Effect of Social Support on Psychological Well-Being Among Older Adults in Low- and Middle-Income Countries of the Asian Region: A Systematic Review

Abstract

Objective

To summarize and compare the literature on social support and its effect on psychological well-being among older adults in low- and middle-income countries of the Asian region.

Design

A Systematic review. The review was registered in the International Prospective Register of Systematic Reviews with identification number XXXXXXXXXX.

Data Sources

Retrieved data from PubMed, CINAHL (EBSCO), PsycINFO, Scopus, and Cochrane Centre Register of Controlled Trials databases. The literature review was conducted from 2018 to 2024.

Review Methods

The review complies with the Joanna Briggs Institute methodology and follows the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.

Results

Initially, 4,615 records were identified using the predefined search strategy. Out of 95 articles selected for full-text screening, 27 met the inclusion criteria. This review identified family and friends as the primary source of social support, enhancing their overall well-being. The higher levels of social support, whether emotional, informational, companionship, or tangible, improve older adults’ psychological well-being and quality of life, including reduced depression, anxiety, and loneliness.

Conclusions

The emotional and mental health of older adults can be diminished significantly due to the lack of adequate social support, leading to a cascade of adverse outcomes. This challenge is especially prevalent in low- and middle-income countries (LMICs), where older adults often struggle to access formal healthcare, social services, and a structured community support system. Promoting robust social networks is crucial for older adults’ well-being and sustainable aging strategies in low-resource settings.

Keywords

Asia low- and middle-income countries older adults psychological well-being social support

Introduction

The aging population is a global concern as increased life expectancies lead to a rapidly growing older demographic. Worldwide, there were 703 million aging population aged 65 years and over in 2019. By 2050, the world's population aged 60 years and over is estimated to double to 1.5 million (United Nations, 2019). Initially, population aging was most evident in high-income countries, more recently, the most significant shifts have been in low and middle-income countries (LMICs). Two-thirds of the world's population over 60 years will be living in LMICs by 2050 (World Health Organization [WHO], 2024). In LMICs, the increasing aging population presents challenges such as insufficient social security, poor healthcare access, and negative stereotypes (Rawal, 2022). With this rapid growth of the older population, promoting health and well-being is essential for aging.

In the last decades, aging well has been conceptualized using different contemporary frameworks like healthy aging, productive aging, positive aging, successful aging, active aging, or competent aging (Belachew et al., 2024; Buys & Miller, 2012; Foster & Walker, 2015). The WHO (2020) defines healthy aging as “the process of developing and maintaining the functional capacity of older adults that enables well-being in older age.” The transformation of social structures, changes in household composition, and living arrangements focus on the importance of social support and social networks (Zanjari et al., 2022). Social support is the care, dedication, concern, and aid offered in relationships along with individuals’ perceptions and beliefs about the assistance they experience during social interactions (Zhang et al., 2022). It serves as an external support system through emotional, substantive, and informative support (Liu et al., 2022), reducing the impact of life stress and social isolation, promoting positive emotional experiences, positive coping mechanisms, and enhancing quality of life (Harandi et al., 2017; Liu et al., 2022; Roohafza et al., 2014).

Old age is one of the most crucial stages of human life as many older adults are unable to live independently, requiring comprehensive and constant care that results in limited social interactions, amplifies families’ obligations, and causes high expenditures (Kinsella & Phillips, 2005). Social support becomes vital for older adults, as they face increased risks of chronic illnesses, physical limitations, loss of income, loss of loved ones, or emotional disturbances such as anxiety and depression (Hatfield et al., 2013; Nemeroff et al., 2010). Previous studies have shown that increased levels of social support enhance the quality of life, improving both the physical and mental health (Kong et al., 2021) and life satisfaction (Dumitrache et al., 2018) of older adults.

Earlier studies examining the relationship between social support and mental health were mostly confined to Western communities with little focus on non-Western settings until recent years (Tajvar et al., 2013). Cultural, societal, and environmental distinctions make it challenging to apply research findings from Western countries to other parts of the world. In Asian countries, the absence of social and family support may lead to more severe mental health consequences compared to Western societies, where autonomy is highly prioritized than interdependence (Eyetsemitan, 2002; Lim & Kua, 2011). Consequently, a comprehensive review is needed to summarize evidence on the association between social support, exploring how and in what context it influences the psychological well-being of older adults. Therefore, this study aims to systematically review existing studies on psychological well-being in older adults in LMICs of Asia and reviewing available evidence to explore which type of social support, such as emotional, informational, substantial, financial support, and social participation, is most effective.

Aims

The aim of this systematic review was to describe the different types of social support and psychological well-being among older adults, and to explain how social support helps in improving psychological health as well as the quality of life of older adults.

Methods

This systematic review was prepared in accordance with the Joanna Briggs Institute's guidelines and has been reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Moher et al., 2015). The review protocol was registered and made available in the International Prospective Register for Systematic Review (PROSPERO) with the registration number XXXXXXXXXX. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Analytical Cross-Sectional Studies (JBI, 2020) was used to assess the methodological quality of the articles.

Search Strategy

The search strategy was developed with the help of an information specialist, focusing on the primary keywords aged, “social support,” “psychological well-being,” and low- and middle-income countries of the Asian region (Table 1). References in the studies that met inclusion criteria were manually reviewed and underwent the same screening and selection process.

Table 1.

Search Strategy.

