1

The German International University

Department of English and Scientific Methods

The Effect of Social Isolation on

Depression

A literature Review submitted by:

Moustafa Amer (13001482)

Nour Samir (ID Number)

Mazen Maged (13005396)

Eslam Yasser (13005335)

RPW T.21

Supervised by: Dr. Omar Galal

April 2025
 2

Outline:

I. Introduction

1. Problem: Depression

2. Theoretical background: Depression affects older adults’ well-being, with 3.8% in

China suffering due to age-related factors (Li et al., (2024)). Social isolation,
common in urban elderly, affects 62.8% in India and is linked to living status and
family ties (Sayed et al., (2023); Kilic et al., (2023)). Purpose and research question:
Social Isolation's impact on Depression?

3. Definitions of Variables: Social Isolation, Depression.

II. Methodology

1. Keywords that guided the research: Social Isolation, Depression.

2. Years covered: 2014-2024.

3. Sources used: Ebsco Host.

4. Inclusion and exclusion.

III. Results:

1. Grouping of Articles:

The studies are grouped based on sample size. Studies with more than 1000 participants are
placed in one group, while those with less than 1000 participants are in another.

2. Study with more than 1000 participants Li, L., Pan, K., Li, J., Jiang, M., Gao, Y., Yang, H.,
& Bian, G. (2024).
-To examine the relationship between social isolation, depression, and anxiety
among adults aged 65+ in Ningbo, China.

-6,664 community-dwelling older adults aged 65 and above.

-
• Social Isolation was measured through living arrangements, frequency of
social contact, and participation in social activities.
• Depression was assessed with the Patient Health Questionnaire (PHQ-9).
• Anxiety was assessed with the Generalized Anxiety Disorder scale (GAD-
 3

7).

-
• 12.67% of participants were socially isolated.
• Social isolation significantly increased the odds of depression (AOR =
1.77) and anxiety (AOR = 1.66).
• The Population Attributable Risk (PAR) showed that 10.66% of depression
could be attributed to social isolation.
 4

3. Study with less than 1000 participants: Nikmat, A. W., Hashim, N. A., Omar, S. A., &
Razali, S. (2015).
a) Purpose & Questions/hypothesis.
To determine the prevalence of loneliness/social isolation and depression among
cognitively impaired older adults in nursing homes.

b) Sample.
110 older adults aged 60-89 living in four government nursing homes in Malaysia.

c) Instruments and procedures.

• Cognitive Impairment: Short Mini Mental State Examination (SMMSE).

• Social Isolation: Friendship Scale (FS).

• Depression: Geriatric Depression Scale (GDS).

d) Results.

• 85.5% of participants had depression.

• 95.5% were socially isolated.

• Depression was significantly associated with social isolation, poor health, and
low education levels.

e) Practical implications.

• Nursing homes should implement mental health screenings and regular social
activities to reduce isolation.

• Staff should be trained to recognize signs of depression and isolation in residents

with cognitive impairment.

• Policies should encourage family involvement and tailored care programs to

improve emotional well-being in institutional settings.
 5

I. Introduction:

Depression is a common mental health disorder characterized by persistent sadness,

lack of interest, and reduced energy, affecting an individual's emotional and physical well-
being. It is especially prevalent among older adults, contributing significantly to disease
burden worldwide (Li et al., 2024)). In China, 3.8% of adults aged 65 and older suffer from
depression, with factors like biological vulnerability, chronic illness, and functional
disability increasing the risk (Li et al., 2024). Social isolation, on the other hand, refers to
limited social interaction and participation, often marked by living alone or having
infrequent contact with others (Sayed et al., 2023). Among elderly populations, particularly
in urban settings, social isolation has become a rising concern, with studies showing that
there is a relation between social isolation and depression. However, information on social
networks of the elderly population is scarce (Sayed et al., 2023).
This study aims to explore the influence of social isolation on depression among
older adults. The central research question is: How does social isolation influence the
prevalence and severity of depression in older adults?

