Abstract
Objective
Our study prospectively assessed the relationship between cumulative handgrip strength and temporal changes in depressive symptoms among adults aged 50 years and over.
Methods
This study was conducted based on two longitudinal cohort studies: the English Longitudinal Study of Ageing (ELSA) and the Survey of Health, Ageing and Retirement in Europe (SHARE). Cumulative handgrip strength was derived from three repeated measurements taken over eight years (ELSA) or six years (SHARE). The mixed linear regression models and Cox regression models were employed to assess the associations between cumulative handgrip strength and temporal changes in depressive symptoms, as well as incident depression risk.
Results
Participants in the lowest quartile of cumulative handgrip strength had higher depressive symptom scores compared to those in the highest quartile in ELSA (β: 0.191; 95% CI: 0.035, 0.348) and SHARE (β: 0.391; 95% CI: 0.267, 0.514), and experienced an accelerated increase in depressive symptoms of 0.040 point/y (95% CI: 0.009, 0.070) in ELSA, and 0.067 point/y (95% CI: 0.045, 0.089) in SHARE during follow-up. Regarding incident depression, the lowest quartile group faced a 55% (HR: 1.55; 95% CI: 1.13, 2.12) and 62% (HR: 1.62; 95% CI: 1.38, 1.90) increased risk of developing depression in ELSA and SHARE, relative to the highest quartile.
Conclusions
Reduced cumulative handgrip strength correlated with accelerated depressive symptom progression and increased depression incidence. Future interventional studies should further investigate if strength/muscular fitness can improve mental health, particularly in older adults.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12889-025-24223-9.
Keywords: Cumulative handgrip strength, Depressive symptoms, SHARE, ELSA, Cohort study
Introduction
Depression, a major mental disorder affecting 350 million people worldwide, is the leading cause of disability [1], and will become the second leading cause of disease burden by 2030 across the world [2]. Accumulated evidence links depression to an elevated risk of several chronic comorbidities such as diabetes [3], cardiovascular disease [4], and arthritis [5], as well as decreased cognitive function and quality of life [6, 7]. Therefore, identifying the individuals at great risk for depressive symptoms is essential for further prevention.
Existing evidence demonstrates that physical activity is an essential modifiable factor in reducing depression [8], and skeletal muscle-derived pathways may play a role in this physical activity-depression link [9, 10]. Thus, low muscle strength might be associated with an elevated risk of depression. Handgrip strength is the most commonly used proxy for overall muscle strength due to its simplicity, low cost, and non-invasive nature, and has been widely utilized in previous studies [11, 12]. Furthermore, previous studies have revealed that handgrip strength can be an effective tool for measuring muscular strength [11] and also be recommended as a vital biomarker for several health outcomes, such as depression, cognition, and premature mortality, in older adults [13]. Emerging studies explored the association between handgrip strength and depressive symptoms/depression. For example, a recent Chinese cohort study involving 8470 participants suggested that higher handgrip strength was associated with a reduced risk of depressive symptoms (HR, 0.74; 95% CI: 0.62, 0.89) [14]. Similar results were found in an Irish study with 4104 adults [15]. Mendelian randomization further supported that increased left-handgrip strength reduced the risk of major depressive disorder [16]. Nevertheless, most prior studies relied on single-time-point handgrip assessments, failing to capture its longitudinal variations and cumulative burdens of handgrip strength, which are subject to change over time due to aging [17] and physical activity [18]. The cumulative exposure effects of handgrip strength on temporal changes in depressive symptoms or depression incidence remained unexplored.
To this end, this study used data from two population-based prospective cohort studies (including ELSA and SHARE) to assess the longitudinal associations of cumulative handgrip strength with changes in depressive symptoms and subsequent depression risk among older adults aged ≥ 50 years.
Methods
Study design and population
Data originated from ELSA and SHARE, prospective cohort studies involving adults ≥ 50 years across 11 countries. The sampling strategies, study designs, and survey methods details are published elsewhere [19, 20]. Data collection occurred biennially via trained researchers. This involved questionnaires via face-to-face interviews, conducting physical examinations, and collecting biological specimens. The London Multicenter Research Ethics Committee approved ELSA (MREC/01/2/91). For SHARE, approval was obtained from both the Ethics Council of the Max Planck Society and the Ethics Committee of the University of Mannheim. All participants provided written consent forms.
Cumulative handgrip strength was calculated using data spanning eight years (ELSA: wave 2 [2004] to wave 6 [2014]) and six years (SHARE: wave 1 [2004] to wave 4 [2010]). Wave 6 of ELSA and wave 4 of SHARE served as the baseline. The primary outcome was changes in depressive symptoms, and the secondary outcome was incident depression. For ELSA, long-term changes in depressive symptoms and incident depression were assessed over six years, from wave 6 (2014) to wave 9 (2020). For SHARE, long-term changes in depressive symptoms and incident depression were assessed over eight years, from wave 4 (2010) to wave 8 (2018). The study design is represented in Fig. 1.
Fig. 1.
The study designs. Abbreviations: ELSA English Longitudinal Study of Aging, SHARE Survey of Health Ageing and Retirement in Europe
Initial cohorts from ELSA and SHARE comprised 17,143 participants, and 7342 and 7588 participants were excluded due to 1) missing handgrip strength data across follow-up waves (ELSA: waves 2, 4, 6; SHARE: waves 1, 2, 4); 2) missing depressive symptoms at baseline; 3) history of psychiatric disease or depression; 4) history of dementia or Alzheimer’ disease; 5) missing necessary covariates at baseline; 6) loss to follow-up (applied only for depressive symptoms trajectories analyses). After exclusion, 9801 participants (2971 from ELSA and 6830 from SHARE) were included for depressive symptom trajectory analyses, and 9555 participants (3178 from ELSA and 6377 from SHARE) were included for incident depression analyses (Supplementary Fig. 1).
Assessments of cumulative handgrip strength
Handgrip strength was measured using the Smedley handheld dynamometer. ELSA (waves 2, 4, 6): measurements were taken three times per hand (dominant hand first) with participants seated, elbows flexed at 90°, and forearms supported [21]. SHARE (waves 1, 2, 4): measurements were taken twice per hand (dominant hand first) with participants seated or standing, elbows flexed at 90°, upper arms against the trunk, and wrists neutral [22]. According to previous studies [23, 24], the average of three (ELSA) or two (SHARE) dominant-hand measurements was used to assess handgrip strength.
Cumulative handgrip strength was measured over three visits. For ELSA, there were waves 2, 4, and 6 (spanning eight years); For SHARE, there were three waves 1, 2, and 4 (spanning six years). To be specific, handgrip strength assessed at the three visits was denoted X1, X2, and X3 for both studies; T1 and T2 represented the time intervals between consecutive visits (ELSA: waves 2→4 and 4→6; SHARE: waves 1→2 and 2→4). Cumulative handgrip strength was calculated as the area under the curve for three measurements using the trapezoid rule [25]:
 |
Given the fixed time intervals in each study, we assigned T1= T2 = “4 years” in ELSA, T1 = "2 years" and T2 = “4 years” in SHARE. To facilitate comparability, the continuous measures of cumulative handgrip strength were categorized into sex-specific quintiles in analyses.