Older People		Social Support		Psychological Well-Being		Low- and Middle-Income Countries of Asia Region
OR		OR		OR		Low- and Middle-Income Countries of Asia Region
Aged	AND	“Social support*”	AND	"Psychological well-being"	AND	Angola OR Algeria OR Bangladesh OR Benin OR Bhutan OR Bolivia OR “Cabo Verde” OR Cambodia OR Cameroon OR Comoros OR Congo OR “Republic of the Congo” OR “Cote d ´Ivoire” OR Djibouti OR Egypt OR “Arab Republic of Egypt” OR “EI Salvador” OR Eswatini OR Ghana OR Haiti OR Honduras OR India OR Indonesia OR Iran OR “Islamic Republic of Iran” OR Kenya OR Kiribati OR “Kyrgyz Republic” OR Kyrgyzstan OR “Lao PDR” OR Lebanon OR Lesotho OR Mauritania OR Micronesia OR “Federated States of Micronesia” OR Mongolia OR Morocco OR Myanmar OR Nepal OR Nicaragua OR Nigeria OR Pakistan OR “Papua New Guinea” OR Philippines OR Samoa OR “São Tomé and Principe” OR Senegal OR “Solomon Islands” OR “Sri Lanka” OR Tanzania OR Tajikistan OR “Timor-Leste” OR Tunisia OR Ukraine OR Uzbekistan OR Vanuatu OR Vietnam OR “West Bank and Gaza” OR Zimbabwe
Elder*		“Family support*”		"Psychological well-being"
Elder*		“Family support*”		"Mental health"
“Older people”		“Social network*		"Mental health"
“Older people”		“Social network*		"Quality of life"
“Older adult”		“Social relationship*		"Quality of life"
“Older adult”
“Senior citizen”
“Senior citizen”		“Social inclusion*”
“Late life”		“Social inclusion*”
“Late life”
Geriatric*
“Aging population”

Inclusion/Exclusion Criteria

Original peer-reviewed research articles published in English were included if they met the following inclusion criteria: (a) Cross-sectional studies conducted in LMICs of Asian region (Hamadeh et al., 2022) and included participants aged 60 and above; (b) Social support as an intervention in the form of emotional support (empathy, concern, love, trust, acceptance, intimacy, encouragement, or caring), informational support (advice, guidance, suggestions, or useful information), companionship (participation and engagement in social activities), and tangible support (financial assistance, material goods and assistance during daily activities); and (c) Reported on psychological factors like stress, anxiety, depression, loneliness, self-esteem, quality of life, life satisfaction, and mental health status. All other methods besides cross-sectional studies were excluded. In addition, discussion papers, case studies, letters to the editors, non-scientific research articles, and review articles were not included.

Selection Process

The study selection process followed the PRISMA guidelines. A comprehensive literature search was done across five databases, including PubMed, Scopus, CIHAHL, PsycINFO, and Cochrane Central Register of Controlled Trials), covering publications from 2018 to 2024. All the records were imported into Zotero reference management software. A total of 4,615 studies were retrieved and organized by using Covidence software. Two reviewers independently searched the literature from databases, screened the title and abstracts, then read the full texts of relevant studies for eligibility and made an overall judgment of quality. Any discrepancies between the reviewers were resolved through discussion until a consensus was reached. Cohen's kappa coefficient for full-text screening was calculated, that is (k = 0.85), which indicated substantial agreement between the two raters. Figure 1 illustrates the study selection process, including the number of records identified, screened, assessed for eligibility, and included in the final review.

Figure 1.

Flow chart of the study selection process.

Quality Assessment

Table 2 outlines the assessment of the risk of bias within the studies included. The articles were assessed for methodological quality by two researchers using the JBI’s Critical Appraisal Checklist for Analytical Cross-Sectional Studies. The authors had a consensus and decided to exclude the articles that scored less than 50% because of a low methodological quality score. Based on this evaluation, all the studies met the methodological quality, with total scores ranging from 5 to 7, and no articles were excluded.

Table 2.

Quality Assessment of Studies Based on the Joanna Briggs Institute (JBI) Critical Appraisal Checklist.

SN	Study	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	JBI Points/Quality Score (out of 8)
1	Abbasi et al.	Y	Y	Y	Y	UC	Y	Y	Y	7
2	Acharya Samadarshi et al.	Y	Y	Y	Y	N	N	Y	Y	6
3	Giang et al.	UC	Y	Y	Y	N	N	Y	Y	5
4	Ilyas et al.	Y	Y	Y	Y	N	N	Y	Y	6
5	Kousha et al.	Y	Y	Y	Y	N	N	Y	Y	6
6	Manandhar et al.	Y	Y	Y	Y	N	N	Y	Y	6
7	Moghadam et al.	Y	Y	Y	Y	N	N	Y	Y	6
8	Narendran et al.	Y	Y	Y	Y	N	N	Y	Y	6
9	Nazari et al.	Y	Y	Y	Y	N	N	Y	Y	6
10	Nguyen et al.	Y	Y	Y	Y	UC	Y	Y	Y	7
11	Pourtaghi et al.	Y	Y	Y	Y	N	N	Y	Y	6
12	Rajapakshe et al.	Y	Y	Y	Y	N	N	Y	Y	6
13	Risal et al.	Y	Y	Y	Y	N	N	Y	Y	6
14	Saber et al.	Y	Y	Y	Y	N	N	Y	Y	6
15	Seddigh et al.	Y	Y	Y	Y	N	N	Y	Y	6
16	Shah et al.	Y	Y	Y	Y	N	N	Y	Y	6
17	Simkhada et al.	Y	Y	Y	Y	N	N	Y	Y	6
18	Susanty et al.	Y	Y	Y	Y	N	N	Y	Y	6
19	Tajvar et al.	Y	Y	Y	Y	N	N	Y	Y	6
20	Tanveer and Batool	Y	Y	Y	Y	N	N	Y	UC	5
21	Tariq et al.	Y	Y	Y	Y	N	N	Y	Y	6
22	Taufik et al.	Y	Y	Y	Y	N	N	Y	Y	6
23	Thapa et al.	Y	Y	Y	Y	N	N	Y	Y	6
24	Wickramasinghe et al.	Y	Y	Y	Y	N	N	Y	Y	6
25	Zakizadeh et al.	Y	Y	Y	Y	N	N	Y	Y	6
26	Zanjari et al.	Y	Y	Y	Y	UC	UC	Y	Y	6
27	Zeinalhajlou et al.	Y	Y	Y	Y	N	N	Y	Y	6

Note: Y = yes (indicates that the criterion was met and score 1 was assigned).

