Elsevier

Experimental Gerontology

Volume 104, April 2018, Pages 147-152
Experimental Gerontology

Sex-related differences in the association between grip strength and depression: Results from the Irish Longitudinal Study on Ageing

https://doi.org/10.1016/j.exger.2018.02.010Get rights and content

Highlights

  • Grip strength was inversely associated with prevalent and incident depression

  • Stronger prospective associations were observed among females than males

  • Smokers, respondents diagnosed with an illness, and those aged 70-79 and 80+ years were most likely to report lowest strength

Abstract

Muscular strength is a modifiable protective factor for mental health across aging populations. Evidence of sex-related differences in its associations with mental health is limited. Therefore, the purpose of this study was to examine sex-related differences in cross-sectional and prospective associations between grip strength and depressive symptoms and status. Participants were community dwelling adults (N = 4505; 56.5% female), aged ≥50 years. As a measure of muscular strength, grip strength (kg) of the dominant hand was assessed using a hand-held dynamometer at baseline. Participants were divided into sex-specific tertiles. The Center for Epidemiological Studies Depression Scale assessed depressive symptoms at baseline and two years later; a score of ≥16 defined caseness of depression. Depressive symptoms were significantly higher among females at baseline (p < 0.001). Prospective models were adjusted for age, sex, waist circumference, social class, smoking, and health status. Among males, the middle and high strength tertiles were non-significantly associated with 32.9% (p = 0.21) and 9.9% (p = 0.74) reduced odds of developing depression, respectively. Among females, the middle and high strength tertiles were non-significantly associated with 28.5% (p = 0.13) and significantly associated with 43.4% (p = 0.01) reduced odds of developing depression, respectively. In the total sample, the middle and high strength tertiles were significantly associated with 31.5% (p = 0.04) and 34.1% (p = 0.02) reduced odds of developing depression, respectively. The interaction between sex and strength was not statistically significant (p = 0.25). The present findings indicated that grip strength was inversely associated with incident depression in older adults, with stronger associations observed among females than males.

Introduction

Depression is identified by the World Health Organization (WHO) as one of the greatest contributors to overall global disease burden, affecting an estimated 350 million people worldwide (WHO, 2012). Depression is a critically important public health problem, particularly among older adults, that is associated with an increased risk of morbidity and suicide (Chapman and Perry, 2008) and decreased physical, social, and cognitive functioning (Blazer, 2003). Additionally, the financial burden associated with depression continues to grow, accounting for at least 1% of the total European economy (Sobocki et al., 2006).

Despite the clear negative consequences of depression, just 56.4% of 12-month cases of DSM-IV mood disorders had received some treatment in the past 12 months (Wang et al., 2005b); however, the vast majority of people with lifetime disorders eventually make treatment contact (Wang et al., 2005a). Among those who do make treatment contact, delays range from six to eight years (Wang et al., 2005a), depression persists in approximately 70% after first-line treatment, and at least 30% remain depressed after four rounds of distinct treatments (Gaynes et al., 2008). Thus, there is a continued need to identify risk factors for depression that can be targeted for prevention.

Engagement in physical activity has been associated with the prevention of late-life depression (Chang et al., 2016), although most examinations of the protective effects of specific physical activity modes focus on aerobic exercise (e.g., walking) and not resistance exercise. On the basis that the quantification of cardiorespiratory fitness is more objective than physical activity, there has been some interest in the predictive role of aerobic fitness for depression (Åberg et al., 2012; Sui et al., 2009). Similarly, research has examined the benefits of maintaining strength, as measured by grip strength, in older age (Arvandi et al., 2016; Peterson et al., 2017). Grip-strength tests are convenient, safe, and reliable, do not require large or expensive equipment, and minimise the burden placed on participants (Leong et al., 2015). Consequently, they are commonly used as an indicator of muscular strength (Bohannon, 2008; Cooper et al., 2010). Grip strength has predicted cardiometabolic disease risk, physical disabilities, and mortality in older adults (Arvandi et al., 2016; Peterson et al., 2017). Some studies have demonstrated the protective influence of grip strength on depression and depressive symptoms (Fukumori et al., 2015; Hamer et al., 2015; Taekema et al., 2010; Veronese et al., 2017), with stronger associations reported among females than males (Veronese et al., 2017); however, these sex-related findings were derived from somewhat small sample sizes and, as the data analysed were collected over 20-years ago, there is a need to demonstrate the replicability of these findings using more recent data from larger population samples.