Assessment of depressive symptoms
Depressive symptoms were assessed using validated scales: the self-reported 8-item version of the Center for Epidemiologic Studies Depression Scale (CES-D 8) in ELSA and the European depression (EURO-D) scale in SHARE. CES-D 8 scale covers eight symptoms, including felt depressed, happy, lonely, sad, enjoyed life, everything was an effort, restless sleep, and could not get going. EURO-D scale covers 12 emotional states, including depressed mood, pessimism, suicidal tendencies, guilt, sleep, interest, irritability, appetite, fatigue, concentration, enjoyment, and tearfulness. Both the CES-D 8 (ELSA) and EURO-D (SHARE) use binary scoring (yes=1/no=0), with total scores ranging 0–12 and 0–8, respectively; higher scores indicate greater depressive severity. They have been assessed as valid and reliable instruments for depression measurement in older adults [26–29]. The primary outcome was long-term changes in depressive symptoms. The secondary outcome was incident depression, defined as CES-D 8 ≥ 4 or EURO-D ≥ 4, consistent with prior studies [30, 31].
Assessment of covariates
At baseline, data were collected on key participant characteristics. Sociodemographic information included age, sex (male or female), marital status (married, single, or unknown), and education level (low, high, or unknown). Health-related lifestyle and behaviors assessed were cigarette smoking (never smoking, former smoking, or current smoking), alcohol drinking (no drinking/light drinking or heavy drinking), and physical activity (with sedentary behavior defined as mild activity less than once per week, moderate as moderate activity more than once per week, or vigorous as vigorous activity more than once per week). Body Mass Index (BMI) was calculated as weight in kilograms divided by height in meters squared (kg/m²), and participants were classified as normal weight (< 25 kg/m²), overweight (25 to < 30 kg/m²), obesity (≥30 kg/m²), or unknown. History of physician-diagnosed diseases was collected for hypertension (defined as self-reported doctor diagnosis, current anti-hypertensive medication use, SBP ≥ 140 mm Hg, or DBP ≥ 90 mm Hg), diabetes (defined as self-reported doctor diagnosis diabetes, current anti-diabetes medication use, or HbA1c ≥ 47.5 mmol/mol [6.5%]), stroke (defined as self-reported doctor diagnosis), heart disease (defined as self-reported doctor diagnosis, including angina, congestive heart failure, and myocardial infarction), cancer (defined as self-reported doctor diagnosis), arthritis (defined as self-reported doctor diagnosis; Supplementary Table 1).
Statistical analyses
Baseline characteristics were summarized as mean (standard deviation, SD) for continuous variable and frequency (percentage) for categorical variables. Comparisons across sex-specific quartiles of cumulative handgrip strength employed ANOVA (for continuous variables) and Chi-square tests (for categorical variables).
Primary analysis employed mixed linear models to evaluate the longitudinal associations between cumulative handgrip strength (modeled as sex-specific quartiles; the highest quartile as reference) and trajectories of depressive symptoms. These models incorporated the participant-level intercept and slope of time as random effects to account for the within-participant correlation. Secondary analysis utilized Cox regression models to estimate hazard ratios (HRs) and 95% CIs for associations between cumulative handgrip strength and incident depression risk. Cumulative handgrip strength was modeled as sex-specific quartiles, with the highest quartile regarded as the reference group. Covariates were adjusted sequentially: Model 1 adjusted for age and sex; Model 2 additionally adjusted for marital status, education level, physical activity, alcohol drinking, and cigarette smoking; Model 3 further adjusted for obesity, hypertension, diabetes, stroke, heart disease, cancer, and arthritis. Linear trends (dose-response relationship) were tested by modeling the median cumulative handgrip strength value within each quartile as a continuous variable in both analyses.
Subgroup analyses stratified participants by age (< 70 vs. ≥ 70 years), sex (male vs. female), physical activity (sedentary behavior, moderate physical activity, vigorous physical activity), and BMI (normal weight, overweight, obesity). Effect modification by these stratifying variables was evaluated by adding interaction terms (stratifying variable*cumulative handgrip strength) to fully adjusted models, with significance assessed using Wald tests.
Sensitivity analyses included: (1) Treating cumulative handgrip strength as a continuous variable in all analyses; (2) Repeating analyses using alternative handgrip strength measures (maximum handgrip strength value from three [the ELSA] or two (the SHARE) dominant hand measurements); (3) Analyzing depressive symptom trajectories only among participants with complete follow-up data; (4) Excluding participants with baseline depression (CES-D 8 ≥ 4 or EURO-D ≥ 4) from depressive symptom trajectory analyses.
Results
The association between cumulative handgrip strength and trajectories of depressive symptoms
A total of 9801 participants (ELSA: n = 2971; SHARE: n = 6830) were included. Baseline characteristics (mean age: 69.65 [SD: 8.17] years; 46.61% men, 30.26% high education level, 12.61% current smokers, 59.22% heavy drinkers, and 43.92% vigorous physical activity) are shown in Table 1. Compared with individuals who were exposed to higher levels of cumulative handgrip strength, those with lower levels of cumulative handgrip strength tended to be old, single, low education level, former-smokers, light drinkers, have sedentary behavior, have normal weight, have a history of hypertension, diabetes, stroke, heart disease, cancer, arthritis (All P < 0.001; Supplementary Table 2). The details for the ELSA and SHARE are shown in Supplementary Tables 3–4.
Table 1.
The basic characteristics for the association between cumulative handgrip strength and trajectories of depressive symptoms
| Characteristic | Total (n = 9801) | ELSA (n = 2971) | SHARE (n = 6830) |
|---|---|---|---|
| Age, years, mean (SD) | 69.65 (8.17) | 71.07 (7.28) | 69.03 (8.46) |
| Sex, male, n (%) | 4568 (46.61) | 1355 (45.61) | 3213 (47.04) |
| Marital status, n (%) | |||
| Married | 6888 (70.28) | 2019 (67.96) | 4869 (71.29) |
| Single | 2772 (28.28) | 952 (32.04) | 1820 (26.65) |
| Unknown | 141 (1.44) | - | 141 (2.06) |
| Education levels, n (%) | |||
| Low | 6393 (65.23) | 1378 (46.38) | 5015 (73.43) |
| High | 2966 (30.26) | 1198 (40.32) | 1768 (25.89) |
| Unknown | 442 (4.51) | 395 (13.30) | 47 (0.69) |
| Cigarette Smoking, n (%) | |||
| Never smoking | 4555 (46.47) | 1102 (37.09) | 3453 (50.56) |
| Former smoking | 4010 (40.91) | 1635 (55.03) | 2375 (34.77) |
| Current smoking | 1236 (12.61) | 234 (7.88) | 1002 (14.67) |
| Alcohol drinking, n (%) | |||
| No or light drinking | 3807 (38.84) | 1002 (33.73) | 2805 (41.07) |
| Heavy drinking | 5804 (59.22) | 1779 (59.88) | 4025 (58.93) |
| Unknown | 190 (1.94) | 190 (6.40) | - |
| Physical activity, n (%) | |||
| Sedentary behavior | 1381 (14.09) | 625 (21.04) | 756 (11.07) |
| Moderate physical activity | 4115 (41.99) | 1461 (49.18) | 2654 (38.86) |
| Vigorous physical activity | 4305 (43.92) | 885 (29.79) | 3420 (50.07) |
| BMI, n (%) | |||
| Normal weight | 3347 (34.15) | 751 (25.28) | 2596 (38.01) |
| Overweight | 4125 (42.09) | 1242 (41.80) | 2883 (42.21) |
| Obesity | 2130 (21.73) | 877 (29.52) | 1253 (18.35) |
| Unknown | 199 (2.03) | 101 (3.40) | 98 (1.43) |
| Hypertension, n (%) | 1724 (58.03) | 2579 (37.76) | |
| Diabetes, n (%) | 1234 (12.59) | 445 (14.98) | 789 (11.55) |
| Stroke, n (%) | 313 (3.19) | 149 (5.02) | 164 (2.40) |
| Heart disease, n (%) | 1079 (11.01) | 323 (10.87) | 756 (11.07) |
| Cancer, n (%) | 363 (3.70) | 154 (5.18) | 209 (3.06) |
| Arthritis, n (%) | 2820 (28.77) | 1288 (43.35) | 1532 (22.43) |
BMI Body mass index, ELSA English Longitudinal Study of Aging, SD standard deviation, SHARE Survey of Health Ageing and Retirement in Europe
The average handgrip strength declined from 31.51 kg in wave 2 to 27.79 kg in wave 6 in ELSA and 34.59 kg in wave 1 to 32.35 kg in wave 4 in SHARE, respectively. We found some differences in handgrip strength across age and sex, and the older and female groups tended to have lower handgrip strength in both cohorts (all P < 0.001). The mean cumulative handgrip strength was 237.39 kg·years (SD: 48.19) in ELSA (eight years) and 201.02 kg·years (SD: 66.24) in SHARE (six years). Significant differences in cumulative handgrip strength across age and sex were found (Supplementary Tables 5–6).
