The Relationship Between Lifestyle and Depression in the Elderly: The Mediating Role of Loneliness

The issue of the promotion of health and a healthy lifestyle seems to be one of the most important ones in psychology, which shows the ever-increasing interest of researchers in this issue and the importance of a healthy lifestyle in different age groups. Therefore, this study aimed to investigate the relationship between lifestyle and depression with the mediating role of loneliness in the elderly. This was a correlational study of structural equations modeling (SEM) type. The statistical papulation included of elderly men and women living in the nursing and care centers for the elderly in Bojnord, Iran in 2022, among whom 200 elderly people were selected using convenience sampling method. The data were collected by Beck’s depression, healthy lifestyle in Iranian elderly people and social and adults’ emotional loneliness of questionnaire. Data were analyzed using SEM in SPSS-25 and Lisrel-8.8 software. The results revealed that the healthy lifestyle has a negative significant relationship with depression, and also the healthy lifestyle has a negative significant relationship with depression. Depression and loneliness had also a significant positive relationship (P<0.01). Besides, the fit indices of the model confirmed the path of healthy lifestyle and depression with the mediating role of loneliness. From a practical point of view, it can be said that teaching a healthy lifestyle to the elderly, including exercise, proper nutrition and close social contact, prevents loneliness and depression. It is necessary for researchers to conduct more research on healthy lifestyle in the elderly.
References
Abd-Alrazaq, A., Alajlani, M., Alhuwail, D., Toro, C. T., Giannicchi, A., Ahmed, A., khlouf, A., Househ., M & Househ, M. (2022). The Effectiveness and safety of serious games for improving cognitive
Abdoli, N., Salari, N., Darvishi, N., Jafarpour, S., Solaymani, M., Mohammadi, M., & Shohaimi, S. (2022). The Global prevalence of major depressive disorder (MDD) among the elderly: A Systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 132, 1067-1073. https://doi.org/10.1016/j.neubiorev.2021.10.041 [Persian]
abilities among elderly people with cognitive impairment: Systematic review and meta-analysis. Journal of medical internet reserch serious games, 10(1), e34592. http://doi.org/10.2196/34592 
Ammar, A., Bouaziz, B., Trabelsi, K., Glenn, J., Zmijewski, P., Müller, P., Chtrouou, H., Jmaeil, M., Driss, T., & Hökelmann, A. (2021). Applying digital technology to promote active and healthy confinement lifestyle during pandemics in the elderly. Biology of Sport, 38(3), 391-396. https://doi.org/10.5114/biolsport.2021.100149
Bhandari, P., & Paswan, B. (2021). Lifestyle behaviours and mental health outcomes of elderly: Modification of socio-economic and physical health effects. Ageing International, 46, 35-69. https://doi.org/10.1016/j.ijge.2015.04.004
Binnewies, J., Nawijn, L., van Tol, M. J., van der Wee, N. J., Veltman, D. J., & Penninx, B. W. (2021). Associations between depression, lifestyle and brain structure: A Longitudinal MRI study. Neuroimage, 231, 117834. https://doi.org/10.1016/j.neuroimage.2021.117834
Chen, X., Liu, Z., Yang, Y., Chen, G., Wan, Q., Qin, G., ... & Ning, G. (2022). depression status, lifestyle, and metabolic factors with subsequent risk for major cardiovascular events: The China cardiometabolic disease and cancer cohort (4C) Study. Frontiers in Cardiovascular Medicine, 9, 865063.‏ https://doi.org/10.3389 
Domènech-Abella, J., Mundó, J., Haro, J. M., & Rubio-Valera, M. (2019). Anxiety, depression, loneliness and social network in the elderly: Longitudinal associations from The Irish longitudinal study on ageing (TILDA). Journal of Affective Disorders, 246, 82–88. doi:10.1016/j.jad.2018.12.043
onoso, F., Cryan, J. F., Olavarría‐Ramírez, L., Nolan, Y. M., & Clarke, G. (2023). Lnflammation, lifestyle factors, and the microbiome‐gut‐brain axis: Relevance to depression and antidepressant action. Clinical Pharmacology & Therapeutics, 113(2), 246-259. https://doi.org/10.1002/cpt.2581
Hershey, M. S., Sanchez-Villegas, A., Sotos-Prieto, M., Fernandez-Montero, A., Pano, O., Lahortiga-Ramos, F., & Ruiz-Canela, M. (2022). The Mediterranean lifestyle and the risk of depression in middle-aged adults. The Journal of Nutrition, 152(1), 227-234.
Isik, K., Başoğul, C., & Yildirim, H. (2021). The relationship between perceived loneliness and depression in the Elderly and influencing factors. Perspectives in Psychiatric Care,57(1) http://doi.org/10.1111/ppc.12572 
Kahlon, M. K., Aksan, N., Aubrey, R., Clark, N., Cowley-Morillo, M., Jacobs, E. A., ... & Tomlinson, S. (2021). Effect of layperson-delivered, empathy-focused program of telephone calls on loneliness, depression, and anxiety among adults during the COVID-19 pandemic: A Randomized clinical trial. JAMA Psychiatry, 78(6), 616-622.‏ http://doi.org/10.1001/jamapsychiatry.2021.0113
Kang, M., Joo, M., Hong, H., & Kang, H. (2021). The Relationship of lifestyle risk factors and depression in Korean adults: A Moderating effect of overall nutritional adequacy. Nutrients, 13(8), 2626. https://doi.org/10.3390/nu13082626
Kim, A. S., Jang, M. H., Park, K. H., & Min, J. Y. (2020). Effects of self-efficacy, depression, and anger on health-promoting behaviors of Korean elderly women with hypertension. International Journal of Environmental Research and Public Health, 17(17), 6296. https://doi.org/10.3390/ijerph17176296
Kraav, S. L., Awoyemi, O., Junttila, N., Vornanen, R., Kauhanen, J., Toikko, T., Soili, M., Lehto, S., & Tolmunen, T. (2021). The Effects of loneliness and social isolation on all-cause, injury, cancer, and CVD mortality in a Cohort of middle-aged Finnish men. A Prospective study. Aging & Mental Health, 25(12), 2219-2228. https://doi.org/10.1080/13607863.2020.1830945
Kraav, S. L., Lehto, S. M., Junttila, N., Ruusunen, A., Kauhanen, J., Hantunen, S., & Tolmunen, T. (2021). Depression and loneliness may have a Direct connection without mediating factors. Nordic Journal of Psychiatry, 75(7), 553-557. https://doi.org/10.1080/08039488.2021.1894231
Lee, S. H., Lee, H., & Yu, S. (2022). Effectiveness of Social Support for Community-Dwelling Elderly with Depression: A Systematic review and meta-analysis. In Healthcare, 10(9), 1598. https://doi.org/10.3390/healthcare10091598
Loehlin, J. C. (2004). Latent variable models: An Introduction to factor, path, and structural equation analysis. London, England: Psychology Press.