N/UC = no/unclear (indicates that the criterion was not met or not clear and score 0 was assigned).

Data Extraction and Synthesis

Narrative synthesis was adopted to analyze the full text of the articles. The analysis was conducted following the framework outlined by Rodgers et al. (2009), which consists of four key steps. First, a theoretical understanding of the relationship between social support and psychological well-being was developed through multiple readings of the selected articles. Next, a preliminary synthesis was conducted by systematically extracting key information such as study characteristics, sampling methods, sample size, measurement tools, data collection, and analysis methods using a predefined extraction form (Table 3). Then, the extracted contents (prevalence rates, psychological health outcomes, quality of life, and different dimensions of social support) were coded, categorized, and grouped into broader thematic headings. Finally, the main results were synthesized into a narrative format that interprets patterns and highlights notable insights and differences (Table 4).

Table 3.

The Sociodemographic Characteristics of the Included Studies.

Author, Country	Study Participants	Sampling, Sample Size (n)	Social Support Measures	Outcome Measures	Mean Age (Years)
Abbasi et al., Iran	Community-dwelling Both men and women	Stratified random 400	Medical Outcome Study Social Support Scale	The Symptoms Checklist-90-Revised	67.39
Acharya Samadarshi et al., Nepal	Community-dwelling Both men and women	Multistage cluster random 671	Social support was assessed with 5-item questionnaire	Geriatric Depression Scale-15 WHO Quality of Life -OLD	68.6
Giang et al., Vietnam	Representative data from Vietnam Ageing Survey Both men and women	Probability proportional to size 2538	Structural and functional support was assessed by self-developed questionnaire	Self-rated health status was investigated with a 5-point-scale response	NR
Ilyas et al., Pakistan	Community-dwelling Both men and women	Purposive sampling 410	MSPSS	Perceived stress scale Rosenberg self-esteem scale Ryff's Psychological Well-Being scale	NR
Kousha et al., Iran	Community-dwelling older adultswho were registered as lonely persons in health records in Health Center of Gorgan city. Both men and women	Census Sampling 213	Lubben Support Network Scale -6 MSPSS	University of California in Los Angeles loneliness scale (20-item version) 17-item Self-care Ability Scale for the Elderly 12-item General Health Questionnaire CASP-19 (Control, Autonomy, Self-realization, and Pleasure)	68.2
Manandhar et al., Nepal	Community-dwelling Both men and women	Multistage systematic random 439	Family support was assessed with 4 questions	Geriatric Depression Scale-15	70.9
Moghadam et al., Iran	Community-dwelling Both men and women	Two-stage, cluster and convenience sampling 168	23-item Phillips Social Support Questionnaire	12-item Quality of Life Scale-short form Clock-drawing test	67.85
Narendran et al., India	Community-dwelling Both men and women	Population proportion to size 290	NR	Geriatric Mental State with Automated Geriatric Examination for Computer Assisted Taxonomy Practitioner Assessment of Network Type Geriatric Depression Scale Mini-Cog Barthel Index	NR
Nazari et al., Iran	Older adults covered by three health centers Both men and women	Random sampling 302	Perceived Social Support Scale	General Health Questionnaire -12	70.01
Nguyen et al., Vietnam	Community-dwelling Both men and women	Two-stage random 376	MSPSS	Patient Health Questionnaire Perceived Barriers to Psychological Treatment	71.7
Pourtaghi et al., Iran	Institutionalized Both men and women	NR 70	Duke Social Support Scale	Geriatric Depression Scale-15 Philadelphia Geriatric Centre Morale Scale	71.0
Rajapakshe et al., Sri Lanka	Community-dwelling Both men and women	Two-stage Cluster 1283	Duke-UNC Functional Social Support Questionnaire	Presumptive Stressful Life Events Scale Modified Katz Index of Independence in Activities of Daily Living The Instrumental Activities of Daily Living Scale	66.15
Risal et al., Nepal	Community-dwelling Both men and women	Multistage systematic random 439	Family support was assessed by 3 questions and financial support was assessed by 1 question	Geriatric depression scale-15 WHO Quality of life-8	70.9
Saber et al., Iran	Community-dwelling Both men and women	Multistage sampling 240	The Medical Outcomes Study Social Support Scale MSPSS	One question concerning self-reported health status One question concerning the level of happiness	66.74
Seddigh et al., Iran	Older adults from daycare centers, residential homes, and living at home Both men and women	Stratified random 315	The Social Support Appraisals scale	Geriatric Depression Scale-15 Barthel index of Activity of Daily Living	68.09
Shah et al., Pakistan	Community-dwelling Men only	Convenience 312	NR	Rosenberg self-esteem questionnaire Bowling Older People's Quality of Life Scale	NR
Simkhada et al., Nepal	Community-dwelling Both men and women	Random 300	NR	Geriatric Depression Scale-15	71.2
Susanty et al., Indonesia	Older adults from community health centers (during hospital visit or from home visit) Both men and women	Stratified random 1360	MSPSS	The ten-item Barthel Index Short Portable Mental Status Questionnaire Geriatric Depression Scale-15 University of California in Los Angeles Loneliness Scale	66.28
Tajvar et al., Iran	Community-dwelling Both men and women	Multistage stratified cluster 644	Social Provisions Scale	12-item Short Form Health Survey	NR
Tanveer and Batool, Pakistan	Community-dwelling Both men and women	Convenience 557	Berlin Social Support Scale	WHO Quality of Life-Bref Health and Lifestyle Questionnaire General Self-Efficacy Scale Rosenberg Self-Esteem Scale	NR
Tariq et al., Pakistan	Community-dwelling Both men and women	Purposive 300	MSPSS	Beck Depression Inventory Activities of Daily Living Instrumental Activities of Daily Living	NR
Taufik et al., Indonesia	Community-dwelling Both men and women	Simple random 310	Family support scale	The Oxford Happiness Questionnaire	NR
Thapa et al., Nepal	Community-dwelling Both men and women	Multistage random 794	MSPSS	Depression, Anxiety Stress Scale-21 Instrumental Activities of Daily Living	71.1
Wickramasinghe et al., Sri Lanka	Both community-dwelling and institutionalized Both men and women	Random sampling (to choose households and elderly homes) and convenience sampling (to choose participants) 140	MSPSS	WHO Quality of Life-Bref Mini-Mental State Examination The Barthel index	72.2 (non-institutionalized)74.9 (institutionalized)
Zakizadeh et al., Iran	Older adults who were registered in comprehensive health centers Both men and women	Simple random 318	MSPSS	General Health Questionnaire Revised University of California in Los Angeles Loneliness Scale	66.74
Zanjari et al., Iran	Community-dwelling Both men and women	Clustered 1280	Social Support Scale	The World Health Organization-Five Well-Being Index	70.90
Zeinalhajlou et al., Iran	Community-dwelling Both men and women	Probability proportional to size 1067	MSPSS	Satisfaction with Life Scale	70.19

