As the increase in the older population (i.e., older than 65 years old) is an imperative social matter in South Korea and other nations, psychosocial problems encountered by older adults, such as loneliness, social isolation, and depression, have been reported as major factors that threaten the quality of life in this population [1]. However, the current lack of social services for community-dwelling older adults could lead to various physical and emotional problems among them [2]. For example, loneliness is significantly associated with decreased activities of daily living [3], health problems [4], cognitive impairment [5], and depressive symptoms [6]. Factors contributing to the loneliness of older adults include lack of social support [7], increased age [6], and related psychological factors (e.g., depression) [6].

In addition, depression is a very common health problem among older adults: 1-4% of the general elderly population has major depression, and the annual incidence rate has been reported to be 0-15%. However, after 70-85 years of age, the prevalence and incidence rate of major depression doubles [8]. In South Korea, depression is even more prevalent in older adults, affecting 20-70% of this group [9]. Depression in older adults has been shown to be highly correlated with a lower quality of life [10], increased healthcare costs [10], and mortality rate [11].

The introduction of computer technology, including the Internet, has changed our lives. In this changed social environment, older adults have more opportunities to use computers in their daily lives for communicating, banking, shopping, health maintenance, seeking leisure activities, and so forth [12]. Moreover, they have currently become the fastest-growing group of Internet users [13] and could active users of health information obtained via Internet [14]. Since the mid-1990s, numerous studies have reported computer learning in older adults, and these studies have extended our understanding of computer usage in this age group. As computer and Internet usage among older adults is becoming an important field, it is necessary to understand how older adults use computers and the Internet to manage psychosocial problems they experience, such as loneliness and depression. Various intervention studies have laid the foundation for understanding how computer and Internet use plays an important role in increasing psychosocial well-being, but also have some inconsistent findings.

Moreover, several systematic reviews and critical syntheses have been conducted based on these previous studies [15-18]. However, they dealt with computer and Internet training as only a small part of intervention studies for reducing older adults' social isolation [16] or included descriptive or correlation studies from all age groups, a practice that prevents us from delineating the effects on older adults [17]. Although one systematic review reported that computer or Internet use did not affect psychosocial well-being in older adults [15], it provides no quantitative evidence of the effectiveness of such interventions on their psychosocial problems and more evidence need to be supplemented with more current data. Therefore, the purpose of the present study was to examine the effectiveness of computer and Internet interventions in reducing loneliness and depression among older adults, through a meta-analysis.

This study was conducted to determine the effectiveness of computer and Internet interventions in decreasing loneliness and depression among older adults. We found that these interventions were significantly effective in decreasing loneliness, but ineffective in decreasing depression. Previous studies reported that older adults were more likely to use the computer and Internet for communication to strengthen existing social networks with family and friends and to develop new social activities that help reduce social isolation, loneliness, and depression, as well as to enhance social support, especially in the presence of mobility and activity limitations [27,28]. However, some researchers suggested that Internet usage has negative or no effects on psychosocial wellbeing [15].

Computer and Internet interventions were effective in decreasing loneliness among older adults in the current study. In other words, a possible reason for these results is that computer and Internet usage are now serving as social supports among older adults, thereby ultimately decreasing their loneliness. Specifically, the results suggested that computer and Internet usage helps older adults to communicate with family and friends as well as obtain news and other useful information [29]. Computer-mediating social support was increased when older adults spent more time using the Internet, had more knowledge of the Internet, were of a lower age group, were women, and had fewer physical barriers [29]. Therefore, when researchers apply computer-mediating social support to older adults, such factors should be considered to help them manage psychosocial wellbeing.

The ineffectiveness of computer and Internet usage on depression among older adults in this study may result from the characteristics of the studies we included. First, two studies had small sample sizes [19,21], which might have limited the generalizability of their results statistically. In general, computer intervention studies tend to have small sample sizes because this kind of intervention needs resources such as computer equipment and spaces. However, one study used a survey design [28] with a large sample size (n = 7,839) and found that computer and Internet use significantly reduced depression in approximately 26% of the participants. Second, the scores on the instruments measuring depression (e.g., Center for Epidemiologic Studies Depression Scale [CES-D] and Geriatric Depression Scale [GDS]) were low at baseline, which indicated that study participants seemed to have low levels of depression. Thus, there was little room for improvement after the intervention. In general, studies on depression require the examination of confounding factors such as age, gender, living arrangement, economic status, education level, cognitive status, activities of daily living, and presence of disease [30]. These factors might influence the effectiveness of computer and Internet interventions for depression. Therefore, in further studies on Internet-based depression intervention, such confounding factors should be controlled for or at least considered.

However, the small number of studies in our meta-analysis limits the generalizability of our own results. In addition, the small number of studies prevents the use of funnel plots to detect publication bias. Further studies should therefore be conducted in this field. However, despite this limitation, our study contributes to existing knowledge in determining the effect of computer and Internet interventions on psychosocial problems among older adults.

In conclusion, computer and Internet interventions were effective in decreasing loneliness, but not depression. Currently, many older adults have the opportunity to use various devices besides a personal computer, such as tablet PCs or smart-devices. In the near future, these devices may play a key role in providing older adults with social networks so that they stay connected with the wider world and obtain new information that has a beneficial effect on their psychosocial wellbeing. Thus, web pages and applications for tablet PCs and smart-devices that older adults find more usable should be developed. In further studies, the effectiveness of these newly developed devices on psychosocial problems should be investigated.