Higher handgrip strength predicts a lower risk of depressive symptoms in rural Chinese populations

Association of handgrip strength asymmetry and weakness with depression among middle-aged and older population in China: A cohort study

BACKGROUND

Handgrip strength (HGS) weakness and asymmetry were recently reported to be associated with age-related health conditions. However, little is known about their combined effects on depression. We aimed to explore the joint association of HGS asymmetry and weakness with depressive symptoms in Chinese middle and older aged population.

METHODS

8700 participants aged ≥45 years were enrolled from China Health and Retirement Longitudinal Study (2015-2018). HGS weakness was determined as maximal HGS < 28 kg in males and <18 kg in females. HGS asymmetry was measured by HGS ratio and was defined using two different rules. Specifically, HGS ratio < 0.90 or >1.10 (10 % rule) and <0.80 or >1.20 (20 % rule) were considered as asymmetry. Participants were classified into four groups: normal and symmetric HGS, asymmetry only, weakness only, and both weakness and asymmetry. Depressive symptoms were assessed by the 10-item Center for Epidemiologic Studies Depression Scale, with scores ≥12 defined as depression. The logistic regression and multiple linear regression models were conducted to estimate the associations between HGS status and depressive symptoms.

RESULTS

The three-year incidence of depression was 19.2 %. After adjusting for covariates, compared to normal and symmetric HGS, participants with both HGS asymmetry and weakness showed the greatest risk of incident depression (10 % rule: OR 1.55, 95 % CI 1.19-2.02; 20 % rule: OR 1.71, 95 % CI 1.16-2.50). The coexistence of asymmetry and weakness was related to a significant increase in depression score (10 % rule: β 0.96, 95 % CI 0.38-1.54; 20 % rule: β 0.94, 95 % CI 0.08-1.81). The complete case analysis supported the results, and the associations were not modified by age, sex, and hand dominance.

LIMITATIONS

Depressive assessment was based on self-reported screening instrument.

CONCLUSIONS

The presence of both HGS asymmetry and weakness was associated with a higher risk of depression. Examining HGS asymmetry along with weakness may aid in identifying individuals at risk of depression to enable early interventions.

Dynapenic abdominal obesity and the risk of depressive symptoms in middle-aged and older Chinese adults: Evidence from a national cohort study

BACKGROUND

Population-based evidence on the relationship between dynapenic abdominal obesity and depressive symptoms is rare. We aimed to prospectively investigate the relationship between dynapenic abdominal obesity and depressive symptoms among middle-aged and older Chinese adults.

METHODS

A total of 9322 participants free of depressive symptoms in the China Health and Retirement Longitudinal Study were included. The participants were divided into four groups: non-dynapenic/non-abdominal obesity (ND/NAO), non-dynapenic/abdominal obesity (ND/AO), dynapenic/non-abdominal obesity (D/NAO) and dynapenic/abdominal obesity (D/AO) according to the sex-specific grip strength (<28 kg for men and <18 kg for women) and waist circumference (≥85 cm for men and ≥80 cm for women) that in line with the Chinese criteria. Depressive symptoms was defined as a score of ≥12 for the 10-item Center for Epidemiological Studies Depression Scale. Logistic regression model was used to explore the association between dynapenic abdominal obesity and depressive symptoms.

RESULTS

After an approximately 3-year of follow-up, 1810 participants (19.4 %) developed depressive symptoms. The multivariable-adjusted odds ratio for the D/AO versus ND/NAO was 1.61 (95 % CI: 1.31-1.98) for depressive symptoms. In addition, this relationship was more profound in participants aged<60 years (OR = 2.27, 95 % CI: 1.60-3.22) than participants aged ≥60 (OR = 1.36, 95 % CI: 1.05-1.77; P-interaction = 0.04). However, dynapenic obesity (defined by body mass index) was not linked to depressive symptoms.

LIMITATIONS

Causal link and residual confounding were not addressed because of the observational study design.

CONCLUSIONS

Dynapenic abdominal obesity was associated with an increased risk of depressive symptoms, especially among those aged<60 years.