Note: MSPSS = Multidimensional Scale of Perceived Social Support; NR = not reported.

Table 4.

The Findings of the Studies Included.

Author(s), Year	Aim and Purpose	Data Collection, Analysis	Main Results
Abbasi et al., 2022	To recognize and screen common mental disorders in elderlies and determine their relationship with social support.	Interview Pearson correlation coefficient, univariate, and multivariate linear regression analyses	Somatization was the most prevalent psychological disorder at 68.9%, while phobic anxiety was the least common at 14.2%. The average social support score was 85.59. Higher social support was significantly associated with fewer mental problems.
Acharya Samadarshi et al., 2022	To assess the quality of life of older adults and explore factors associated with it.	Face-to-face interview Multiple logistic regression analysis	Depression was prevalent among 79.7% of older adults. Most older adults reported a fair quality of life at 82.41%. Depression and chronic illnesses were associated with a lower quality of life. Older adults receiving social support had a 9.97 times better quality of life than those who did not.
Giang et al., 2020	To examine social support factors associated with self-rated health among older men and women.	Self-administered questionnaire Bivariate analyses, multivariable logistic regression	Female older adults received more financial support during sickness/injuries than males. Male older adults reported higher satisfaction with family respect, while females reported higher satisfaction with community respect. There was no significant gender difference in receiving financial support from children. Social participation improved self-rated health, especially among older men. Informational support was linked to better self-rated health for both genders.
Ilyas et al., 2020	To address the factors involved in friends, family, and someone's special support that affect physical well-being and psychological well-being mediated by the spirituality, self-esteem, and ego integrity among older adults.	NR Confirmatory factor analysis (CFA), Cronbach's alpha, structural equation modeling	High support in sickness was noted with family and friends as primary sources. Spouses were the most common source of support in sharing problems, accounting for 41.2%. High satisfaction with the social support received in old age was reported by 48.3%. Self-esteem and ego integrity positively influenced psychological well-being.
Kousha et al., 2022	To identify the determinants of, and relationship between, subjective loneliness, general health and quality of life (QoL) among lonely community-dwelling older adults.	Face-to-face interview Pearson correlation coefficient, one-way ANOVA, hierarchical regression analysis	The mean score for loneliness was 38.4, and the mean score for quality of life was 38.3. Positive quality of life was significantly associated with social networks, social support, and self-care ability. Lower levels of loneliness and better general health were related to higher quality of life.
Manandhar et al., 2019	To estimate the prevalence of depression among the elderly and to identify factors associated with geriatric depression.	Door-to-door survey-based field interviews Bivariate and multivariate logistic regression analyses with odds ratios and adjusted odds ratio	The overall prevalence of geriatric depression was 56%. Geriatric depression was more common in females at 59.2% than in males at 52.2% and was higher in those above 75 years at 66.9% compared to 51.3% in < 75 years age group. Older adults who felt ignored, disrespected, or abused by their families were more likely to experience depression.
Moghadam et al., 2020	To investigate the relationship between social support and quality of life in the elderly.	NR Pearson correlation coefficient	The mean score for quality of life was 34.67, while the mean score of social support was 73.25. Family support had the highest means among social support subscales. Higher social support, particularly from family, was associated with a better quality of life.
Narendran et al., 2023	To identify the relative contributions of subjective social isolation, i.e., loneliness and objective social isolation, measured in terms of support network type, to depression, well-being, and hopelessness.	Interview Chi-squared test	38% reported satisfaction with life. 26.5% felt loneliness, with 13.1% experiencing intrusive loneliness and 7.9% feeling painful loneliness. 19.4% reported hopelessness. 48.6% showed signs of depression, and 20.3% had persistent depression. A poor social support network system was significantly associated with loneliness and depression.
Nazari et al., 2021	To determine the association between perceived social support and mental health status among older adults.	Face-to-face interview t-test, ANOVA, the Pearson correlation, and multiple linear regressions	The average perceived social support score was 130.95, and the general health score was 7.29. All subscales of perceived social support showed a significant negative correlation with general health. Greater emotional support, higher satisfaction with support, and fewer negative interactions were linked with better mental health.
Nguyen Hang Nguyet et al., 2021	To identify the prevalence of depression and perceived barriers to assessing psychological services among elderly people.	Face-to-face interview Multivariable logistic regression and linear regression	The mean Patient Health Questionnaire score was 7.2, indicating minimal depression risk. 26.1% of older adults were at risk of depression, with 18.6% mild, 5.1% moderate, and 2.4% severe. Women had a higher depression rate than men, with 32% compared to 14.3%. Older adults aged 70 and above had a higher depression rate than those under 70, with 31.3% compared to 28.8%. Family support was significant for mental health, with higher scores for those not depressed. Depressive older adults received less social support than non-depressive.
Pourtaghi et al., 2019	To assess the effect of depression and social support on morale in the elderly.	Participants completed the questionnaire, with investigators reading it aloud for those unable to do so. Multiple linear regression analysis, Pearson's and Spearman's correlation coefficient	Social support improved morale (P = 0.003; β= 0.347) No statistically significant relationship between depression and social support (P = 0.388).
Rajapakshe et al., 2019	To quantify the prevalence and associated factors of depression in a highly urbanized setting.	Interview Chi-squared and logistic regression analyses	The overall prevalence of depression was 13.9% with 11.2% mild and 2.7% severe. Older adults with perceived inadequate social support were more than twice as likely to experience depression as those with perceived adequate social support.
Risal et al., 2020	To study the quality of life of the elderly and their special needs.	Face-to-face interview Independent sample t-tests, linear regression, and Pearson's correlations	The mean total quality of life score was 25.7, with the psychosocial domain having the highest mean score of 7.2. Older adults under 75 reported higher quality of life scores than those 75 and older. The prevalence of geriatric depression was 56%. The absence of geriatric depression and adequate family time were positive predictors of a higher quality of life.