Depressive symptoms increased longitudinally (ELSA: 1.05 to 1.26; SHARE: 1.94 to 2.20) and showed an inverse gradient across cumulative handgrip quartiles. Participants in the lowest quartile exhibited greater symptom increases over time compared to the highest quartile (0.14 vs. 0.23 in ELSA; 0.18 vs. 0.52 in SHARE; Supplementary 7–8).
Participants in the lowest quartile of cumulative handgrip strength had higher depressive symptom scores than those in the highest quartile in both studies (β: 0.191; 95% CI: 0.035, 0.348 in ELSA; β: 0.391; 95% CI: 0.267, 0.514 in SHARE). They also showed an accelerated annual increase in depressive symptoms of 0.040 point/y (95% CI: 0.009, 0.070) in ELSA, and 0.067 point/y (95% CI: 0.045, 0.089; Table 2) in SHARE after controlling for all covariates. Sensitivity analyses adjusting only for sociodemographic/lifestyle covariates yielded similar results (Supplementary Table 9). Significant linear trends across quartiles were observed for depressive symptom acceleration in both cohorts (P for trend ≤ 0.01). Modeling cumulative handgrip strength continuously, each unit decline was associated with an increase in depressive symptoms (β: 0.136; 95% CI: 0.056, 0.216 in ELSA; 0.328; 95% CI: 0.265, 0.391 in SHARE) and accelerated worsening over time (β: 0.012; 95% CI: 0.002, 0.023 in ELSA; 0.010; 95% CI: 0.002, 0.018 in SHARE; Table 2). In the subgroup analyses, we found slight disparitis across age, sex, physical activity, and BMI in the association between cumulative handgrip strength decline and trajectories of depressive symptoms (Table 3).
Table 2.
The association between cumulative handgrip strength and trajectories of depressive symptoms (point/year)
| Countries | Cumulative handgrip strength, kg | Cumulative handgrip strength·years, kg·y | ||
|---|---|---|---|---|
| Coef (95% CI) | P value | Coef (95% CI) | P value | |
| ELSA (UK) | ||||
| Categorical variable | ||||
| Quartile 4 | Ref. | Ref. | ||
| Quartile 3 | −0.003 (−0.147, 0.141) | 0.97 | 0.018 (−0.011, 0.048) | 0.22 |
| Quartile 2 | −0.032 (−0.179, 0.116) | 0.68 | 0.046 (0.016, 0.075) | 0.01 |
| Quartile 1 | 0.191 (0.035, 0.348) | 0.02 | 0.040 (0.009, 0.070) | 0.01 |
| Pfor trenda | 0.09 | 0.01 | ||
| Continuous variable | ||||
| Per SD declineb | 0.136 (0.056, 0.216) | < 0.001 | 0.012 (0.002, 0.023) | 0.02 |
| SHARE (All countries) | ||||
| Categorical variable | ||||
| Quartile 4 | Ref. | Ref. | ||
| Quartile 3 | 0.057 (−0.054, 0.168) | 0.31 | 0.013 (−0.008, 0.034) | 0.24 |
| Quartile 2 | 0.112 (−0.002, 0.226) | 0.06 | 0.034 (0.013, 0.055) | 0.01 |
| Quartile 1 | 0.391 (0.267, 0.514) | < 0.001 | 0.067 (0.045, 0.089) | < 0.001 |
| Pfor trenda | < 0.001 | < 0.001 | ||
| Continuous variable | ||||
| Per SD declineb | 0.328 (0.265, 0.391) | < 0.001 | 0.010 (0.002, 0.018) | 0.01 |
Beta coefficients were estimated using a linear mixed model. All models were adjusted for age (continuous, years), sex (male and female), marital status (single, married, and unknown), education level (low, high, and unknown), physical activity (sedentary behavior, moderate physical activity, vigorous physical activity, and unknown), alcohol drinking (no or light drinking, heavy drinking, and unknown), and cigarette smoking (never, former, and current), BMI (normal weight, overweight, obesity, and unknown), hypertension (yes or no), diabetes (yes or no), stroke (yes or no), heart disease (yes or no), cancer (yes or no), and arthritis (yes or no)
CI Confidence interval, Coef Coefficient, ELSA English Longitudinal Study of Aging, SD standard deviation, SHARE Survey of Health Ageing and Retirement in Europe
a P values for trend were estimated by assigning the median cumulative handgrip strength value for each cumulative handgrip strength quartile and modeling it as a continuous variable
bEstimated as the beta coefficient for standardized cumulative handgrip strength using the z-score
Table 3.
