; GDS =Yesa age’s Ge ia ic Dep ession Scale (abb e ia ed); GDS-G =Glasgow’s Dep ession Scale; HADS =Hospi al Anxie y and Dep ession Scale; M =mean age; Mini PASS-ADD =Mini Psychia ic Assessmen o Adul s wi h De elopmen al Disabili ies; n= o al sample o e i ees; PCP =P ima y Ca e Physician; R = ange o age; SD =s anda d de ia ion. 3.2. P e alence o Dep ession The scales and measu emen ins umen s o e alua e dep ession mos used and collec ed in he selec ed a icles we e mos ly he ollowing: “Beck’s Dep ession In en o y” (BDI-2) wi h 44.5% (n=5), he “Yesa age’s Ge ia ic Dep ession Scale” (GDS) in 18.2% o he sample (n=2), ollowed by he “Cen e o Epidemiological S udies-Dep ession” (CES-D) scale, he “Glasgow’s Dep ession” (GDS-G) scale, he “Hospi al Anxie y and Dep ession Scale” (HADS) scale, he “Quali y o Li e Index” (QLI), o he ”Mini Psychia ic Assessmen o Adul s wi h De elopmen al Disabili ies” (Mini PASS-ADD). Acco ding o he esul s ob ained in he s udies included in his sys ema ic e iew, i is concluded ha he e i ees wi h he highes p e alence o dep ession a e he ones who e i e in a manda o y ashion o due o illness [20,28,29]. Acco ding o he da a ound in his e iew, he es ima ed p e alence o dep ession in e i ees anges om 0.42 o 22.7%, di e en ia ing be ween manda o y and olun a y e i emen , as well as by he le el o dep ession su e ed: minimum (46.7–66.7%), sligh (10–40%), mode a e (17.1–24%) and se e e (3.8–16.7%). 3.3. Me a-Analysis o he P e alence o Dep ession in Re i ees The o al sample o e i ees collec ed in he sys ema ic e iew is n=3019, e en ually including a o al o n=360 e i ees in he me a-analysis, as wo a icles had o be disca ded om he me a-analysis o no con ibu ing da a on he p e alence o dep ession (n=9). The ollowing able shows he absolu e igu es o he p e alence o dep ession in he di e en samples o e i ees om he selec ed a icles (Table 3). The sample aken om he s udies is om he e i ed in gene al popula ion, which was analyzed by he men ioned scales. Table 3. P e alence o dep ession in e i ees. Au ho s and Yea n o al o Re i ees n o al o Re i ees wi h Dep ession Cla k e al., 2018 [19] 50 12 Hebe e al., 2018 [20] 80 10 Ge ogianni e al., 2017 [21] 414 122 Kyp aiou e al., 2017 [22] 502 135 Culph e al., 2015 [23] 12 11 S ancli e e al., 2015 [24] 58 4 Oli e e al., 2013 [26] 30 28 Lizaso e al., 2009 [28] 119 6 Schwingel e al., 2009 [29] 1754 32 When he sensi i i y analysis was pe o med, he es ima ed alue o he p e alence did no change in a s a is ically signi ican way when each o he s udies was emo ed om he analysis. An Egge ’s Heal hca e 2020,8, 321 7 o 11 analysis showed ha he e was no publica ion bias, wi h i s esul s showing no s a is ical signi icance (p=0.121). In he he e ogenei y analysis, he I 2 index was 98.7% (95% CI =98.4–98.9%), showing high he e ogenei y. Rega ding he p e alence alues ob ained in he me a-analysis, he p e alence o dep ession in e i ees was 28% (95% CI =13–46%), as can be seen in Figu e 2. Figu e 2. Fo es plo o he p e alence o dep ession in e i ees. 4. Discussion A e analyzing he 11 a icles included in his sys ema ic e iew, and answe ing o he wo- old objec i e o his pape ( o analyze he p e alence o dep ession in e i ees and he psychoeduca ional app oach o dep ession), he esul s e eal a 28% p e alence o dep ession in e i ees, which shows ha almos one- hi d o his collec i e popula ion ha e his condi