Association between handgrip strength and depressive symptoms in patients undergoing hemodialysis: a cross-sectional study from a single Chinese center

BACKGROUND

The relationship between handgrip strength (HGS) and depression in patients undergoing hemodialysis (HD) was unknown. Therefore, we aimed to clarify this association in a cohort of patients.

METHODS

HGS was used as a representative indicator of muscle strength and was measured with a handheld dynamometer. Depressive symptoms were assessed with the self-reported Patient Health Questionnaire-9. A multivariable logistic regression model and restricted cubic spline analysis were used to assess the relationship between HGS and depression.

RESULTS

The prevalence of depression in our study was 34% in 568 Chinese patients undergoing HD. Compared with patients in the lowest tertiles of absolute and weighted HGS, patients in the highest tertiles of HGS had an approximately 59% lower [odds ratio (OR) = 0.41, 95% confidence interval (CI) = 0.24-0.68; OR = 0.41, 95%CI = (0.24-0.69)] prevalence of depressive symptoms after multivariate adjustments. Besides, the risk of depression in hemodialysis patients decreased by 33% (OR = 0.67, 95%CI = 0.53-0.85) and 32% (OR = 0.68, 95%CI = 0.54-0.85) for each standard deviation increase in absolute HGS and weighted HGS, respectively. The prevalence of depressive symptoms decreased with both increasing absolute HGS and weighted HGS after multivariate adjustments (p for trend < 0.05). Furthermore, a linear dose-response relationship was observed between absolute HGS and weighted HGS and the prevalence of depressive symptoms (pnonlinearity>0.05).

CONCLUSIONS

This study suggests that lower handgrip strength, a simple and modifiable parameter, is associated with a higher prevalence of depression in Chinese patients undergoing HD. Considering that depression is often unrecognized or underdiagnosed in HD patients, lowered muscle strength should be an important indicator and incentive for medical staff to screen for depression.

Muscle Quality Index is inversely associated with psychosocial variables among Chilean adolescents

A good muscle quality index (MQI) may have an inverse relationship with psychosocial variables of depression, anxiety, and stress in adolescents. Unfortunately, little scientific evidence has related MQI to psychosocial variables in this population. Therefore, this research aimed to determine the relationship between the MQI and psychosocial variables of depression, anxiety, and stress in Chilean adolescents. In this quantitative correlational design study, sixty adolescents participated voluntarily (mean ± standard deviation [SD]: age 15.11 ± 1.78 years). Anthropometric parameters, prehensile strength, MQI, and psychosocial variables were evaluated. The results showed that adolescents with high levels of MQI presented lower levels of depression (7.50 ± 6.06 vs. 10.97 ± 5.94), anxiety (5.64 ± 4.81 vs. 9.66 ± 5.12), and stress (6.79 ± 5.09 vs. 10 ± 5.58), in addition to reported lower abdominal obesity (WtHR, 0.47 ± 0.07 vs. 0.52 ± 0.07) than those with low levels of MQI. The group with high levels of MQI reported a higher prevalence of nonanxiety (81.3%, p = 0.031) and a lower prevalence of abdominal obesity (55.8%, p = 0.023). Likewise, a significant inverse association was evidenced between MQI and depression (β; -6.18, 95% CI; -10.11: -2.25, p = 0.003), anxiety (β; -6.61, 95% CI; -9.83: -3.39, p < 0.001) and stress (β; -4.90, 95% CI; -8.49: -1.32 p = 0.008). In conclusion, the results suggest that high levels of MQI are associated with a higher prevalence of nonanxiety in adolescents and a significant inverse association between MQI and levels of depression, anxiety, and stress.

Reduced grip strength potentially indicates depression: Investigating multicontinental databases

BACKGROUND

Multi-national studies in the association between handgrip strength and depression in middle and older aged adults are limited. Hence, Brazil, China, Europe, Korea, United Kingdom (UK) and United States (US) datasets were utilized to investigate this association.