Saber et al., 2021	To assess the association between social support, happiness, and self-rated health among older adults.	Face-to-face interview The Pearson correlation coefficient, t-test, one-way ANOVA	A significant number of older adults reported moderate happiness (41.3%) to high happiness (34.1%), while 12.1% reported low happiness. The mean score of received social support was 58.36, with the highest in informational support and the lowest in kindness. The mean score of perceived social support was 42.3, with friends providing the highest support, followed by important adults and family. Most older adults rated their health as good (39.9%) or moderate (41.3), while 18.8% rated it as bad.
Seddigh et al., 2020	To assess perceived social support and depression in the elderly members of senior day care centers and compare the results with that of elderly individuals living at nursing homes and home.	Participants were asked to complete the questionnaires. One-way ANOVA, Chi-squared test, Fisher's exact test, Pearson's correlation, and linear regression	Older adults in nursing homes had higher depression levels than those in day centers. Day center residents reported the highest perceived social support, while nursing home residents reported the lowest. Increased social support was linked to lower depression scores, with the greatest impact seen in nursing home residents.
Shah et al., 2021	To analyze the implications of multifaceted life predictors for senior citizens's self-esteem.	Participants completed the questionnaire, with investigators reading it aloud for those unable to do so. The PLS-SEM path model	Social integration had the greatest influence on self-esteem. The close family ties and intimate friendships spur strong identity and self-esteem.
Simkhada et al., 2018	To ascertain the prevalence of depression in older adults in the wider community setting and identify potential contributory risk factors.	Face to face interview Univariate and multivariate logistic regression analyses	60.6% of older adults had depressive symptoms, with most experiencing mild depression (27.7%), followed by moderate (21.1%) and severe depression (11.8%). Depression was more common in females (68.4%) than males (51.1%). Physical support, financial support, respect from family, and family time are protective factors against depression.
Susanty et al., 2022	To understand the prevalence of loneliness and its associated factors among community-dwelling older adults.	Participants completed the questionnaire, with investigators reading it aloud for those unable to do so. Univariate and multivariate logistic regression analyses	64% of older adults experienced loneliness. Among those who felt lonely, 12.7% reported it “always,” 51.2% “sometimes,” 19% “seldom,” and 17.1% “never.” Depression is one of the significant predictors of loneliness. Older adults experiencing higher depression are 1.29 times more likely to feel lonely.
Tajvar et al., 2022	To examine the relationship between perceived social support and dimensions of health-related quality of life and to examine possible gender interaction and some other factors.	Face-to-face interview Univariable and multivariable logistic regression analyses	The mean perceived social support score was 71.8, with women scoring slightly lower than men. Both genders had the highest scores in “attachment” and the lowest in the “social integration” dimension. Older men had better health-related quality of life scores than women, with higher scores in both physical and mental health. Lower perceived social support revealed worse health-related quality of life outcomes.
Tanveer & Batool, 2019	To assess the predictive relationship of bio psychosocial factors and quality of life among the elderly.	Self-administered questionnaire Pearson correlation and hierarchical regression analysis	Self-esteem was positively correlated with social support (r = 0.42). Perceived social support was positively correlated with the social domain of biopsychosocial determinants (r = 0.60). Biopsychosocial factors (health, lifestyle, self-efficacy, self-esteem, and social support) were key in determining quality of life.
Tariq et al., 2020	To investigate the mediating role of perceived social support on the relationship between physical disability and symptoms of depression in senior citizens.	Interview One-way ANOVA with the Student–Newman–Keuls test, correlation, and multiple linear regression	Perceived social support from family, friends, and significant others was negatively correlated with depression, i.e., higher social support was associated with lower depression symptoms. Family support had the strongest negative correlation with depression (β = −0.152, p < 0.01).
Taufik et al., 2021	To identify differences in the level of happiness of elderly Muslims based on several factors: work, health, salary, Islamic study, and marriage.	NR Multiple regression and ANOVA	Family support had a greater impact on happiness than participation in religious activities in older adults.
Thapa et al., 2020	To estimate the prevalence and associated factors for depression, anxiety, and stress symptoms among older adults.	Face-to-face interview Chi-squared tests, t-tests, Pearson's correlation, and multivariate analyses	The prevalence of depression, anxiety, and stress were 15.4%, 18.1%, and 12.1% respectively. Low social support was a common risk factor associated with depression, anxiety, and stress. Government allowance was negatively associated with depressive and anxiety symptoms.
Wickramasinghe et al., 2022	To assess and compare QoL and associated factors of institutionalized and non-institutionalized older adults.	Interviewer-administered questionnaire Independent sample t-test, Spearman's correlation coefficient, and one-way ANOVA	The mean score of the overall QoL was high among non-institutionalized older adults compared to that of institutionalized. Lower levels of perceived social support tend to lower the QoL of institutionalized older adults. Institutionalized women had a higher quality of life than institutionalized men (54.5% Vs 41.3%).
Zakizadeh et al., 2022	To determine the predictors of mental health in the elderly with the role of social support and loneliness.	Self-administered questionnaire Spearman correlation, Mann–Whitney and Kruskal–Wallis tests, and hierarchical linear regression analysis	The mean score of total social support was 43.57. The mean score of loneliness was 32.37. Higher social support from friends and reduced feelings of loneliness significantly contributed to improved mental health.
Zanjari et al., 2022	To compare the impact of two-way (providing and receiving) social support on the well-being of older adults.	Face-to-face interview One-way ANOVA, independent sample t-test, and multiple hierarchical regression analyses	59.1% rated their perceived health status as “good,” 30.5% as “fair,” and 10.4% as “bad.” The mean score for receiving social support (20.70) was higher than for providing social support (17.71). Providing social support has a more significant impact on well-being than just receiving support. Both emotional and instrumental support, whether given or received, were important for well-being.
Zeinalhajlou et al., 2020	To investigate levels of life satisfaction among older people living at home and the factors that influence it.	Face-to-face interview Chi-squared test and logistic regression	The mean score for life satisfaction was 14.14, with most being “dissatisfied.” Higher perceived social support increased life satisfaction, with a 1.06 times higher chance of improvement for each increase in support.