ion. The sca ce numbe o esea ch s udies on he heme e eal e y dissimila pe cen ages [30,31] and i is di icul o compa e hem, as has al eady been seen in he e y a icles included in he me a-analysis [19–24,26,27]. E en so, me a-analyzing he collec ed da a on he p e alence o his disease gi es as a b oad iew o he magni ude o he p oblem and allows o he es ima ion o a pe cen age which un eils he eal impo ance o he phenomenon, so as o ace i wi h s a egies o p e en ion and ea ly de ec ion [18–20]. To his should be added ha he majo i y o he s udies included in his e iew (41.6%) use “Beck’s Dep ession In en o y”, whose es has a high eliabili y wi h a C onbach’s Alpha o 0.91 [32]. The bo om line is ha he esul s highligh he sani a y ole in he psychoeduca ional app oach wi h 41.6% (n=5), ollowed by p e en ion wi h 25% (n=3) and, inally, de ec ion and adhe ence o he ea men wi h 16.6% each (n=2). Some o he a icles included in his e iew p opose he ealiza ion by p ima y ca e nu sing p o essionals p og ams aimed a e alua ing and assis ing people who a e in his pe iod o hei li es [ 20 – 22 ], helping people o ind new ac i i ies ha mo i a e hem [ 29 ], encou aging hem o pa icipa e in communi y g oups [ 24 ], helping indi iduals o deal wi h he new si ua ion [ 22 ] and inding ac i i ies ha inc ease hei sel -es eem again [26]. Acco ding o he s udy ca ied ou by Hebe and collabo a o s [ 20 ], he in ol emen o he amily in his new s age is also impo an , wi h nu sing being in cha ge o gi ing hem he in o ma ion necessa y so ha hey a e able o de ec in ime he appea ance o symp oms o dep ession. A sec ion o e i ees hea ily a ec ed by dep ession, acco ding o he s udy ca ied ou by Lizaso and collabo a o s [ 28 ], a e hose who e i e due o illness, being a ield in which nu sing could ac in o de o educe he p e alence o dep ession ha we ind in hese people. Heal hca e 2020,8, 321 8 o 11 In many cases, he ansi ion pe iod owa ds e i emen is loaded wi h unce ain y among he popula ion, wi h e i ees being mo e suscep ible o de eloping men al heal h p oblems [ 20 ]. Fo his eason, some o he a icles included in his e iew sugges ha he heal h p o essionals mus implemen p og ams in ended o e alua e and help he people in his pe iod o hei li es [ 20 – 22 ], helping indi iduals in hei sea ch o new ac i i ies ha mo i a e hem [ 29 ], o encou age hem o pa icipa e in communi y g oups [ 24 ], o help hem build he necessa y will powe o ace he new si ua ion [23], and o ind ac i i ies ha imp o e hei sel -es eem [26]. The WHO de ends aging as a p ocess in which oppo uni ies a e s eamlined o ha e good heal h, social pa icipa ion and sel -con idence in o de o enjoy a good quali y o li e by means o campaigning o an ac i e aging p ocess [ 33 ]. This ac i e aging p ocess would include no only good physical and men al heal h, bu also social pa icipa ion, hus a oiding ea ing olde people as passi e beings and ull o needs [ 5 ]. Ac i e aging can be applied bo h indi idually and in g oups, as long as i po en ia es he physical, social, and men al well-being o he elde ly popula ion; o his eason, bo h in socie y and in he socio-sani a y policies, he impo ance i eally has by means o subsidies and p omo ion ini ia i es o his mo emen has o be assigned so ha he popula ion a e in o med. All o he abo e could help o educe he g ea numbe o dea hs p oduced a e exi ing he s age which socie y unde s ands as ac