Therefore, the key objectives of the study reported here was to investigate (1) associations between grip strength and both concurrent depressive symptoms and depression status and the development of depressive symptoms and depression two-years later, and (2) sex-related differences in these associations using data from the Irish Longitudinal Study on Ageing (TILDA). It was hypothesised that grip strength would be associated with lower odds of depression, and this association would be stronger among females than males.

Section snippets

Methods

This study used STROBE recommendations to guide reporting (Von Elm et al., 2008).

Participant characteristics

Compared to the analytic sample, a significantly greater proportion of excluded respondents were aged 50–59 years (47.0% vs 41.2%), smokers (17.2% vs 14.5%), and healthy (43.0% vs 36.3%; all p < 0.05). Excluded males were stronger than included males (2.41 kg, 95%CI: 1.54 to 3.28), and excluded females were stronger than included females (2.53 kg, 95%CI: 1.96 to 3.10). There were no significant differences in waist circumference, smoking status, and depression status.

Baseline participant

Discussion

This study investigated the association between grip strength and concurrent and subsequent development of depressive symptoms and depression status in a large, nationally-representative cohort of older Irish adults. Approximately 8.9% of the current sample reported depression, supporting previous findings among Irish adults (Gallagher and Hannigan, 2014). Consistent with previous reports, higher rates of depression were observed among females (11.1%) than males (6.1%). The key findings of the

Conclusion

The findings of the present study indicated that grip strength was inversely associated with depression in older adults. These findings reiterate the importance of maintaining strength levels in later life, with potentially greater benefits for depression found among females than males.

Acknowledgements

The authors disclose no conflicts of interest. The TILDA study was supported by the Irish Government, the Atlantic Philanthropies, and Irish Life PLC. This work was also supported by the Health Research Board (Grant reference: HRA_PHS/2012/30). The sponsors played no role in study design, methods, subject recruitment, data collection, analysis or preparation of the paper.

References (43)

  • A. Barrett et al.

    Fifty Plus in Ireland 2011: First Results From the Irish Longitudinal Study on Ageing (TILDA)

    (2011)
  • A. Beekman et al.

    Criterion validity of the Center for Epidemiologic Studies Depression scale (CES-D): results from a community-based sample of older subjects in the Netherlands

    Psychol. Med.

    (1997)
  • D.G. Blazer

    Depression in late life: review and commentary

    J. Gerontol. Ser. A Biol. Med. Sci.

    (2003)
  • R.W. Bohannon

    Hand-grip dynamometry predicts future outcomes in aging adults

    J. Geriatr. Phys. Ther.

    (2008)
  • J.D. Carter et al.

    Sustained obesity and depressive symptoms over 6 years: race by gender differences in the health and retirement study

    Front. Aging Neurosci.

    (2016)
  • D.P. Chapman et al.

    Depression as a major component of public health for older adults

    Prev. Chronic Dis.

    (2008)
  • J. Cohen

    A power primer

    Psychol. Bull.

    (1992)
  • R. Cooper et al.

    Objectively measured physical capability levels and mortality: systematic review and meta-analysis

    Br. Med. J.

    (2010)
  • G. Cumming

    The new statistics: why and how

    Psychol. Sci.

    (2014)
  • M. Da Boit et al.

    Sex differences in the response to resistance exercise training in older people

    Physiol. Rep.

    (2016)
  • J.C. Davis et al.

    Sustained cognitive and economic benefits of resistance training among community-dwelling senior women: a 1-year follow-up study of the brain power study

    Arch. Intern. Med.

    (2010)
  • Cited by (44)

    • Associations between changes in physical fitness and psychological difficulties status among Norwegian adolescents

      2021, Mental Health and Physical Activity
      Citation Excerpt :

      The existing evidence suggests that having a lower body mass index (BMI) and preventing CRF from declining is prospectively associated with lower odds of depression (Bjerkeset, Romundstad, Evans, & Gunnell, 2008; Dishman et al., 2012; Shigdel, Stubbs, Sui, & Ernstsen, 2019). Regarding muscular strength, a recent study indicated that grip strength is associated with lower odds for developing depression, for females only (McDowell, Gordon, & Herring, 2018). In the context of physical fitness and mental health research, adolescents are an understudied population.

    View all citing articles on Scopus
    View full text