The association between cumulative handgrip strength and trajectories of depressive symptoms (point/year) across subgroups
| Countries | Number | Cumulative handgrip strength, kg | Cumulative handgrip strength·years, kg·y | |||
|---|---|---|---|---|---|---|
| Coef (95% CI) |
P for interactiona |
Coef (95% CI) |
P for interactiona |
|||
| ELSA (UK) | ||||||
| Age, years | 0.01 | 0.24 | ||||
| 50–70 | 1,537 | 0.122 (0.023, 0.221) | 0.001 (−0.013, 0.013) | |||
| ≥ 70 | 1,434 | 0.191 (0.058, 0.325) | 0.013 (−0.005, 0.032) | |||
| Sex | 0.01 | 0.80 | ||||
| Male | 1,355 | 0.064 (−0.031, 0.159) | 0.020 (0.002, 0.038) | |||
| Female | 1,616 | 0.216 (0.056, 0.375) | 0.027 (−0.003, 0.057) | |||
| Physical activity | 0.17 | 0.02 | ||||
| Sedentary behavior | 625 | −0.037 (−0.251, 0.177) | 0.043 (0.013, 0.073) | |||
| Moderate physical activity | 1,461 | 0.208 (0.093, 0.324) | 0.001 (−0.015, 0.017) | |||
| Vigorous physical activity | 885 | 0.140 (0.019, 0.260) | 0.007 (−0.009, 0.023) | |||
| BMI | 0.68 | 0.65 | ||||
| Normal weight | 751 | 0.073 (−0.100, 0.247) | 0.009 (−0.014, 0.031) | |||
| Overweight | 1,242 | 0.058 (−0.057, 0.173) | 0.019 (0.003, 0.034) | |||
| Obesity | 877 | 0.245 (0.091, 0.398) | 0.009 (−0.011, 0.029) | |||
| SHARE (all countries) | ||||||
| Age, years | 0.06 | 0.78 | ||||
| 50–70 | 4,053 | 0.295 (0.217, 0.373) | 0.005 (−0.004, 0.014) | |||
| ≥ 70 | 2,777 | 0.401 (0.294, 0.509) | 0.003 (−0.011, 0.017) | |||
| Sex | 0.01 | 0.61 | ||||
| Male | 3,213 | 0.189 (0.112, 0.265) | 0.035 (0.021, 0.049) | |||
| Female | 3,617 | 0.395 (0.274, 0.517) | 0.041 (0.020, 0.062) | |||
| Physical activity | < 0.001 | 0.70 | ||||
| Sedentary behavior | 756 | 0.740 (0.528, 0.953) | 0.001 (−0.027, 0.029) | |||
| Moderate physical activity | 2,654 | 0.383 (0.276, 0.489) | 0.007 (−0.008, 0.021) | |||
| Vigorous physical activity | 3,420 | 0.179 (0.098, 0.261) | 0.011 (0.001, 0.020) | |||
| BMI | 0.01 | 0.15 | ||||
| Normal weight | 2,596 | 0.261 (0.153, 0.369) | 0.002 (−0.011, 0.015) | |||
| Overweight | 2,883 | 0.287 (0.194, 0.380) | 0.021 (0.009, 0.032) | |||
| Obesity | 1,253 | 0.492 (0.351, 0.632) | 0.009 (−0.008, 0.026) | |||
Estimated as the beta coefficient for standardized cumulative handgrip strength using the z-score
Beta coefficients were estimated using a linear mixed model. All models were adjusted for age (continuous, years), sex (male and female), marital status (single, married, and unknown), education level (low, high, and unknown), physical activity (sedentary behavior, moderate physical activity, vigorous physical activity, and unknown), alcohol drinking (no or light drinking, heavy drinking, and unknown), and cigarette smoking (never, former, and current), BMI (normal weight, overweight, obesity, and unknown), hypertension (yes or no), diabetes (yes or no), stroke (yes or no), heart disease (yes or no), cancer (yes or no), and arthritis (yes or no)
CI Confidence interval, Coef Coefficient, ELSA English Longitudinal Study of Aging, SD standard deviation, SHARE Survey of Health Ageing and Retirement in Europe
a P for interaction was estimated by adding a product term of the stratifying variable and cumulative handgrip strength to the main models and used Wald tests to assess these modification effects
Sensitivity analyses showed some disparities in associations between cumulative handgrip strength and trajectories of depressive symptoms across ten countries in SHARE. Positive associations between cumulative handgrip strength decline and depressive symptoms were found in Belgium, Denmark, France, Italy, Spain, and Sweden, and positive associations between cumulative handgrip strength decline and an accelerated increase in depressive symptoms were found in Spain and Switzerland (Supplementary Table 10). Results remained consistent when we calculated cumulative handgrip strength using the dominant hand's maximun measurement (Supplementary Table 11), when we restricted our analyses to participants with complete follow-up data (Supplementary Table 12), or when we deleted participants with depression (CES-D 8 ≥ 4 or EURO-D ≥ 4) at baseline (Supplementary Table 13).
The association between cumulative handgrip strength and risk of incident depression
A total of 9555 participants (ELSA: n = 3178; SHARE: n = 6377) were included. Baseline characteristics (mean age: 69.70 [SD, 8.20] years; 50.55% men, 31.72% high education level, 12.62% current smokers, 60.18% heavy drinkers, and 44.96% vigorous physical activity) are shown in Table 4. Compared with individuals with higher levels of cumulative handgrip strength, those with lower levels of cumulative handgrip strength tended to be old, single, low education level, non-smokers, light drinkers, have sedentary behavior, have normal weight, have a history of hypertension, diabetes, stroke, heart disease, cancer, and arthritis (All P ≤ 0.01; Supplementary Table 14). The details for each cohort are shown in Supplementary Tables 15–16.
Table 4.
The basic characteristics for the association between cumulative handgrip strength and risk of incident depression
| Characteristic | Total (n = 9555) | ELSA (n = 3178) | SHARE (n = 6377) |
|---|---|---|---|
| Age, years, mean (SD) | 69.70 (8.20) | 71.08 (7.37) | 69.02 (8.50) |
| Sex, male, n (%) | 4830 (50.55) | 1468 (46.19) | 3257 (51.07) |
| Marital status, n (%) | |||
| Married | 6772 (70.87) | 2173 (68.38) | 4599 (72.12) |
| Single | 2648 (27.71) | 1005 (31.62) | 1643 (25.76) |
| Unknown | 135 (1.41) | - | 135 (2.12) |
| Education levels, n (%) | |||
| Low | 6052 (63.34) | 1462 (46.00) | 4590 (71.98) |
| High | 3031 (31.72) | 1288 (40.53) | 1743 (27.33) |
| Unknown | 472 (4.94) | 428 (13.47) | 44 (0.69) |
| Cigarette Smoking, n (%) | |||
| Never smoking | 4275 (44.74) | 1172 (36.88) | 3103 (48.66) |
| Former smoking | 4074 (42.64) | 1759 (55.35) | 2315 (36.30) |
| Current smoking | 1206 (12.62) | 247 (7.77) | 959 (15.04) |
| Alcohol drinking, n (%) | |||
| No or light drinking | 3590 (37.57) | 1076 (33.86) | 2514 (39.42) |
| Heavy drinking | 5750 (60.18) | 1887 (59.38) | 3863 (60.58) |
| Unknown | 215 (2.25) | 215 (6.77) | - |
| Physical activity, n (%) | |||
| Sedentary behavior | 1236 (12.94) | 634 (19.95) | 602 (9.44) |
| Moderate physical activity | 4023 (42.10) | 1584 (49.84) | 2439 (38.25) |
| Vigorous physical activity | 4296 (44.96) | 960 (30.21) | 3336 (52.31) |
| BMI, n (%) | |||
| Normal weight | 3256 (34.08) | 805 (25.33) | 2451 (38.44) |
| Overweight | 4063 (42.52) | 1332 (41.91) | 2731 (42.83) |
| Obesity | 2058 (21.54) | 931 (29.30) | 1127 (17.67) |
| Unknown | 178 (1.86) | 110 (3.46) | 68 (1.07) |
| Hypertension, n (%) | 4206 (44.02) | 1831 (57.61) | 2375 (37.24) |
| Diabetes, n (%) | 1193 (12.49) | 476 (14.98) | 717 (11.24) |
| Stroke, n (%) | 285 (2.98) | 151 (4.75) | 134 (2.10) |
| Heart disease, n (%) | 1000 (10.47) | 337 (10.60) | 663 (10.40) |
| Cancer, n (%) | 386 (4.04) | 170 (5.35) | 216 (3.39) |
| Arthritis, n (%) | 2592 (27.13) | 1356 (42.67) | 1236 (19.38) |
BMI Body mass index, ELSA English Longitudinal Study of Aging, SD standard deviation, SHARE Survey of Health Ageing and Retirement in Europe
The average handgrip strength declined from 31.61 kg in wave 2 to 27.88 kg in wave 6 in the ELSA and 35.58 kg in wave 1 to 33.17 kg in wave 4 in the SHARE, respectively. The older group and females tended to have lower handgrip strength in both cohorts (all P < 0.001). The mean cumulative handgrip strength was 238.21 kg·years (SD: 82.94) in ELSA (eight years) and 206.71 kg·years (SD: 65.52) in SHARE (six years). The older and female groups had lower levels of cumulative handgrip strength (Supplementary Tables 17–18).
The rates of depression increased with the years in ELSA (from 0.00 to 8.23%) and SHARE (from 0.00 to 18.24%). Participants in the lowest quartile of cumulative handgrip strength had higher rates of depression at the end of follow-up than those in the highest quartile (11.28% vs. 5.52% in the ELSA; 28.49% vs. 12.67% in the SHARE; Supplementary 19–20).
