Prevalence and Predictors of Depressive Symptom Trajectories in Older Adults: A Systematic Review

Abstract

Purpose

To describe the distribution patterns and cross-study heterogeneity of depressive symptom trajectories in older adults and to identify consistent predictors of high-symptom trajectories for targeted intervention strategies.

Methods

Following PRISMA 2020 guidelines, six databases were searched from April 2010 to January 2026 for longitudinal studies using latent variable mixture models in adults aged ≥ 60 years. Study quality was assessed using the Newcastle–Ottawa Scale. Descriptive synthesis was employed due to methodological heterogeneity.

Results

Twenty-one studies (median N = 3428; 26 observations after accounting for within-study stratification by sex, poverty status, and country) met inclusion criteria. High-symptom trajectories were identified in 18 of 21 studies (0%–42.2%). Low-symptom trajectories predominated (12.4%–84.5%). Consistent risk factors included female sex, functional limitations, and multimorbidity. Higher educational attainment was the most consistent protective factor.

Conclusions

Older adults exhibit heterogeneous depressive symptom trajectories, with clinically significant high-symptom subgroups universally present but context-dependent. Modifiable predictors provide evidence for precision prevention strategies. Because estimates are descriptive and derived from heterogeneous instruments, they should be interpreted as heuristic indicative ranges rather than precise global benchmarks. Standardized assessment protocols are needed to enable quantitative synthesis.