METHODS

A cross-sectional study was conducted with 51,285 participants aged >45 years. Handgrip strength scores were divided into quartiles, groups 1 (highest) to 4 (lowest) in each database, and depression measures converted to binary scores.

RESULTS

Males in China and UK reported higher adjusted odds ratios (aORs) of depression for groups 2, 3, and 4 than for group 1. Brazil, US, and Korea reported greater aORs in groups 3 and 4 whereas Europe demonstrated increased aORs for group 4 only. Among females, China, Brazil, US, and Korea showed high aORs across all groups, while UK and Europe reported increased aORs for group 4 only. Highest ORs were reported from Korea in group 4 for males (aOR: 3·09; 95 % CI: 2·15-4·43; p < 0·001) and females (aOR: 3·74; 95 % CI: 2·78-5·03; p < 0·001). When removing the regional factor, aORs were higher in lower groups, with the highest reported from group 4 for males (aOR: 2·32; 95 % CI: 2·09-2·58; p < 0·001) and females (aOR: 2·11; 95 % CI: 1·95-2·29; p < 0·001).

LIMITATIONS

Being a cross-sectional study, the results were not able to establish the causal direction between handgrip strength and depression.

CONCLUSION

Lower handgrip strength was associated with an increased likelihood of depression. Early assessment of handgrip strength may identify populations at-risk for depression among middle and older aged adults.

Muscle strength and incidence of depression and anxiety: findings from the UK Biobank prospective cohort study

BACKGROUND

Depression and anxiety are the leading mental health problems worldwide; depression is ranked as the leading cause of global disability with anxiety disorders ranked sixth. Preventive strategies based on the identification of modifiable factors merit exploration. The aim of the present study was to investigate the associations of handgrip strength (HGS) with incident depression and anxiety and to explore how these associations differ by socio-demographic, lifestyle, and health-related factors.

METHODS

The analytic sample comprised 162 167 participants (55% women), aged 38-70 years, from the UK Biobank prospective cohort study. HGS was assessed at baseline using dynamometry. Depression and anxiety were extracted from primary care and hospital admission records. Cox proportional models were applied, with a 2 year landmark analysis, to investigate the associations between HGS and incident depression and anxiety.

RESULTS

Of the 162 167 participants included, 5462 (3.4%) developed depression and 6614 (4.1%) anxiety, over a median follow-up period of 10.0 years (inter-quartile range: 9.3-10.8) for depression and 9.9 (inter-quartile range: 9.0-10.8) for anxiety. In the fully adjusted model, a 5 kg lower HGS was associated with a 7% (HR: 1.07 [95% CI: 1.05, 1.10]; P < 0.001) and 8% (HR: 1.08 [95% CI: 1.06, 1.10]; P < 0.001) higher risk of depression and anxiety, respectively. Compared with participants in the sex and age-specific highest tertiles of HGS, those in the medium and lowest tertiles had an 11% (HR: 1.11 [95% CI: 1.04, 1.19]; P = 0.002) and 24% (HR: 1.24 [95% CI: 1.16, 1.33]; P < 0.001) higher risk of depression and 13% (HR: 1.13 [95% CI: 1.06, 1.20]; P < 0.001) and 27% (HR: 1.27 [95% CI: 1.19, 1.35]; P < 0.001) higher risk of anxiety, respectively. The association of HGS with depression was stronger among participants with average or brisk walking pace (vs. slow walking pace; P_interaction  < 0.001). The association with anxiety was stronger in those participants aged ≥58 years (vs. ≤58 years; P_interaction  = 0.002) and those living in more affluent areas (vs. deprived; P_interaction  = 0.001).

CONCLUSIONS

Handgrip strength was inversely associated with incident depression and anxiety. Because HGS is a simple, non-invasive, and inexpensive measure, it could be easily used in clinical practice to stratify patients and identify those at elevated risk of mental health problems. However, future research should assess if resistance training aimed at increasing HGS can prevent the occurrence of mental health conditions.