A total of 433 and 1611 participants developed incident depression during follow-up in ELSA and SHARE, respectively. The rates of incident depression were 28.41 and 50.85 per 1,000 person-years in participants in ELSA and SHARE. As shown in Table 5, individuals in the lowest quartile of cumulative handgrip strength had 55% (HR, 1.55; 95% CI: 1.13, 2.12 for ELSA) and 62% (HR, 1.62; 95% CI: 1.38, 1.90 for SHARE) higher risk of depression than those in the highest quartile. Significant linear trends existed for the risk of depression across quartiles of cumulative handgrip strength in both cohorts (P for trend ≤ 0.01). We observed no big changes in the sensitivity analyses when we only controlled for sociodemographic/lifestyle covariates (Supplementary Table 21). A 1-SD decline in cumulative handgrip strength was linked with increased HRs of depression in both ELSA (HR, 1.22; 95% CI: 1.02, 1.44) and SHARE (HR: 1.38; 95% CI: 1.27, 1.51). Subgroup analyses ahowed no essential heterogeneities across age, sex, physical activity, and BMI (All P for interaction ≥ 0.06; Table 6).
Table 5.
The association between cumulative handgrip strength and risk of incident depression
| Countries | Case/person years | Cumulative handgrip strength·years, kg·y | |
|---|---|---|---|
| HR (95% CI) | P value | ||
| ELSA (UK) | |||
| Categorical variable | |||
| Quartile 4 | 74/4153 | Ref. | |
| Quartile 3 | 99/3882 | 1.36 (1.01, 1.85) | 0.04 |
| Quartile 2 | 119/3853 | 1.44 (1.06, 1.94) | 0.02 |
| Quartile 1 | 141/3352 | 1.55 (1.13, 2.12) | 0.01 |
| P for trenda | 0.01 | ||
| Continuous variable | |||
| Per SD declineb | 433/15,240 | 1.22 (1.02, 1.44) | 0.02 |
| SHARE (All countries) | |||
| Categorical variable | |||
| Quartile 4 | 317/8709 | Ref. | - |
| Quartile 3 | 340/8204 | 1.10 (0.94, 1.28) | 0.24 |
| Quartile 2 | 432/8064 | 1.32 (1.13, 1.53) | < 0.001 |
| Quartile 1 | 522/6703 | 1.62 (1.38, 1.90) | < 0.001 |
| P for trenda | - | < 0.001 | - |
| Continuous variable | |||
| Per SD declineb | 1611/31,680 | 1.38 (1.27, 1.51) | < 0.001 |
HRs were estimated using a Cox regression model. All models were adjusted for age (continuous, years), sex (male and female), marital status (single, married, and unknown), education level (low, high, and unknown), physical activity (sedentary behavior, moderate physical activity, vigorous physical activity, and unknown), alcohol drinking (no or light drinking, heavy drinking, and unknown), and cigarette smoking (never, former, and current), BMI (normal weight, overweight, obesity, and unknown), hypertension (yes or no), diabetes (yes or no), stroke (yes or no), heart disease (yes or no), cancer (yes or no), and arthritis (yes or no)
CI Confidence interval, ELSA English Longitudinal Study of Aging, HR Hazard ratio, SD Standard deviation; SHARE Survey of Health Ageing and Retirement in Europe
aP values for trend were estimated by assigning the median cumulative handgrip strength value for each cumulative handgrip strength quartile and modeling it as a continuous variable
bEstimated as the HRs for standardized cumulative handgrip strength using the z-score
Table 6.
The association between cumulative handgrip strength and risk of incident depression across subgroups
| Countries | Case/person years | Cumulative handgrip strength·year, kg·y | ||
|---|---|---|---|---|
| HR (95% CI) | P for interactiona | |||
| ELSA (UK) | ||||
| Age, years | 0.64 | |||
| 50–70 | 185/8508 | 1.26 (0.99, 1.61) | ||
| ≥ 70 | 248/6732 | 1.19 (0.94, 1.50) | ||
| Sex | 0.99 | |||
| Male | 129/7233 | 1.23 (0.95, 1.59) | ||
| Female | 304/8007 | 1.24 (0.98, 1.57) | ||
| Physical activity | 0.22 | |||
| Sedentary behavior | 125/2635 | 1.18 (0.87, 1.59) | ||
| Moderate physical activity | 221/7674 | 1.25 (0.97, 1.61) | ||
| Vigorous physical activity | 87/4931 | 1.36 (0.92, 2.00) | ||
| BMI | 0.72 | |||
| < 25 kg/m2 | 91/3834 | 1.06 (0.70, 1.59) | ||
| 25–30 kg/m2 | 168/6553 | 1.18 (0.91, 1.53) | ||
| >30 kg/m2 | 156/4441 | 1.34 (1.00, 1.79) | ||
| SHARE (All countries) | ||||
| Age, years | 0.06 | |||
| 50–70 | 877/20,258 | 1.40 (1.25, 1.58) | ||
| ≥ 70 | 734/11,422 | 1.31 (1.14, 1.50) | ||
| Sex | 0.92 | |||
| Male | 657/16,648 | 1.31 (1.17, 1.48) | ||
| Female | 954/15,032 | 1.42 (1.23, 1.63) | ||
| Physical activity | 0.89 | |||
| Sedentary behavior | 205/2405 | 1.36 (1.08, 1.71) | ||
| Moderate physical activity | 685/11,546 | 1.50 (1.31, 1.73) | ||
| Vigorous physical activity | 721/17,729 | 1.29 (1.12, 1.47) | ||
| BMI | 0.98 | |||
| Normal weight | 578/12,030 | 1.29 (1.10, 1.51) | ||
| Overweight | 688/13,765 | 1.41 (1.24, 1.61) | ||
| Obesity | 322/5552 | 1.41 (1.17, 1.70) | ||
Estimated as the HRs for standardized cumulative handgrip strength using the z-score
HRs were estimated using a Cox regression model. All models were adjusted for age (continuous, years), sex (male and female), marital status (single, married, and unknown), education level (low, high, and unknown), physical activity (sedentary behavior, moderate physical activity, vigorous physical activity, and unknown), alcohol drinking (no or light drinking, heavy drinking, and unknown), and cigarette smoking (never, former, and current), BMI (normal weight, overweight, obesity, and unknown), hypertension (yes or no), diabetes (yes or no), stroke (yes or no), heart disease (yes or no), cancer (yes or no), and arthritis (yes or no)
CI Confidence interval, ELSA English Longitudinal Study of Aging, HR Hazard ratio, SD Standard deviation, SHARE Survey of Health Ageing and Retirement in Europe
aP for interaction was estimated by adding a product term of the stratifying variable and cumulative handgrip strength to the main models and used Wald tests to assess these modification effects
Sensitivity analyses identified heterogeneity in associations between cumulative handgrip strength decline and risk of incident depression across ten countries in SHARE, with positive associations observed in France, Italy, Spain, and Switzerland (Supplementary Table 22). Results were robust when using the maximum dominant handgrip strength (Supplementary Table 23).
Discussion
Using repeated measurements of handgrip strength and depressive symptoms from two prospective cohorts, we extended evidence on handgrip strength-depression relationship by accounting for cumulative exposure effects of handgrip strength. Lower cumulative handgrip strength was associated with an accelerated increase in depressive symptoms and higher incident depression risk in adults aged ≥ 50 years.