In the reviewed studies, depression and social isolation were measured using
different validated scales. In the study by (Li et al. (2024)), depression was assessed using
the Patient Health Questionnaire (PHQ-9), where a score of 10 or higher indicated
moderate to severe depression. Social isolation was measured through living arrangements,
frequency of social contact, and participation in activities, with a score of 2 or more
indicating isolation. (Nikmat et al. (2015)) measured depression in older adults using the
Geriatric Depression Scale (GDS), with higher scores indicating greater depressive
symptoms, while social isolation was assessed using the Friendship Scale, where lower
scores reflected higher isolation. (In Sayed et al. (2023)), depression was measured with
the GDS-15, and social isolation was determined using the Lubben Social Network Scale,
where scores below 12 indicated social isolation.
 6

Methodology
This literature review aims to explore and understand the relationship between
social isolation and depression in older adults by analyzing studies published between
(2014-2024). A thorough and inclusive search was done on EBSCO Host using keywords
like "social isolation", "depression " and "loneliness". The search only included peer-
reviewed articles and the studies were all cross sectional and descriptive. After reviewing
253 articles based on title and abstract, there were only 16 relevant studies. Five studies
were not included as they were secondary sources or they were irrelevant, this resulted in
the selection of 11 primary research articles, with sample sizes ranging from fewer than
100 to over 1000 participants. The studies included were from multiple different regions,
including India, China and Malaysia, to keep in account the cultural differences that could
affect social isolation and depression. The studies assessed social isolation using scales
such as the Lubben Social Network Scale and Friendship Scale, while depression was
measured using the Geriatric Depression Scale and PHQ-9. Social isolation was defined by
multiple different factors like where people live, how much they socialize and their
engagement in activities. Depression was measured using scores where higher scores
meant more severe depression. The studies used both qualitative and quantitative methods,
using statistics and regression to determine the relationship between the variables. All
studies were ethically approved and had the participants consent. This review synthesizes
the findings to provide insights into how social isolation and depression affect each other
in older adults and identifies the most important factors that influence this relationship in
different cultures.
 7

Results:

All four articles included in this literature review can be grouped into two groups according to
the sample size. The first group contains the studies with small sample size (less than 1000
participants). This group includes three studies (Kilic et al., 2023; Nikmat et al., 2015; Sayed et
al., 2023). The second group contains studies with large sample size (more than 1000
participants). This group includes only one study (Li et al., 2024).

The first article in the first group Kilic et al., (2023) aimed to examine the relationship between
fear of COVID-19, social isolation, and depression among elderly individuals during the
pandemic. The inferred research question is; what is the effect of social isolation on depression
in older adults? The research sample consisted of 362 elderly individuals aged 65 and above,
registered with family health centers in Turkey. The average age of the participants was 73.70 +
9.17; 53% were female. The inferred criteria of sample selection is convenient. Instruments
included in this study are the Fear of COVID-19 Scale to measure the fear of Covid-19, The
NHP Social Isolation sub-scale to measure social isolation. The scale is rated on a five-point
Likert scale and includes five questions. The items are ranked as ‘1 = I strongly disagree, 5 = I
strongly agree’, with increased scores indicating increased social isolation levels, and the
Geriatric Depression Scale-Short Form to measure depression. The participants respond to the
questions considering their emotions within the past 1 week. The responses are given as ‘yes’ or
‘no’, and depending on the question, the answers are scored as one point. The scale has five
positive items (1, 5, 7, 11, 13) and 10 negative items (2–4, 6, 8–10, 12, 14, 15). One point is
given when positive questions are responded as no and negative questions are responded as yes.
A total score of eight and over is considered significant for a depression diagnosis. The type of
procedure is cross-sectional. Data were collected after consent was received from elderly
individuals who agreed to participate in the study. The questionnaires prepared in the online
environment were administered to the participants on the phone and filled in according to their
responses. Data were collected after consent was received from elderly individuals who agreed to
participate in the study. The questionnaires prepared in the online environment were
administered to the participants on the phone and filled in according to their responses.
participate in the study?’, to which they marked as ‘yes’ or ‘no’. The participants whose consent
 8