Longitudinal association between muscle strength and depression in middle-aged and older adults: A 7-year prospective cohort study in China

BACKGROUND

Evidence regarding the associations between muscle strength in different parts of the body and depression is lacking. This study examined whether poor muscle strength is associated with a higher incidence of depression in a large cohort of middle-aged and older adults.

METHODS

In total, 5,228 middle-aged and older adults from the China Health and Retirement Longitudinal Study without depression at baseline were followed for 7 years. Their demographic characteristics, chronic diseases and lifestyle behaviors were assessed. After adjusting for relevant variables, a Cox regression was used to determine the relationship between muscle strength and incident depression.

RESULTS

Over 32,544 person-years of follow-up, 1,490 participants developed depression. Low muscle strength at baseline was associated with a higher 7-year incident of depression, even after excluding those who developed depression within 2 years. After adjusting for confounding factors, it was found that a higher baseline relative handgrip strength was a protective factor against depression (HR [95% CI]=0.575 [0.430-0.768] for the lowest quartile vs. the highest quartile; p<0.001). Longer times on the 5TSTS test were a risk factor for depression (HR [95% CI]=1.321 [1.077-1.621] for the lowest quartile vs. the highest quartile; p = 0.007). When the strengths of the upper and lower limbs were considered together, the hazard ratio for depression in people with relatively greater muscle strength was 0.463 (95% CI=0.307-0.699; p<0.001).

CONCLUSIONS

Muscle strength could be predictive of depression, and the combined measurement of upper and lower limb muscle strength can improve the predictive ability.

The association between handgrip strength and depression in cancer survivors: a cross-sectional study

Background

The association between handgrip strength and depression in cancer survivors has been unexplored until now. We aim to examine the association between handgrip strength and depression in cancer survivors by using publicly available data (National Health and Nutrition Examination Survey).

Methods

Two waves of data from the National Health and Nutrition Examination Survey, from 2011–2012 and 2013–2014, were extracted and combined to explore this important issue. We extracted maximum patient handgrip strength value (from both hands). The Patient Health Questionnaire (PHQ-9) was used to evaluate depression with a cut-off >  = 10 points indicating that patients had depressive symptoms. Other basic characteristics and health-related variables were also collected. We used Least Absolute Shrinkage and Selection Operator (LASSO) regression to select potential confounding factors. Multivariable linear or logistic regression models were adopted to explore whether handgrip strength as a continuous variable, or low handgrip strength, was associated with depressive symptoms.

Results

There were 876 cancer survivors in our present total sample, with 403 (46.0%) males and 473 females (54.0%). The mean (SD) age of the entire group was 64.67 (13.81) years. The prevalence of depression and low handgrip strength was 12.90% and 16.7%, respectively. The results showed that handgrip strength was negatively associated with depressive symptoms in cancer survivors (OR = 0.95, 95%CI:0.92–0.99; P = 0.024). In addition, after adjusting for age, gender, race; marital status, polypharmacy, sleep disorder, arthritis, congestive heart failure, history of stroke, type of cancer, chronic coronary bronchitis and being overweight, cancer survivors with low handgrip strength had a 2.02-fold risk of depression, compared to those with normal handgrip strength (OR = 2.02,95%CI:1.07–3.81; P = 0.028).

Conclusions

Our present study suggests that low handgrip strength, as a simple and modifiable parameter, is associated with a higher risk of depression in cancer survivors. Therefore, future larger-scale prospective cohort studies are warranted to determine this association.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02795-0.

Exploring the bidirectional associations between handgrip strength and depression in middle and older Americans

OBJECTIVE

Current evidence on the relationship between decreased handgrip strength and depression risk is controversial, and there is limited study focus on the potential bidirectional associations between them. We aim to explore their bidirectional relationships.

METHODS

This study used panel data from the Health and Retirement Study involving 17,713 aging Americans (≥50 years old) who participated in at least 2 waves. Smedley spring-type hand-held dynamometer was used to assess the handgrip strength. Depression was evaluated by the 8-item Center for Epidemiologic Studies-Depression (CESD) scale. Time-lagged general estimating equations (GEE) were used to assess the bidirectional association between handgrip strength and the depression risk.