i e, namely he wo king li e [34]. Acco ding o a s udy conduc ed by Hebe and collabo a o s [ 20 ], he commi men o he amily membe s is also impo an in his new s age, he mul idisciplina y eam o heal h p o essionals being in cha ge o gi ing hem he necessa y in o ma ion so ha hey can p omp ly de ec he onse o he symp oms o dep ession. In he same line is a s udy by Wahyuni e al., whe e he ela ion be ween he elde ly’s social suppo and he incidence a e o dep ession is assessed. The au ho s conclude ha he g ea e he le el o social suppo , he lowe he incidence o dep ession will be. They s ess he impo ance o heal h wo ke s, especially nu ses, since among hei compe ences is p o iding heal h se ices, especially when hey ela e o p o iding social suppo and o he an icipa ed incidence o dep ession in he homes o he elde ly [35]. The in e change places o e i ees [ 23 , 26 ] a e also men ioned, spaces whe e he indi iduals can pe o m ac i i ies olun a ily, pa icipa e in opinion o ums wi h o he e i ees, suppo each o he and all supe ised and o ganized by well- ained pe sonnel [36]. A g oup o e i ees which is deeply a ec ed by dep ession a e hose who e i e due o illness [20,28,29] , his being a ield in which ac ions could be aken wi h he aim o educing he no iceable p e alence o dep ession in hese indi iduals. E en so, his s udy concludes ha he e is no di ec ela ionship be ween dep ession and e i emen , wi h he possibili y ha e i ing inc eases he le els o dep ession he pe son has al eady su e ed om, o ha dep ession is he eason o e i ing. In o de o elucida e his, u he esea ch is needed, using longi udinal s udies ha allow he es ablishing o causali y ela ions and e i y i aging is a mode a o a iable in he de elopmen o dep ession in e i ees, al hough he e al eady exis s udies wi h his ype o design ha ha e p o ed dep ession and e i emen a e di ec ly ela ed [25]. On he o he hand, he di e en a icles included in he e iew di e en ia e he p e alence o dep ession su e ed by he pa icipan s o each s udy depending on i i s le el is minimum, sligh , mode a e o se e e, o mode a e, sligh o high le els [ 19 , 21 – 23 , 26 ], he pe cen age being highe in he case o minimum dep ession, which coincides and suppo s he impo ance o p e en ion and ea ly de ec ion, a eas in which he heal h p o essional plays an essen ial ole [37]. Limi a ions Se e al limi a ions ha e occu ed, among which he ollowing a e wo h highligh ing: he sca ce numbe o a icles ound add essing he s udy heme and he ac ha such a icles a e conduc ed in a ious coun ies wi h di e en e i emen ages and socioeconomic di e ences ha may in luence he e i emen p ocess, such as he pensions ecei ed, he socio-sani a y sys em, e c. Ano he limi a ion is he ac ha pa o he sample has had a manda o y e i emen by any o he disease, which Heal hca e 2020,8, 321 9 o 11 may be a mode a ing a iable o conside . Apa om ha , he e a e ew esea ch s udies on his heme and he sca ce da a con ibu ed on he p e alence o dep ession in e i ees a e e y dissimila , hus inc easing he he e ogenei y o he esul s, as can be e i ied in he esul s o he me a-analysis pe o med in his s udy. Ano he in luencing ac o is he ac ha he majo i y o he s udies a e c oss-sec ional and desc ip i e, u he longi udinal esea ch s udies being necessa y so as o es ablish causali y and de e mine i aging is a mode a o a iable in he de elopmen o dep ession in e i ees. 