was received online and who indicated to have agreed to participate in the study were
administered the questionnaire and scale items prepared in an online environment. Necessary
permissions were obtained from the authors of the scales used as data collection tools. The
results revealed A positive and medium-level relationship was found between the fear of
COVID-19 and social isolation and a positive and high-level relationship between social
isolation and depression. the results are statistically significant (P < 0.01). The practical
implications highlight the importance of addressing mental health during health crises,
recommending virtual social support systems and targeted interventions to reduce fear and
prevent depression in elderly populations.

The second study in the first group (Nikmat etal., 2015) aimed to determine the prevalence of
social isolation and depression among older adults with cognitive impairment in nursing homes.
The inferred research question is; what is the effect of social isolation on depression in older
adult with cognitive impairment in institutional care settings? The research sample included 110
elderly individuals, aged 60 to 89, with cognitive impairment residing in government nursing
homes. Of nine governments’ nursing homes in West Malaysia. The inferred criteria of sample
selection is convenient. The instruments used were the Short Mini Mental State Examination
(SMMSE) to assess cognitive impairment. The Friendship Scale (FS) to measure social isolation.
It consists of 6-items with three of the items covering the feelings of loneliness and the other
three items probing the importance of actual social contacts. Responses are categorized into 5
levels of perceived social isolation (Almost always/Most of the time/About half the
time/Occasionally/Not at all). A total score is derived from the summation of item responses
(items 1, 3 and 6 are reversed prior to scoring). A score of ‘0’ indicates complete social isolation
and a score of ‘24’ indicates high social connectedness. The Geriatric Depression Scale (GDS) to
evaluate depression. contains 15 items (GDS- 15). These items seek information representing
lowered affect, decreased activity levels, irritability, withdrawal, distressing thoughts, and
negative judgments about the past, present and future. It is presented in a yes/no response format
with one point is assigned to each answer. Items were summed and higher scores indicate higher
depression level. The procedure type is cross sectional. Prior to the study, ethical approval was
sought and granted from the Human Research Ethics Committee of The University of
 9

Melbourne, Victoria, Australia, the Malaysia Research Ethics Committee and the National
Institute of Health, Malaysia. As participants in this study were classified as a vulnerable group
in research, such ethics approval was gained conforming to the Helsinki Declaration, particularly
with regard to informed consent. The results showed that 85.5% of the participants were
diagnosed with depression, while 95.5% were socially isolated, with a strong association
between isolation and depression. Loneliness/social isolation was strongly associated to
depression and relationship satisfaction with children. The practical implications of this study
suggest that nursing homes should introduce regular mental health assessments and social
engagement activities to reduce isolation and improve emotional well-being in cognitively
impaired residents.

The third study in the first group (Sayed etal., 2023) aimed to investigate the prevalence and
predictors of social isolation and depression among elderly individuals in an urban Indian
community. The inferred research question is; what is the effect of social isolation on depression
in older adult? The sample consists of 961 in the urban health training center area, India
Selection of the elderly population was done using a systematic random sampling method. The
Majority of 165 (91.7%) were in the age group of 60– 74 years, followed by 13 (7.2%) in the age
group of 75– 84 years and 2 (1.1%) in the age group of 85 years and above. The mean age of the
subject was 65.87 ± 5.859 years. Among the elderly, majority were female 119 (66.1%).
Instruments included the Lubben Social Network Scale (LSNS-6) for social isolation which
includes 6 items. The Geriatric Depression Scale (GDS-15) is used to measure depression and it
includes 15 items. The procedure type is cross-sectional. The community‑based cross‑sectional
study was conducted through house‑to‑house survey. The written informed consent was obtained
after giving details about the study in the local language. Data were collected from May to June
2023 after obtaining clearance from the institutional ethics committee. Case report form was
filled by taking face‑to‑face interview method by the principal investigator. The results indicated
that 62.8% of participants were socially isolated and 43.9% suffered from depression. Social
isolation was more common among individuals living alone and those with lower education
levels. social isolation is associated with depression and is statistically significant (P = 0.001).
The practical implications highlight the need for community-level interventions such as social
programs and targeted mental health services to address isolation and prevent depression in
urban elderly populations.
 10