RESULTS

In the fully adjusted model, every 5 kg decreased handgrip strength was associated with a 6% (95%CI: 3%-9%) increased risk of depression. Compared with non-weakness participants, those with weakness had a higher depression risk (OR = 1.22, 95%CI: 1.09-1.36). Conversely, depression might associate with a 0.33 kg (95% CI: 0.09-0.56) decrease in handgrip strength and increased the risk of weakness by 18% (95% CI: 6%-33%). In addition, the results remained stable in the stratified analyses by gender and sex. Interestingly, the above-mentioned associations were also observed in overweight and obese participants.

CONCLUSIONS

The present study found bidirectional associations between handgrip strength and depression risk. Our results indicated early interventions for depression and handgrip strength might achieve reciprocal benefits over time.

Socioeconomic differences in handgrip strength and its association with measures of intrinsic capacity among older adults in six middle-income countries

Handgrip strength, a measure of muscular strength is a powerful predictor of declines in intrinsic capacity, functional abilities, the onset of morbidity and mortality among older adults. This study documents socioeconomic (SES) differences in handgrip strength among older adults aged 50 years and over in six middle-income countries and investigates the association of handgrip strength with measures of intrinsic capacity-a composite of all the physical and mental capacities of an individual. Secondary data analysis of cross-sectional population-based data from six countries from the WHO's Study on global AGEing and adult health (SAGE) Wave 1 were conducted. Three-level linear hierarchical models examine the association of demographic, socioeconomic status and multimorbidity variables with handgrip strength. Regression-based Relative Index of Inequality (RII) examines socioeconomic inequalities in handgrip strength; and multilevel linear and logistic hierarchical regression models document the association between handgrip strength and five domains of intrinsic capacity: locomotion, psychological, cognitive capacity, vitality and sensory. Wealth quintiles are positively associated with handgrip strength among men across all countries except South Africa while the differences by education were notable for China and India. Work and nutritional status are positively associated with handgrip strength. Our findings provide new evidence of robust association between handgrip strength and other measures of intrinsic capacity and confirms that handgrip strength is a single most important measure of capacity among older persons.

Bidirectional Associations between Handgrip Strength and Depressive Symptoms: A Longitudinal Cohort Study

OBJECTIVES

This study aimed to examine the bidirectional associations between handgrip strength and depressive symptoms in a nationally representative sample.

DESIGN

Cohort study with a 4-year follow-up.

SETTING AND PARTICIPANTS

A total of 13,208 participants from the China Health and Retirement Longitudinal Study were included in the analyses.

METHODS

Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies-Depression Scale. Separate generalized estimating equations were used to analyze the cross-sectional and longitudinal associations between handgrip strength and depressive symptoms. Restricted cubic spline models were performed to explore the shape of the dose-response relationship.

RESULTS

Decreased handgrip strength was related to subsequent increased risk of depressive symptoms, such that participants in the lowest quartile of handgrip strength were found to have an approximately 36% increased in their risk of depressive symptoms compared with those in the highest quartile [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.17, 1.58]. There was a linear dose-response relationship between handgrip strength and risk of depressive symptoms (P_nonlinearity = .25), in that a 5-unit increment in handgrip strength may lead to an 11% decrease in the risk of depressive symptoms (OR 0.89, 95% CI 0.85, 0.92). Conversely, depressive symptoms were prospectively associated with subsequent decreased handgrip strength (β = -0.84, 95% CI -1.13, -0.55). An approximatively L-shaped dose-response pattern was found for the association between depressive symptoms level and handgrip strength (P_nonlinearity = .02).

CONCLUSIONS AND IMPLICATIONS

The present study identified bidirectional associations between handgrip strength and depressive symptoms, and the associations were found to have a dose-response pattern. It provides important insights into integrated mental and physical health intervention strategies that simultaneously promote handgrip strength and depressive symptoms.