Similar to previous findings from other Western populations [32], the mean handgrip strength in our study was higher than that of the evidence from Asian populations [33, 34]. Differences in anthropometry, participants’ age, and dynamometers might explain these disparities. We found significant differences in handgrip strength across age and sex. Consistently, a Korean study (n = 2378, adults aged ≥ 65 years) reported the mean handgrip strength was 19.2 kg (females) and 30.7 kg (males) [35]. Another study recruited 5877 American adults and found that handgrip strength of males was stronger and that handgrip strength decreased with age [32].
To our knowledge, this is the first study linking cumulative handgrip strength to incident depression risk. Our study found that individuals in the lowest quartile of cumulative handgrip strength had higher rates of depression during follow-up than those in the highest quartile in both ELSA and SHARE. Results from regression models further confirmed that exposure to lower cumulative handgrip strength was associated with elevated incident depression risk. Prior studies mainly focused on the predictive value of baseline handgrip strength on incident elevated depressive symptoms/or depression [36]. For example, a recent meta-analysis included eight cohort studies involving 30,727 individuals from eight countries and suggested that higher handgrip strength was related to a decreased risk of incident elevated depressive symptoms (RR: 0.74; 95% CI: 0.65, 0.85) [37]. Similar results have also been reported in another meta-analysis [38]. A recent cohort study recruited 17,713 aging Americans from the Health and Retirement Study and revealed that a 5 kg decrease in handgrip strength was associated with a 6% (95% CI: 3%, 9%) increased risk of depression [39]. Consistently, a Mendelian study demonstrated that increased left-handgrip strength correlated with reduced risk of major depressive disorder [16]. However, handgrip strength is a time-varying variable. Our study suggested that handgrip strength declined over the years, but the decline might be different across individuals. Thus, single handgrip strength measurement cannot reflect the long-term cumulative effects of muscle functionality. Our study prospectively collected repeated measurements of handgrip strength from 11 countries, including the United Kingdom and ten European countries, and robustly demonstrated a positive association between long-term cumulative handgrip strength decline and risk of incident depression. Handgrip strength, as a simple, low-cost, and invasive tool, has been suggested as a predictor of overall muscular strength [11] and has been widely used in previous studies to assess overall muscular strength [13, 37]. However, other measurements, such as knee extension strength, should be used to warrant the positive association between muscular strength decline and depression in the near future.
Given the time-varying nature of depressive symptoms, our study also explored the effect of cumulative handgrip strength on long-term changes in depressive symptoms. We observed that lower cumulative handgrip strength was related to an accelerated increase in depressive symptoms over time. This might partially explain the prospective positive link between cumulative handgrip strength decline and incident depression. Consistently, a recent study conducted on 6783 Korean individuals from the Korean Longitudinal Study of Aging found a 2-year handgrip strength decline was linked with an increase in depressive symptoms (β:−0.017 for men; −0.020 for women) [40]. However, this study had some limitations, including a relatively short time (two years) for measuring changes in handgrip strength and limited generalizability of results (only Korean populations). Our study assessed the cumulative handgrip strength over six or eight years and expanded to individuals from Europe and the United Kingdom.
The evidence of the associations between handgrip strength and depressive symptoms across sex gained increased attention, and the results were controversial. Our results suggested the association between cumulative handgrip strength and long-term changes in depressive symptoms was slightly stronger in females than in males in two cohorts, while no heterogeneities were found across sex in terms of the association between cumulative handgrip strength and risk of incident depression. These disparities have been widely reported in previous studies. A study conducted on 24,109 Chinese adults found that the inverse association between baseline handgrip strength and depressive symptoms was stronger in females than in males [41]. All results suggested that strength/muscular fitness should be enhanced in females as they can benefit more from improving handgrip strength. However, another study from China demonstrated this association is stronger in males [36]. The results of the associations between handgrip strength and depressive symptoms across age were disparities in two cohort studies. The association between cumulative handgrip strength and long-term changes in depressive symptoms was slightly stronger in individuals aged ≥ 70 than in those aged 50–70 years old in ELSA, but not in SHARE. The reasons for these disparities across sex and age were unknown; more epidemiological and animal experiments should be explored in the future.
The mechanisms underlying the association between cumulative handgrip strength and elevated depressive symptoms are evolving, and some possible explanations have been suggested. Previous studies suggested a common genetic basis between grip strength and depression. A recent study suggested that rs117744620, located in the LRR1 gene on chromosome 14, was a shared gene [42]. LRR1 regulates 4-1BB-mediated signaling cascades, which lead to NF-кB activation, and increases the risk of developing depression. In addition, LRR1 could affect actin and have an impact on muscle strength [43]. Second, chronic low-grade inflammation (i.e., interleukin [IL]−6, IL-1, tumor necrosis factor-α, or C-reactive protein) and oxidative stress contribute to both depression pathophysiology [44], and reduced grip strength [45]. Third, skeletal muscle works as an endocrine organ, which can produce myokines, such as brain-derived neurotrophic factor and nerve growth factor, in response to exercise [46]. Previous evidence demonstrated these myokines played an important role in the pathophysiology of depression [47]. Fourth, engaging in physical activity could promote self-esteem, social support, and self-efficacy, which could reduce depressive symptoms [48]. Individuals who had greater handgrip strength usually had higher PA levels, resulting in decreased depressive symptoms.
Clinical and public health implications
Combined with previous evidence, the positive association between lower cumulative handgrip strength/or baseline handgrip strength and depressive symptoms could provide a simple, low-cost, and non-invasive method to identify populations at great risk for depression. Our findings propose incorporating dynamic handgrip strength assessments into mental health screening protocols. This recommendation aligns with previous evidence demonstrating that muscle-strengthening physical activity constitutes an effective measure against later-life depression, as muscle-strengthening exercise can promote muscle strength and further reduce depression [49–51]. Meanwhile, a meta-analysis of randomized controlled trials further demonstrated that concurrent use of resistance training was essential for protein supplementation to improve muscle strength [52]. Thus, public health campaigns and policies targeting mental health promotion should emphasize the importance of sustainable muscular fitness development through integrated programs incorporating both exercise regimens and nutritional support.
Strengths and limitations
A key strength of this study lies in two large population-based prospective cohort studies spanning 11 countries, provide robust evidence on the relationship between cumulative handgrip strength and depressive symptoms. Our longitudinal design—featuring repeated measurements—represents the first examination of cumulative handgrip strength to depressive symptoms trajectories. Furthermore, we adjusted various potential confounding factors, including socio-demographic characteristics, lifestyle factors, and chronic diseases. Despite this, several limitations of our study warrant mention. First, despite adjusting for several key covariates, certain unmeasured confounding factors—notably nutrition status—that could influence the relationships, could not be incorporated due to data limitations. Second, while handgrip strength provides a validated measure of upper body muscular strength, further investigations should incorporate complementary metrics such as chair-rising time to assess lower limb muscle strength. Third, the reliance on self-reported depressive symptom questionnaires rather than clinician-administered diagnostic interviews introduces potential measurement bias. Fourth, given that the participants with dementia or Alzheimer’s disease may have difficulty reporting depressive symptoms, thus, our study excluded individuals with dementia or Alzheimer’s disease. This limited the generalizability of our results to individuals with dementia or Alzheimer’s disease.
Conclusions
This study first showed that exposure to low levels of cumulative handgrip strength was associated with an accelerated increase in depressive symptoms and a higher risk of incident depression. Future interventional studies should further investigate if strength/muscular fitness can improve mental health, especially among older adults.
Supplementary Information
Acknowledgements
The authors thank the original data creators, depositors, copyright holders, the funders of the Data Collections for using data from the English Longitudinal Study of Ageing and the Survey of Health, Aging and Retirement in Europe.
