Association Of Physical Performance With Depressive Symptoms In Middle Aged And Old Adults

Aim:Depressive symptoms is a common mental disease among middle-aged and elderly people.The frequent dangerous behaviors induced,such as self-injury and suicide,lead to the increased rate of disability and mortality.At the same time,the economic burden caused by depression treatment and the mental stress caused by disease attack reduced the quality of life of individual and family.With the aging of the global population,depression in middle-aged and elderly adults has become one of the main public health problems in the world.Previous studies have shown that physical performance was associated with depressive symptoms,but fewer studies with large sample and on causal associations.Based on the data from large international databases,this study will evaluate the association of physical performance with depressive symptoms,and further explore the causality between physical performance and depressive symptoms,providing a scientific basis for formulating interventions of depressive symptoms.Methods:The data was from the Survey of Health,Ageing and Retirement in Europe（SHARE）.SHARE was a large-scale longitudinal study of old adults aged 50 and over in14 European countries,collecting information every two years on health and socio-economic living conditions of individual and family.A total of seven surveys have been conducted（2004/05～2019）.Wave 2（2016）was baseline data in this study,and following up the data in wave 4 wave 5,wave 6,wave 7 for the analysis.SHARE collect various health aging information such as demographic characteristics,physical measurement,socioeconomic status through computer assisted personal interview system and physical examination.Hand-held dynamometer and Mini-Wright peak flow meter were used to measure grip strength and the peak expiratory flow,repectively.The chair standing test was used to assess the time for participants to stand up from the chair and sit down again five times without hand assistance.The evaluated scores of four and above in the European Depression Scale are defined as depressive symptoms.Taking grip strength,peak expiratory strength and chair standing test at baseline as independent variables and depressive symptoms as outcome.The independent variables were divided into four groups of the low,medium,higher,and the highest levels,with the low level group as the reference group.Logistic regression model was used to analyzing the association between physical performance and depressive symptoms.Stratified analysis was carried out according to the age and sex to explore the association between physical performance and depressive symptoms in different populations.The restrictive cubic spline model was fitted according to the logistic regression model adjusted for all potential confounding factors to analyze the dose-response relationship between physical performance and depressive symptoms.Further,the predictive ability of physical performance on depressive symptoms was explored through the analysis of Receiver Operating Characteristic curve.Time cross-lagged path analysis was performed based on the structural equation model to evaluate the causality between physical performance and depressive symptoms.Results:1.The study at baseline included 13,589 European older adults aged over 50,including8,769 with depressive symptoms and 26,189 without depressive symptoms.2746（17%）male participants had depressive symptoms,and 6023（31.41%）female participants had depressive symptoms.Among those with depressive symptoms,the median age was 66years-old.Among those without depressive symptoms,the median age was 63 years-old.There was significant differences of characteristic variables at baseline betwwen groups.with depressive symptoms and without depressive symptoms.2.The association of grip strength with depressive symptoms Grip strength was negatively associated with depressive symptoms.After adjusting for all potential confounding factors,ORs（95%CI）of grip strength in the middle,higher,highest level groups were 0.687（0.582-0.810）,0.531（0.442-0.637）and 0.347（0.273-0.441）compared to the lowe level group.The association of the grip strength with depressive symptoms was significant in stratified analysis（men,women,≥65 years-old and<65 years-old）.The restrictive cubic spline results was presented on a nonlinear dose-response relationship between grip strength with the depressive symptoms(P _nonlinear<0.001).ROC curve analysis showed that grip strength had a certain predictive effect on depressive symptoms,with AUC of 0.690（0.681-0.700）.The results of time cross-lagged path analysis showed that depressive symptoms at baseline was associated with the grip strength in wave 4,and in wave 4→wave 5 and wave 6→wave 7,grip strength was associated with subsequent depressive symptoms.3.The association of peak expiratory flow with depressive symptoms Peak expiratory flow was negatively associated with depressive symptoms.After adjusting for all potential confounding factors,ORs（95%CI）of peak expiratory flow in the middle,higher,highest level groups were 0.692（0.593-0.807）,0.562（0.478-0.660）and 0.517（0.430-0.622）.compared to the low level group.The association of peak expiratory flow with depressive symptoms was stable in stratified analysis（men,women,≥65 years-old and<65 years-old）.The restrictive cubic spline results showed an approximately L-shaped nonlinear dose-response relationship between peak expiratory flow and depressive symptoms(P_nonlinear<0.001).The results of ROC curve analysis showed that peak expiratory flow had a certain predictive effect on depressive symptoms,with AUC of 0.684（0.674-0.693）.The results of time cross-lagged path analysis showed that peak expiratory flow at baseline was associated with subsequent depressive symptoms in wave 4,and in wave 4→wave 6,depressive symptoms in wave 4 was associated with subsequent peak expiratory flow in wave 6.4.The association of chair standing test with depressive symptoms Chair standing test was positively associated with the risk of depressive symptoms.After adjusting for all potential confounding factors,the OR（95%CI）of the chair standing test in the middle,higher,highest level groups were1.189（0.992-1.426）,1.479（1.231-1.778）and 1.865（1.549-2.245）compared to the low level group.The results of stratified analysis showed that the association between chair standing test and depressive symptoms remained stable in different sex and age groups.The results of restricted cubic spline model showed that there was approximately inverted L-shaped nonlinear relationship between the chair standing test and depressive symptoms(P_nonlinear<0.001).The results of ROC curve analysis showed that chair standing test had a certain predictive effect on depressive symptoms,with AUC of 0.678（0.667-0.689）.The results of time cross-lagged path analysis showed that chair standing test at baseline was associated with subsequent depressive symptoms in wave 5.Conclusions:In middle-aged and elderly Europeans,grip strength and peak expiratory flow were negatively associated with depressive symptoms,while chair standing test was positively associated with depressive symptoms.And there was a bidirectional causal relationship between physical performance and depressive symptoms.