5. Conclusions The high pe cen age o minimum dep ession is wo h highligh ing, wi h he ole o heal h p o essionals being e y impo an o p e en hese le els om ad ancing in o a deepe dep ession. Acco ding o he selec ed a icles in his e iew, he es ima ed o al p e alence o dep ession in e i ees is 29%. The e o e, and conside ing he numbe o e i ees wo ldwide, his implies ha one ou o h ee e i ees su e s om dep ession o , mo e op imis ically, one ou o ou ce ainly su e s om his disease. S ill, a g ea e diagnos ic eliabili y and app op ia e ools a e needed o alida e his p e alence da a, so ha we can unde s and how many e i ees mee he diagnos ic c i e ia o majo dep ession. Answe ing o he second objec i e based on he impo ance o he psychoeduca ional app oach o dep ession in e i ees, i is concluded ha he nu sing p o essionals ha e o be in o med o be able o de ec he signs and symp oms o dep ession, especially in p ima y ca e, he place whe e he highes le el o au onomy exis s and in which a good popula ion sc eening should be conduc ed in ela ion o his disease. The app oach o a opic as e sa ile as dep ession mus be done om a mul idisciplina y pe spec i e ha in eg a es all kinds o p o essionals such as physicians, nu ses, psychologis s, social wo ke s, occupa ional he apis s, e c. Supplemen a y Ma e ials: The ollowing a e a ailable online a h p://www.mdpi.com/2227-9032/8/3/321/s1, Table S1: A icles selec ed in he sys ema ic e iew. Au ho Con ibu ions: Concep ualiza ion, R.L.S.; me hodology, M.P.-C., L.R.-B. and R.L.S.; So wa e, J.L.G.-U.; alida ion, M.P.-C., L.R.-B., R.L.S., I.R.-G., N.S.-M. and J.L.G.-U.; o mal Analysis, M.P.-C., L.R.-B. and J.L.G.-U.; in es iga ion, M.P.-C., L.R.-B. and R.L.S.; esou ces, M.P.-C. and L.R.-B.; da a cu a ion, M.P.-C., L.R.-B., R.L.S., I.R.-G., N.S.-M. and J.L.G.-U.; w i ing—o iginal d a p epa a ion, L.R.-B. and R.L.S.; w i ing— e iew and edi ing, I.R.-G. and N.S.-M.; isualiza ion, M.P.-C., L.R.-B., R.L.S., I.R.-G., N.S.-M. and J.L.G.-U.; supe ision, M.P.-C., L.R.-B. and J.L.G.-U.; p ojec adminis a ion, M.P.-C. and L.R.-B. All au ho s ha e ead and ag eed o he published e sion o he manusc ip . Funding: This pape has no ecei ed any unding. Acknowledgmen s: To An onio Mo eno Gue í n o his ex e nal assessmen as an expe in Ge ia ics, and o Jos é Manuel Ma í nez Mon illa o his assessmen as an ex e nal agen o he me hodology de eloped o ca y ou he s udy. Con lic s o In e es : The au ho s decla e no con lic o in e es . Re e ences 1. Wo ld Heal h O ganiza ion. Dep ession. 2017. A ailable online: h ps://www.who.in / opics/dep ession/es/ (accessed on 30 Janua y 2020). 2. Wo ld Heal h O ganiza ion. 2020. A ailable online: h ps://www.who.in /es/news- oom/ ac -shee s/de ail/ dep ession (accessed on 30 Janua y 2020). 3. Ni a do, F.; Gainza, V. Re i emen a ings. Impo ance and ad an ages o he p epa a ion. Ge oin o 2009 , 4, 1–12. 4. Aguile a, M.Á.Heal h and Re i emen ; Uni e si y Edi o ial: Guadalaja a, México, 2010. 5. Zunzunegui, M.V.; B é land, F. C oss-sec o al policies o add ess he challenge o ac i e aging. Repo . SESPAS 2010. Gac. Sani . 2010,24, 68–73. [C ossRe ] [PubMed] 6. B ink, T.L. Dep ession in he aged: Dynamics and ea men . J. Na l. Med. Assoc. 1977 ,69, 891–893. [PubMed] 7. To es, H.M.L.; Sep ú l eda, Y.L.; Aguila , J.L.V.; P é ez, R.H. Psychosocial ac o s ha a ec he dep ession o he eldes adul . Medimay 2015,21, 65–74.