The handgrip strength and risk of depressive symptoms: a meta-analysis of prospective cohort studies

PURPOSE

Many studies have investigated the association between handgrip strength (HGS) and depressive symptoms, but the conclusion remain controversial. We performed a meta-analysis to evaluate the longitudinal association between HGS and risk of depressive symptoms.

METHODS

PubMed, PSYCINFO and EMBASE databases were searched for eligible publications up to April 2020. Pooled relative risks (RRs) with 95% confidence intervals were calculated using random-effects model. Publication bias was estimated using Egger's test and the funnel plot. Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of eligible studies.

RESULTS

The present meta-analysis included 8 cohort studies with 30,727 participants. Overall, higher HGS was related to a decreased risk of depressive symptoms: the pooled risk ratio (RR) of 0.74 [95% confidence intervals (CI) 0.65-0.85] with a moderate heterogeneity (I² = 60.5%, P = 0.013). HGS was significantly associated with a reduced risk of depressive symptoms in males (RR = 0.69; 95% CI 0.50-0.94), but not in females.

CONCLUSIONS

Lower HGS was associated with an increased risk of depressive symptoms. Further studies are needed to confirm these findings and to investigate the sex differences.

Association Between Changes in Muscle Strength and Risk of Depressive Symptoms Among Chinese Female College Students: A Prospective Cohort Study

Muscle strength can be a predictor of depressive symptoms among the elderly. We conducted a prospective study aiming to examine the association between change of handgrip strength and the incidence risk of depressive symptoms among Chinese female college students. Handgrip strength was used as a representative indicator of skeletal muscle strength, and a handheld digital smedley dynamometer was applied to measure handgrip strength. We also used the 20-item Zung self-rating depression scale to evaluate depressive status, and a score of ≥50 indicated moderate-to-severe depressive symptoms. During a 1-year follow-up period, the incidence of depressive symptoms is 10.7%. Multivariate logistic regressions analysis revealed that the multivariable-adjusted ORs (95% CI) of depressive symptoms for the categories of handgrip strength change was 1.00 (reference) for group 1, 0.57 (0.28, 1.19) for group 2, 0.41 (0.19, 0.89) for group 3 and 0.33 (0.11, 0.99) for group 4 (p = 0.018). This study indicated that change of handgrip strength level over one-year period is negatively associated with risk of depressive symptoms among Chinese female college students.

Handgrip Strength and Depression Among Older Chinese Inpatients: A Cross-Sectional Study

OBJECTIVE

There have been studies exploring the association between handgrip and depression among community-dwelling adults; however, evidence for this association among hospitalized older adults is scarce. We aimed to use a larger-scale population from multiple centers to explore the association between low handgrip strength and depression.

METHODS

This was a cross-sectional study that included hospitalized patients aged 65 years or older from different hospitals in China. Depression was assessed by a short-form Chinese Geriatric Depression Scale (GDS-15) with a cutoff value of 5 points or more. Dominant hand handgrip strength was assessed by a dynamometer. A generalized additive model and multivariable regression analysis were conducted.

RESULTS

There were 9,368 participants, with an average age of 72.4 (SD=5.7) in the final analysis. The prevalence of low handgrip strength and depressive symptoms among older Chinese hospitalized patients was 50.3% and 16.3%, respectively. There seemed to be a nonlinear relationship between handgrip strength and depression, and curve fitting and threshold analyses indicated that when handgrip strength was less than 35.6 kg, the depression risk decreased significantly with increasing handgrip strength. However, this association between handgrip strength and depression was not significant when the handgrip strength was greater than 35.6 kg. In addition, after adjusting for potential confounders, older patients with low handgrip strength had an increased risk of depression compared to those with normal handgrip strength (OR=1.46; 95% CI=1.27-1.68). The subgroup analysis found the results were unchanged.

CONCLUSION

Our study indicates that low handgrip strength was associated with a higher risk of depression among older Chinese hospitalized patients, implying that early patient screening for handgrip strength and initiating effective intervention programs, such as resistance training and nutritional supplements, could be helpful for older patients.