Note: NR = not reported; ANOVA = analysis of variance; PLS-SEM = partial least square-structural equation model; QoL = quality of life.

Results

Characteristics of Included Studies

Twenty-seven cross-sectional studies were included in the review. Eleven studies are from Southwest Asia: Iran (n = 11) (Abbasi et al., 2022; Kousha et al., 2022; Moghadam et al., 2020; Nazari et al., 2021; Pourtaghi et al., 2019; Saber et al., 2021; Seddigh et al., 2020; Tajvar et al., 2022; Zakizadeh et al., 2022; Zanjari et al., 2022; Zeinalhajlou et al., 2020); 12 studies are from South Asia: Nepal (n = 5) (Acharya Samadarshi et al., 2022; Manandhar et al., 2019; Risal et al., 2020; Simkhada et al., 2018; Thapa et al., 2020), Pakistan (n = 4) (Ilyas et al., 2020; Shah et al., 2021; Tanveer & Batool, 2019; Tariq et al., 2020), Sri Lanka (n = 2) (Rajapakshe et al., 2019; Wickramasinghe et al., 2022), and India (n = 1) (Narendran et al., 2023); and 4 are from Southeast Asia: Indonesia (n = 2) (Susanty et al., 2022; Taufik et al., 2021) and Vietnam (n = 2) (Giang et al., 2020; Nguyen Hang Nguyet et al., 2021). Most studies investigated the role of social support in enhancing psychological well-being (n = 23). In addition, mental health problems (n = 15) with a specific focus on depression (n = 8), and quality of life (n = 7) among older adults were the focus of exploration.

Out of 27 studies, 10 used the Multidimensional Scale of Perceived Social Support (MSPSS), while others used the Social Provision Scale, Duke Social Support and Stress Scale (DUSOCS), Duke-UNC Functional Social Support Questionnaire, Lubben Support Network Scale, Social Support Appraisals Scale, Medical Outcome Study Social Support Survey (MOS-SS) and Berlin Social Support Scale. Psychological well-being was assessed using Geriatric Depression Scale (GDS) (n = 8), Rosenberg Self-Esteem Scale (n = 3), and Depression, Anxiety, Stress Scale (DASS) (n = 1). Quality of life and health status were evaluated using the World Health Organization Quality of Life (WHOQOL) (n = 5), General Health Questionnaire (GHQ) (n = 3), and Patient Health Questionnaire (PHQ) (n = 1) (Table 3).

The total sample size of all 27 studies was 15,536. Sample size varied greatly between 70 and 2,538 in the included studies, with the mean age between 66.15 and 74.9 years. Most studies (n = 19) had less than 500 participants, with the smallest sample size of 70 (Pourtaghi et al., 2019). The largest sample size was 2538 (Giang et al., 2020), followed by 1,360 (Susanty et al., 2022), and 1283 (Rajapakshe et al., 2019). Other sample sizes varied between 557 and 1,280 participants. Except for one study that investigated only men (Shah et al., 2021), the rest of the studies included both males and females, in which the proportion of women ranged from 28% (Tariq et al., 2020) to 91.1% (Kousha et al., 2022). The study participants of most of the studies (n = 21) were residing in communities, participants registered in healthcare facilities (n = 3), mixed samples from daycare centers, residential nursing homes, and living at home (n = 2), and representative data from aging survey (n = 1).

Social Support

Social support is broadly recognized as a key factor examined in most studies, significantly associated with many demographic and health-related factors. Numerous studies inspected social support into two distinct aspects: perceived (Ilyas et al., 2020; Saber et al., 2021; Seddigh et al., 2020; Tajvar et al., 2022; Tariq et al., 2020) and received (Saber et al., 2021) support. Meanwhile, one study explored it by distinguishing between structural and functional support (Giang et al., 2020). In studies from South and Southwest Asia, both received and perceived social support are essential, with family (Ilyas et al., 2020) and friends (Saber et al., 2021) being the primary sources of support. According to Saber et al. (2021), informational support was found to rank highest, and kindness was the lowest for received support, and less than half of the older adults reported neither good nor bad levels of happiness.