Lotfaliany, M., Hoare, E., Jacka, F. N., Kowal, P., Berk, M., & Mohebbi, M. (2019). Variation in the prevalence of depression and patterns of association, sociodemographic and lifestyle factors in community-dwelling older adults in six low-and middle-income countries. Journal of Affective Disorders, 251, 218-226.‏ https://doi.org/10.1016/j.jad.2019.01.054
Mintzer, J., Donovan, K. A., Kindy, A. Z., Lock, S. L., Chura, L. R., & Barracca, N. (2019). Lifestyle Choices and Brain Health. Frontiers in Medicine, 6. http://doi.org/10.3389/fmed.2019.00204 
Mohammadi Mehr, M., Zamani-Alavijeh, F., Hasanzadeh, A., & Fasihi, T. (2019). Effect of healthy lifestyle educational programs on happiness and life satisfaction in the elderly: A Randomized controlled trial study. Iranian Journal of Ageing, 13(4), 440-451.http://doi.org/ 10.32598/SIJA.13.4.440  ‏[Persian]
Park, K. H., Yoo, E. Y., Kim, J., Hong, I., Lee, J. S., & Park, J. H. (2021). Applying Latent Profile Analysis to identify lifestyle profiles and their association with loneliness and quality of life among community-dwelling middle-and older-aged adults in South Korea. International Journal of Environmental Research and Public Health, 18(23), 12374. https://doi.org/10.3390/ijerph182312374
Sadeghi, A., Jafari, H., Rouhani, H., Eidy, F., Zhiani Fard, A., Davoodi, N. (2020). Relationship betweennutritional status andlate-life depression inEsfarayne, Iran. ElderlyHealth Journal;6(1), 24-30. https://doi.org/10.18502/ehj.v6i1.3412  [Persian]
Shirmohammadi Fard, S., Sanagoo, A., Behnampour, N., Roshandel, G., & Jouybari, L. (2020). Health promotion lifestyle in elderly in Gorgan, Northern Iran (2019). Journal of Gorgan University of Medical Sciences, 22(3), 121-128. http://goums.ac.ir/journal/article-1-3674-en.html [Persian]‏
Sivakumar, P. T., Mukku, S., Tiwari, S. C., Varghese, M., Gupta, S., & Rathi, L. (2022). Interface of Law and Psychiatric Problems in the Elderly. Indian Journal of Psychiatry, 64(Suppl 1), S163–S175. http://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_47_21
Solmi, M., Koyanagi, A., Thompson, T., Fornaro, M., Correll, C. U., & Veronese, N. (2020). Network analysis of the relationship between depressive symptoms, demographics, nutrition, quality of life and medical condition factors in the Osteoarthritis Initiative database cohort of elderly North-American adults with or at risk for osteoarthritis. Epidemiology and Psychiatric Sciences, 29, e14 http://doi.org/10.1017/S204579601800077X
Stefan-Dabson K, Mohammadkhani P, Massah-Choulabi O. )2007.( Psychometrics Characteristic of Beck Depression Inventory-II in Patients with Magor Depressive Disorder. Rehabilitation in Psychotic Disorders & Diseases, 8, 0-82. http://rehabilitationj.uswr.ac.ir/article-1-135-en.html
Wakefield, J. R. H., Bowe, M., Kellezi, B., Butcher, A., & Groeger, J. A. (2019). Longitudinal associations between family identification, loneliness, depression, and sleep quality. British Journal of Health Psychology. http://doi.org/10.1111/bjhp.12391
Wang, X., Arafa, A., Liu, K., Eshak, E. S., Hu, Y., & Dong, J. Y. (2021). Combined healthy lifestyle and depressive symptoms: A Meta-analysis of observational studies. Journal of Affective Disorders, 289, 144-150. https://doi.org/10.1016/j.jad.2021.04.030
Zakizadeh R, Bahreini M, Farhadi A, Bagherzadeh R. (2023). assessing the Mediating role of depression in the Relationship between feeling of loneliness and social functioning in the Elderly. Salmand Iranian Journal of Ageing, 17 (4) :580-595.http://doi.org/10.32598/sija.2022.3339.1  [Persian]
Zhao, Y., Zhang, Y., Teopiz, K. M., Lui, L. M., McIntyre, R. S., & Cao, B. (2023). presence of depression Is associated with functional impairment in middle-aged and elderly Chinese adults with vascular disease/diabetes mellitus—A Cross-sectional study. International Journal of Environmental Research and Public Health, 20(2), 1602. https://doi.org/10.3390/ijerph20021602