After reviewing the studies with smaller sample sizes, the following section will focus on the
larger-sample size.

The only study in the second group (Li etal., 2024) aimed to examine the relationship between
social isolation, depression, and anxiety among older adults living in community settings in
Ningbo, China. The inferred research question is; what is the effect of social isolation on
depression and anxiety in elderly individuals? The research sample included 6,664 community-
dwelling adults aged 65 and older who are randomly selected from Ningbo, which is situated in
the Yangtze River Delta region of China. Depression and anxiety were assessed using a validated
9-item Patient Health Questionnaire (PHQ-9) and a 7-item validated Generalized Anxiety
Disorder (GAD-7) scale; these measures were based on the participants’ experiences over the
previous 2 weeks, and each item was rated on a 4-point scale: “not at all” = 0, “several days” = 1,
“more than half of the days” = 2, and “nearly every day” = 3. The total scores of the PHQ-9 and
GAD-7 ranged from 0 to 27 and from 0 to 21, respectively. Social isolation was assessed using
three questions that addressed whether the participant lived alone (yes = 1, no = 0), had social
contact (contacted less than once per month = 1, other = 0), and participated in social activities
(participated less than once per week = 1, other = 0); these questions have been described
elsewhere. Then the scores of the responses are summed to these questions, and a score of 2 or 3
was considered to indicate social isolation. The procedure is cross-sectional. All of the
questionnaires were completed by the participants during face-to-face sessions with community
workers. For participants who could not complete the paper questionnaire without assistance, the
community workers verbally read the questions and completed the questionnaires according to
the participants’ answers. Ethical approval for this study was obtained from the Ethics
Committee of Ningbo Kangning Hospital, and written informed consent was obtained from all
participants. The results showed that 12.67% of participants were socially isolated, and socially
isolated individuals were 1.77 times more likely to experience depression (p < 0.001) which is
statistically significant. Additionally, 10.66% of depression cases could be attributed to social
isolation, with a stronger effect observed among women (p < 0.05). The practical implications
suggest that reducing social isolation through policy initiatives and community programs could
significantly decrease depression rates, especially in elderly women.
 11

References

Kilic, D., Aslan, G., Ata, G., & Bakan, A. B. S. (2023). Relationship between the fear of
COVID‐19 and social isolation and depression in elderly individuals. Psychogeriatrics,
23(2), 222–229. [Link]

Li, L., Pan, K., Li, J., Jiang, M., Gao, Y., Yang, H., & Bian, G. (2024). The associations of social
isolation with depression and anxiety among adults aged 65 years and older in Ningbo,
China. Scientific Reports, 14(1), 19072. [Link]

Nikmat, A. W., Hashim, N. A., Omar, S. A., & Razali, S. (2015). Depression and
loneliness/social isolation among patients with cognitive impairment in nursing home.
ASEAN Journal of Psychiatry, 16(2), 1–10.

Sayed, N. N., Salunke, N. M., Parande, M. A., Tambe, M. P., Bugade, V. D., & Borle, P. S.
(2023). Social isolation and depression and its predictors among elderly of the urban field
practice area of a medical college: A community-based cross-sectional study. Journal of
the Indian Academy of Geriatrics, 19(4), 232–238.