Gender differences were evident in the studies on how social support affected health outcomes in the Southwestern region. Women had higher perceived social support needs than men (Tajvar et al., 2022). However, Saber et al. (2021) found that men reported higher social support, while women were more likely to express their needs and receive emotional support from their social circles. Studies from Southeast Asia revealed that poor self-rated health in women was attributed to inadequate support from their children and no physical support for activities of daily living. For men, it was linked to a lack of social participation and dissatisfaction with community respect (Giang et al., 2020).

Psychological Well-Being

A. Mental Health Symptoms

Mental health problems in older adults are of growing concern, especially in low and middle-income countries where research studies are scarce. These mental health issues greatly affect psychological well-being with a high occurrence of mental health disorders like somatization, depression, anxiety, and stress in both South (Thapa et al., 2020) and Southwest Asia (Abbasi et al., 2022). Men exhibited better mental health than women in Southwest Asia (Zakizadeh et al., 2022). Self-esteem and self-efficacy showed a positive correlation with social support that underscores the importance of both in enhancing psychological well-being (Tanveer & Batool, 2019).

B. Depression

Geriatric depression is highly prevalent in South and Southwest Asia, with a markedly high rate of depressive symptoms in Nepal (60.6%) (Simkhada et al., 2018) and Iran (60.5%) (Abbasi et al., 2022) compared to the Southeast Asian region, Vietnam (26.1%) (Nguyen Hang Nguyet et al., 2021). Most of these cases were mild depression (Rajapakshe et al., 2019; Simkhada et al., 2018). Women were more likely to experience depression than men (Manandhar et al., 2019; Nguyen Hang Nguyet et al., 2021; Rajapakshe et al., 2019; Simkhada et al., 2018; Tariq et al., 2020). Depression is common in the 60 to 64 age group (Rajapakshe et al., 2019) following the age group of 70 years and above (Nguyen Hang Nguyet et al., 2021; Tariq et al., 2020). In Southwest Asia, the older adults in nursing homes experienced the highest levels of depression in comparison with those attending day care centers (Seddigh et al., 2020). Higher depression levels were strongly correlated with lower morale (Pourtaghi et al., 2019).

C. Loneliness and social isolation

The prevalence of loneliness among community-dwelling older adults is high, and older women are more likely to feel lonely than men in Southeast Asia (Susanty et al., 2022). Meanwhile, in Southwest Asia, most experienced moderate loneliness (Kousha et al., 2022) and expressed dissatisfaction with their lives (Zeinalhajlou et al., 2020). Additionally, Susanty et al. (2022) further explored that loneliness exacerbates depressive symptoms, further underscoring the importance of social support for the older population. A study from Southeast Asia revealed that older adults who live alone or lack social participation have poorer self-rated health (SRH) and are at greater risk of psychological distress (Giang et al., 2020).

D. Happiness and well-being

In Southwest Asia, there is a strong connection between happiness and self-rated health in older adults, with emotional well-being and social connections interacting in complex ways (Saber et al., 2021). Likewise, in South Asia, older adults who feel included in family decision-making, receive financial and physical support, and spend time with family members were less likely to have depressive symptoms (Simkhada et al., 2018). Family support, engagement in religious and community activities positively influenced happiness among older adults in Southeast Asia (Taufik et al., 2021).

Relationship Between Social Support and Psychological Well-Being

In most of the studies, social support is identified as a critical protective factor against psychological disorders and depression among older adults. In South Asia, family and spousal support enhanced spirituality leading to increased self-esteem and ego integrity, both improving psychological well-being (Ilyas et al., 2020). Older adults who reported not being given enough time by their families and perceived a lack of respect were more likely to suffer from depression (Manandhar et al., 2019). Engagement in social activities and maintaining social connections were mitigating factors against depression (Nguyen Hang Nguyet et al., 2021; Thapa et al., 2020). Receiving social support and allowance were effective in reducing depression, anxiety, and stress (Thapa et al., 2020).

A study conducted in Southeast Asia depicted that increased social support also had a great influence on happiness (Taufik et al., 2021). Similarly, Nguyen Hang Nguyet et al. (2021) states that lower perceived social support is strongly linked to a greater incidence of depression. In Southwestern Asia, higher levels of social support are significantly associated with lower scores of psychological disorders (Abbasi et al., 2022), while strong social participation was protective against poor mental health (Tajvar et al., 2022). Emotional support and satisfaction with received support were the predictors of mental health (Nazari et al., 2021). Moreover, greater social support reduced loneliness, which was associated with better mental health outcomes (Kousha et al., 2022; Zakizadeh et al., 2022). In contrast, Pourtaghi et al. (2019) reported no statistically significant correlation between depression and social support, focusing on the complexity of these relationships.

Relationship Between Social Support and Quality of Life

Studies from South and Southwest Asia depicted that there is a positive relationship between social support and quality of life among older adults; as social support increases, the quality of life improves (Acharya Samadarshi et al., 2022; Moghadam et al., 2020; Tanveer & Batool, 2019). Also, social support improved morale (Pourtaghi et al., 2019), and adequate family support, including positive relationships and perceived respect, was strongly associated with a higher quality of life in the older population (Risal et al., 2020). Older adults living apart from their families particularly gain from broader social networks, including friends and community social groups, which were more effective than family support in reducing loneliness and enhancing mental health (Zakizadeh et al., 2022). Social integration and support from both family and friends were significant predictors of self-esteem (Shah et al., 2021). Furthermore, higher perceived social support had a beneficial effect, contributing to increased life satisfaction (Zeinalhajlou et al., 2020) among older adults. Gender-based differences in the perception and effect of social support were also observed. Saber et al. (2021) and Tajvar et al. (2022) identified older women reporting lower levels of support, which negatively impact their quality of life. A study from South Asia revealed that non-institutionalized older adults had higher quality of life scores than institutionalized (Wickramasinghe et al., 2022).

