title: Relationship between depression and frailty in older adults: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Depression and frailty are prevalent and burdensome in older age. However, the relationships between these entities are unclear and no quantitative meta- analysis exists. We conducted a systematic review and meta-analysis to investigate the associations between depression and frailty.
  
  
  METHODS
  Two authors searched major electronic databases from inception until November-2016 for cross-sectional/longitudinal studies investigating depression and frailty. The strength of the reciprocal associations between frailty and depression was assessed through odds ratios (ORs) adjusted for potential confounders.
  
  
  RESULTS
  From 2306 non duplicated hits, 24 studies were included. The overall prevalence of depression in 8023 people with frailty was 38.60% (95% CI 30.07-47.10, I2=94%). Those with frailty were at increased odds of having depression (OR adjusted for publication bias 4.42, 95%CI 2.66-7.35, k=11), also after adjusting for potential confounders (OR=2.64; 95%CI: 1.59-4.37, I2=55%, k=4). The prevalence of frailty in 2167 people with depression was 40.40% (95%CI 27.00-55.30, I2=97%). People with depression were at increased odds of having frailty (OR=4.07, 95%CI 1.93-8.55, k=8). The pooled OR for incident frailty, adjusted for a median of 7 confounders, was 3.72 (95%CI 1.95-7.08, I2=98%, k=4), whilst in two studies frailty increased the risk of incident depression with an OR=1.90 (95%CI 1.55-2.32, I2=0%).
  
  
  CONCLUSIONS
  This meta-analysis points to a reciprocal interaction between depression and frailty in older adults. Specifically, each condition is associated with an increased prevalence and incidence of the other, and may be a risk factor for the development of the other. However, further prospective investigations are warranted.
authors.affiliation: Kayseri Education and Research Hospital, Geriatric Center, Kayseri, Turkey.
authors.forename: Pinar
authors.initials: P
authors.lastname: Soysal
authors.affiliation: National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy; Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Veronese
authors.affiliation: Faculty of Education and Health, University of Greenwich, London, United Kingdom.
authors.forename: Trevor
authors.initials: T
authors.lastname: Thompson
authors.affiliation: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
authors.forename: Kai G
authors.initials: KG
authors.lastname: Kahl
authors.affiliation: IMPACT Strategic Research Centre, Deakin University School of Medicine, and Barwon Health, Geelong, VIC, Australia; Laboratory of Calcium Binding Proteins in the Central Nervous System, Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Brisa S
authors.initials: BS
authors.lastname: Fernandes
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom.
authors.forename: A Matthew
authors.initials: AM
authors.lastname: Prina
authors.affiliation: Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy; Department of Neurosciences, University of Padova, Padova, Italy; Local Health Unit 17, Mental Health Department, Padova, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Solmi
authors.affiliation: Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom.
authors.forename: Patricia
authors.initials: P
authors.lastname: Schofield
authors.affiliation: Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain.
authors.forename: Ai
authors.initials: A
authors.lastname: Koyanagi
authors.affiliation: Department of Psychiatry, Tsyr- Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Taiwan.
authors.forename: Ping-Tao
authors.initials: PT
authors.lastname: Tseng
authors.affiliation: Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan; Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Pao-Yao
authors.initials: PY
authors.lastname: Lin
authors.affiliation: Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.
authors.forename: Che-Sheng
authors.initials: CS
authors.lastname: Chu
authors.affiliation: MRC Unit for Lifelong Health and Ageing at UCL, 33 Bedford Place, London WC1 B5JU, United Kingdom; Oxford Institute of Population Ageing, University of Oxford, 66 Banbury Road, Oxford, OX2 6PR, United Kingdom.
authors.forename: Theodore D
authors.initials: TD
authors.lastname: Cosco
authors.affiliation: Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France; Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
authors.forename: Matteo
authors.initials: M
authors.lastname: Cesari
authors.affiliation: Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
authors.forename: Andre F
authors.initials: AF
authors.lastname: Carvalho
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom; Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom. Electronic address: brendon.stubbs@kcl.ac.uk.
authors.forename: Brendon
authors.initials: B
authors.lastname: Stubbs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D016330:Frail Elderly / Q000523:psychology*; D000073496:Frailty / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D006801:Humans; D015994:Incidence; D015995:Prevalence; D012307:Risk Factors
keywords: Depression; Frail; Geriatrics; Meta-analysis; Older adults; Psychiatry