Abbreviations
- CES-D
Epidemiologic Studies Depression Scale
- ELSA
The English Longitudinal Study of Ageing
- EURO-D
The European-depression
- HR
Hazard ratio
- RR
Relative risk ratio
- SHARE
The Survey of Health, Ageing and Retirement in Europe
Authors’ contributions
Qingping Xue conceived and designed the study, supervised the statistical analyses, wrote the first draft of the manuscript, contributed to the interpretation of the results and critically revised the manuscript.Kuifang Guo contributed to the study concept and designed the study, supervised the statistical analyses, contributed to the interpretation of the results and critically revised the manuscript.Xue Yang, Jieru Peng, Mei Xiong, Yachao Li, and Yang Gao conceived and designed the study, contributed to the interpretation of the data and critically revised the manuscript.All authors read and approved the final version, and no other person contributed substantially to the paper.
Funding
This work was supported by supported by the National Natural Science Foundation of China (Grant No. 72204031), Sichuan Applied Psychology Research Center (No. CSXL-24212), and Chengdu Medical College School Fund (No. CYS18-02).
Data availability
The database used and analyzed during the current study cannot be publicly available due to the application restrictions imposed by the ELSA and SHARE data.
Declarations
Ethics approval and consent to participate
ELSA was approved by the London Multicenter Research Ethics Committee (MREC/01/2/91). The Ethics Committee of the University of Mannheim obtained ethical approval of SHARE from the first to fourth waves. In 2018, the Ethics Council of the Max Planck Society reviewed and approved the fourth and subsequent waves of the SHARE project.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the global burden of disease study 2017. Lancet. 2018;392(10159):1789–858. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3(11):e442. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Graham EA, Deschenes SS, Khalil MN, Danna S, Filion KB, Schmitz N. Measures of depression and risk of type 2 diabetes: a systematic review and meta-analysis. J Affect Disord. 2020;265:224–32. [DOI] [PubMed] [Google Scholar]
- 4.Harshfield EL, Pennells L, Schwartz JE, Willeit P, Kaptoge S, Bell S, Shaffer JA, Bolton T, Spackman S, Wassertheil-Smoller S. Association between depressive symptoms and incident cardiovascular diseases. JAMA. 2020;324(23):2396–405. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Xue Q, Pan A, Gong J, Wen Y, Peng X, Pan J, Pan X-F. Association between arthritis and depression risk: a prospective study and meta-analysis. J Affect Disord. 2020;273:493–9. [DOI] [PubMed] [Google Scholar]
- 6.Jakobsen LH, Rask IK, Kondrup J. Validation of handgrip strength and endurance as a measure of physical function and quality of life in healthy subjects and patients. Nutrition. 2010;26(5):542–50. [DOI] [PubMed] [Google Scholar]
- 7.Shaughnessy KA, Hackney KJ, Clark BC, Kraemer WJ, Terbizan DJ, Bailey RR, McGrath R. A narrative review of handgrip strength and cognitive functioning: bringing a new characteristic to muscle memory. J Alzheimers Dis. 2020;73(4):1265–78. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Hallgren M, Owen N, Stubbs B, Vancampfort D, Lundin A, Dunstan D, Bellocco R, Lagerros YT. Cross-sectional and prospective relationships of passive and mentally active sedentary behaviours and physical activity with depression. Br J Psychiatry. 2020;217(2):413–9. [DOI] [PubMed] [Google Scholar]
- 9.Agudelo LZ, Femenía T, Orhan F, Porsmyr-Palmertz M, Goiny M, Martinez-Redondo V, Correia JC, Izadi M, Bhat M, Schuppe-Koistinen I. Skeletal muscle PGC-1α1 modulates kynurenine metabolism and mediates resilience to stress-induced depression. Cell. 2014;159(1):33–45. [DOI] [PubMed] [Google Scholar]
- 10.Allison DJ, Nederveen JP, Snijders T, Bell KE, Kumbhare D, Phillips SM, Parise G, Heisz JJ. Exercise training impacts skeletal muscle gene expression related to the kynurenine pathway. Am J Physiol-Cell Physiol. 2019. 10.1152/ajpcell.00448.2018. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Vaida S, Nariya DM. Handgrip strength as a predictor of muscular strength and endurance: a cross-sectional study. J Clin Diagn Res. 2021;15(1):YC01–4.
- 12.Wang J, Zhou X, Qiu S, Deng L, Li J, Yang L, Wei Q, Dong B. The association between grip strength and depression among adults aged 60 years and older: a large-scaled population-based study from the longitudinal aging study in India. Front Aging Neurosci. 2022;14:937087. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Bohannon RW. Grip strength: an indispensable biomarker for older adults. Clin Interv Aging. 2019;14:1681–91. 10.2147/CIA.S194543. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Zhao Z, Ji C, Liu Y, Gao S, Xia Y. Higher handgrip strength predicts a lower risk of depressive symptoms in rural Chinese populations. J Affect Disord. 2020;269:12–7. [DOI] [PubMed] [Google Scholar]
- 15.McDowell CP, Gordon BR, Herring MP. Sex-related differences in the association between grip strength and depression: results from the Irish longitudinal study on ageing. Exp Gerontol. 2018;104:147–52. [DOI] [PubMed] [Google Scholar]
- 16.Li N, Zhou R, Zhang B. Handgrip strength and the risk of major depressive disorder: a two-sample Mendelian randomisation study. Gen Psychiatry. 2022;35(5):e100807. 10.1136/gpsych-2022-100807. [DOI] [PMC free article] [PubMed]
- 17.Beenakker KGM, Ling CH, Meskers CGM, Craen AJMD, Stijnen T, Westendorp RGJ, Maier AB. Patterns of muscle strength loss with age in the general population and patients with a chronic inflammatory state. Ageing Res Rev. 2010;9(4):431–6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Bilajac L, Juraga D, Zuljevic H, Glavi MM, Rukavina T. The influence of physical activity on handgrip strength of elderly. Arch Gerontol Geriatr Res. 2019;4(1):020–4.