Discussion

The review provides a comprehensive overview of mental health issues, social support, and quality of life of older adults in low- and middle-income countries of the Asian region. These results highlight the key aspects of psychological well-being and underline the relationship between social support and mental health outcomes of the older population.

Social support is a complex multifaceted concept lacking standardized measurement, making comparisons across studies vague and difficult. From the measurement, social support is primarily distinguished into two categories: perceived and received social support. Poor social support is associated with depression (Mulat et al., 2021). It plays a pivotal role in achieving higher life satisfaction (Bramhankar et al., 2023) and is related to various demographic and health aspects. Older adults who reported a need for more support had poorer health at nearly twice the rate compared to those who were satisfied with the support they received (White et al., 2009).

Most of the studies addressed depression as a major mental health issue in older adults. Compared to other countries like Thailand (Charoensakulchai et al., 2019), China (Lin et al., 2020), and Egypt (El-Gilany et al., 2018), Nepal (Simkhada et al., 2018), and Iran (Abbasi et al., 2022) have a higher prevalence of depression. This review found older women to be more prone to mental health issues than men, particularly depression, which aligns with the results of a national survey in the USA (Cheung & Mui, 2023) and a longitudinal aging study in India (Paul et al., 2023). This disparity in depression rate may be due to biological factors and women's greater household responsibilities and economic dependence, particularly in lower-income settings. Among older adults with depression, mild depression was the most prevalent form (Amha et al., 2020), which is consistent with the findings of this study.

Our review results revealed that older women experienced feelings of loneliness more frequently than men (Susanty et al., 2022), and this finding corresponds with the study conducted in Germany (Boehlen et al., 2023). However, after adjusting the confounding variables, the likelihood of loneliness was higher in men than women (Kim & Lee, 2022). In the present study, many older adults reported dissatisfaction with their lives, whereas a study conducted in the USA found that older adults were more satisfied as they age (Cho & Cheon, 2023). This difference between high-income and low- and middle-income countries may be attributed to varying cultural perceptions of aging, economic stability, access to healthcare, and social support mechanisms. The findings suggest a strong link between older adults’ happiness and their self-rated health. This result agrees with the previous study that has identified self-rated health as a crucial determinant of overall happiness (Mohammadi et al., 2022).

Analysis revealed gender differences showing that older women experience lower levels of support, which negatively affects their quality of life. The increased social support improves the quality of life and promotes a stronger sense of self-worth among older adults (Chen et al., 2014; LaRocca & Scogin, 2015; Şahin et al., 2019), aligning with the findings of this study.

The current review identified social support, family engagement, social participation, and community involvement as important protective factors that reduce depression, loneliness, and psychological distress while improving happiness and overall psychological well-being among older adults. The findings are consistent with the findings of Giebel et al. (2022) and Das et al. (2025) which focused that community-based psychosocial interventions, social participation, family involvement, and supportive social networks play a pivotal role in reducing depression, loneliness, and psychological distress while enhancing psychological well-being, life satisfaction, and quality of life among older adults in LMICs. Strong social support, frequent interactions, and closer family ties reduce depressive symptoms in older adults who rely more on family support. Unlike Western countries, older Asians depend more on their families due to cultural expectations. Thus, elder care in LMICs of Asian regions should be family focused.

This review enables healthcare professionals, administrations, and stakeholders to prioritize policies and resources that expand social support in healthcare facilities and focus on geriatric psychosocial care. This study can guide future researchers by identifying gaps in social support systems for older adults in LMICs and promoting culturally sensitive interventions to improve their mental health outcomes.

Limitation

This review has several limitations. Firstly, it focuses on cross-sectional studies, which only provide data from a single point in time, making it challenging to establish causal relationships between social support and psychological well-being. Additionally, the included studies exhibit significant heterogeneity in their methods of measuring social support and psychological well-being, complicating comparisons, and compromising the validity of the overall conclusions. Furthermore, the review is limited to studies conducted in Asia, reducing the generalizability of the findings to other regions.

Conclusion

The psychological well-being of older adults is a significant concern in LMICs. Depression, anxiety, stress, and loneliness are prevalent among this population, with older women showing worse mental health outcomes than men. Countries like Nepal and Iran have a high incidence of geriatric depression.

Self-esteem and self-efficacy are closely tied to psychological well-being, emphasizing the need for a comprehensive support system. Meeting the psychological needs of older adults in LMICs necessitates a comprehensive approach that prioritizes social support, recognizes gender differences, and incorporates cultural values in elderly care practices. Older adults often face unique challenges such as social isolation and health-related issues, highlighting the need to create a strong network of support that provides emotional and practical assistance, thereby promoting resilience and overall well-being. By fostering supportive environments and reinforcing family networks, we can improve the psychological well-being and quality of life of the older adults in LMICs of the Asian region.

Footnotes

Acknowledgments

The authors gratefully acknowledge the support provided by the information specialist at the University of Eastern Finland.

ORCID iD

Kalpana Paudel

Ethics Approval Statement

This systematic review was conducted following PRISMA guidelines and registered in PROSPERO (Identification No: CRD42022334415).

Informed Consent Statement

As this is a systematic review, patient consent was not required as no new patient data were collected.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the EDUFI Fellowship (grant number TM-22-11772).

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

As a systematic review, this review does not involve new data collection. The data supporting the review are available in the cited references.

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