- 19.Börsch-Supan A, Brandt M, Hunkler C, Kneip T, Korbmacher J, Malter F, Schaan B, Stuck S, Zuber S. Data resource profile: the survey of health, ageing and retirement in Europe (SHARE). Int J Epidemiol. 2013;42(4):992–1001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Steptoe A, Breeze E, Banks J, Nazroo J. Cohort profile: the English longitudinal study of ageing. Int J Epidemiol. 2013;42(6):1640–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Li Y, Zhu L, Zhang C, Zhao H, Wang W, Guo L, Lu CJIA. The grip strength loss rate and the subsequent cognitive decline rate in older adults: the moderating role of social isolation. Innov Aging. 2024;8(8):igae055. 10.1093/geroni/igae055. [DOI] [PMC free article] [PubMed]
- 22.López-Bueno R, Calatayud J, Andersen LL, Casaña J, Koyanagi A, del Pozo Cruz B, Smith L. Dose–response association of handgrip strength and risk of depression: a longitudinal study of 115 601 older adults from 24 countries. Br J Psychiatry. 2023;222(3):135–42. [DOI] [PMC free article] [PubMed]
- 23.Maniscalco L, Veronese N, Ragusa FS, Vernuccio L, Dominguez LJ, Smith L, Matranga D, Barbagallo M. Sarcopenia using muscle mass prediction model and cognitive impairment: A longitudinal analysis from the English longitudinal study on ageing. Arch Gerontol Geriatr. 2024;117: 105160. [DOI] [PubMed] [Google Scholar]
- 24.Hamer M, Batty GD, Kivimaki M. Sarcopenic obesity and risk of new onset depressive symptoms in older adults: English longitudinal study of ageing. Int J Obes. 2015;39(12):1717–20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Qiu S, Cai X, Liang Y, Chen W, Wang D, Sun Z, Xie B, Wu T. Cumulative muscle strength and risk of diabetes: A prospective cohort study with mediation analysis. Diabetes Res Clin Pract. 2023;197:110562. [DOI] [PubMed] [Google Scholar]
- 26.Castro-Costa E, Dewey M, Stewart R, Banerjee S, Huppert F, Mendonca‐Lima C, Bula C, Reisches F, Wancata J, Ritchie K, The SHARE project. Ascertaining late‐life depressive symptoms in europe: an evaluation of the survey version of the EURO‐D scale in 10 nations. Int J Methods Psychiatr Res. 2008;17(1):12–29. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Guerra M, Ferri C, Llibre J, Prina AM, Prince M. Psychometric properties of EURO-D, a geriatric depression scale: a cross-cultural validation study. BMC Psychiatry. 2015;15(1):1–14. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401. [Google Scholar]
- 29.Turvey CL, Wallace RB, Herzog R. A revised CES-D measure of depressive symptoms and a DSM-based measure of major depressive episodes in the elderly. Int Psychogeriatr. 1999;11(2):139–48. [DOI] [PubMed] [Google Scholar]
- 30.Han FF, Wang HX, Wu JJ, Yao W, Hao CF, Pei JJ. Depressive symptoms and cognitive impairment: a 10-year follow-up study from the survey of health, ageing and retirement in Europe. Eur Psychiatry. 2021;64(1):e55. [DOI] [PMC free article] [PubMed]
- 31.Veronese N, Solmi M, Maggi S, Noale M, Sergi G, Manzato E, Prina AM, Fornaro M, Carvalho AF, Stubbs B. Frailty and incident depression in community-dwelling older people: results from the ELSA study. Int J Geriatr Psychiatry. 2017;32(12):e141-9. [DOI] [PubMed] [Google Scholar]
- 32.Yorke AM, Curtis AB, Shoemaker M, Vangsnes EJJ. Grip strength values stratified by age, gender, and chronic disease status in adults aged 50 years and older. J Geriatr Phys Ther. 2015;38(3):115–21. [DOI] [PubMed] [Google Scholar]
- 33.Ong HL, Abdin E, Chua BY, Zhang Y, Seow E, Vaingankar JA, Chong SA, Subramaniam M. Hand grip strength among older adults in Singapore: a comparison with international norms and associative factors. BMC Geriatr. 2017;17:1–11. [DOI] [PMC free article] [PubMed]
- 34.Pan PJ, Lin CH, Yang NP, Chen HC, Tsao HM, Chou P Hsu NW. Normative data and associated factors of hand grip strength among elderly individuals: the Yilan study. Sci Rep. 2020;10(1):6611. [DOI] [PMC free article] [PubMed]
- 35.Kim KH, Park SK, Lee DR, Lee J. The relationship between handgrip strength and cognitive function in elderly Koreans over 8 years: a prospective population-based study using Korean longitudinal study of ageing. Korean J Fam Med. 2018;40(1):9–15. [DOI] [PMC free article] [PubMed]
- 36.Lian Y, Wang GP, Chen GQ, Jia CX. Bidirectional associations between handgrip strength and depressive symptoms: a longitudinal cohort study. J Am Med Dir Assoc. 2021;22(8):1744–50. e1. [DOI] [PubMed]
- 37.Huang X, Ma J, Ying Y, Liu K, Jing C, Hao G. The handgrip strength and risk of depressive symptoms: a meta-analysis of prospective cohort studies. Qual Life Res. 2021;30(9):2467–74. [DOI] [PubMed] [Google Scholar]
- 38.Zasadzka E, Pieczyńska A, Trzmiel T, Kleka P, Pawlaczyk M. Correlation between handgrip strength and depression in older adults—a systematic review and a meta-analysis. Int J Environ Res Public Health. 2021;18(9): 4823. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 39.Luo J, Yao W, Zhang T, Ge H, Zhang D. Exploring the bidirectional associations between handgrip strength and depression in middle and older Americans. J Psychosom Res. 2022;152:110678. [DOI] [PubMed] [Google Scholar]
- 40.Kim H, Jeong W, Kim SH, Park YS, Jang SI, Park EC. Association between changes in handgrip strength and depression in Korean adults: a longitudinal panel study. Sci Rep. 2022;12(1):13643. [DOI] [PMC free article] [PubMed]
- 41.Gu Y, Li X, Zhang Q, Liu L, Meng G, Wu H, Zhang S, Wang Y, Zhang T, Wang X. Grip strength and depressive symptoms in a large-scale adult population: the TCLSIH cohort study. J Affect Disord. 2021;279:222–8. [DOI] [PubMed] [Google Scholar]
- 42.Zhang T, Ji L, Luo J, Wang W, Tian X, Duan H, Xu C, Zhang D. A genetic correlation and bivariate genome-wide association study of grip strength and depression. PLoS One. 2022;17(12):e0278392. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 43.Ganipineni VDP, Idavalapati ASKK, Tamalapakula SS, Moparthi V, Potru M, Owolabi OJ. Depression and hand-grip: unraveling the association. Cureus. 2023;15(5):e38632. [DOI] [PMC free article] [PubMed]
- 44.Nobis A, Zalewski D, Waszkiewicz N. Peripheral markers of depression. J Clin Med. 2020;9(12):3793. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 45.Westbury L, Fuggle N, Syddall HE, Duggal N, Shaw S, Maslin K, Dennison E, Lord J, Cooper C. Relationships between markers of inflammation and muscle mass, strength and function: findings from the Hertfordshire cohort study. Calcif Tissue Int. 2018;102:287–95. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 46.Severinsen MCK, Pedersen BK. Muscle–organ crosstalk: the emerging roles of myokines. Endocr Rev. 2020;41(4):594–609. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 47.Mondal AC, Fatima M. Direct and indirect evidences of BDNF and NGF as key modulators in depression: role of antidepressants treatment. Int J Neurosci. 2019;129(3):283–96. [DOI] [PubMed] [Google Scholar]
- 48.Miller KJ, Mesagno C, McLaren S, Grace F, Yates M, Gomez R. Exercise, mood, self-efficacy, and social support as predictors of depressive symptoms in older adults: direct and interaction effects. Front Psychol. 2019;10:2145. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 49.Kong J-Y, Hong H, Kang H. Relationship between physical activity and depressive symptoms in older Korean adults: moderation analysis of muscular strength. BMC Geriatr. 2022;22(1):884. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 50.Shi J, Gao M, Xu X, Zhang X, Yan J. Associations of muscle-strengthening exercise with overweight, obesity, and depressive symptoms in adolescents: findings from 2019 youth risk behavior surveillance system. Front Psychol. 2022;13:980076. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 51.Bennie JA, Teychenne M, Tittlbach S. Muscle-strengthening exercise and depressive symptom severity among a nationally representative sample of 23,635 German adults. J Affect Disord. 2020;266:282–7. [DOI] [PubMed] [Google Scholar]
- 52.Tagawa R, Watanabe D, Ito K, Otsuyama T, Nakayama K, Sanbongi C, Miyachi M. Synergistic effect of increased total protein intake and strength training on muscle strength: a dose-response meta-analysis of randomized controlled trials. Sports Medicine-Open. 2022;8(1):1–12. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The database used and analyzed during the current study cannot be publicly available due to the application restrictions imposed by the ELSA and SHARE data.