Association between handgrip strength and symptoms of anxiety and depression among university students

A cross-sectional study of 216 university students found that lower left-hand grip strength was associated with higher anxiety and depression symptom scores, although the relationships were weak and do not establish that muscle weakness causes psychological distress. The study included 138 female and 78 male undergraduates aged 18 to 24 at RAK Medical and Health Sciences University in the United Arab Emirates. Participants were apparently healthy, and students already diagnosed with and receiving treatment for anxiety or depression were excluded. In the combined analysis, left-hand grip strength had statistically significant negative correlations with both GAD-7 anxiety scores and PHQ-9 depression scores, while right-hand grip showed no significant association with either outcome.

Handgrip strength is an established measure of upper-limb muscular performance and is used as an indicator of broader neuromuscular function. Researchers recorded maximal voluntary contractions with a Jamar plus+ digital hand dynamometer, adjusting the handle to each participant’s hand size. Participants were seated upright with the shoulder adducted, elbow flexed at 90 degrees, forearm in a neutral position and wrist held between 0 and 30 degrees of extension. Each hand was tested three times with rest between trials, and the highest measurement for each hand was used in the analysis. Across the full sample, mean left-hand grip strength was 26.77 with a standard deviation of 10.33, while mean right-hand strength was 28.47 with a standard deviation of 11.58. The investigators did not record hand dominance.

After the physical measurements, participants completed the Generalized Anxiety Disorder-7 scale, or GAD-7, and the Patient Health Questionnaire-9, or PHQ-9. These validated self-administered instruments assessed symptoms over the preceding two weeks and were scored according to standardized guidelines. The sample’s mean GAD-7 score was 6.38 with a standard deviation of 4.88, and its mean PHQ-9 score was 7.44 with a standard deviation of 5.75. These numbers describe questionnaire scores rather than diagnoses made through clinical interviews. No individual symptom pattern or clinical severity category should therefore be inferred for the group as a whole.

In the combined analysis of all 216 students, left-hand grip strength was weakly and negatively associated with anxiety symptoms, with a Pearson correlation of r = −0.185 and a two-tailed p-value of 0.006. The table reporting the overall results gave a similar but slightly weaker correlation with depression, r = −0.148, with p = 0.030. The article’s narrative contains an internal numerical inconsistency: in the results prose it states an overall left-hand grip and PHQ-9 correlation of −0.238, and gives post hoc power of 94.6 percent for that value, whereas Table 3 reports −0.148. The discrepancy means that the exact magnitude and corresponding power estimate for the overall depression association require cautious interpretation. Right-hand grip strength was not significantly correlated with anxiety, r = −0.131, p = 0.054, or depression, r = −0.106, p = 0.119.

The anxiety and depression scores were themselves strongly associated in the full sample, with a correlation of r = 0.705 and p < 0.001. In other words, students reporting more generalized anxiety symptoms also tended to report more depressive symptoms. That statistical relationship is separate from the findings involving grip strength and does not show that anxiety causes depression, or vice versa. It indicates that the two questionnaire measures varied together in this sample. The left-hand correlations with mental-health scores were modest in size, and the study reported post hoc power of approximately 78.3 percent for the left-hand grip and GAD-7 association. Because power calculations were conducted after the data were collected, they characterize the study’s sensitivity to the observed effect sizes rather than guarantee that smaller relationships were absent.

Sex-specific analyses revealed a different pattern. Male students had substantially greater grip strength than female students, with mean left-hand values of 36.43 versus 21.31 and mean right-hand values of 39.34 versus 22.32; both sex differences were significant at p < 0.001. Females had a higher mean GAD-7 score than males, 7.17 versus 4.99, with p = 0.005, while their mean PHQ-9 score of 8.02 did not differ significantly from the male mean of 6.42, p = 0.123. Among the 138 female participants, left-hand grip was significantly associated with lower PHQ-9 scores, r = −0.238, p = 0.005, and right-hand grip had a smaller association in the same direction, r = −0.168, p = 0.049. Neither hand’s grip strength was significantly associated with GAD-7 scores among women. Among the 78 male participants, no grip measurement was significantly associated with either questionnaire.

These sex-specific results should not be interpreted as evidence that increasing muscle strength would protect women from depression or that the association is absent in men. The investigators used unadjusted correlation analyses, and several potential confounding or explanatory factors were not collected, including height, weight, body mass index, muscle mass, physical activity, sleep quality, caffeine intake, socioeconomic status, stress and hormonal status. Without adjustment, the observed relationships cannot be separated from these other influences. The smaller samples within each sex also limited the study’s ability to detect modest correlations. In addition, the non-significant right-hand result in the full sample and the absence of significant grip relationships among men cannot be treated as proof that no association exists, particularly given the post hoc power estimates and the number of comparisons.

Several mechanisms proposed in earlier research could be consistent with the findings, but none was tested directly in this study. Greater handgrip strength has previously been associated with brain-health measures such as hippocampal volume and white-matter integrity, processes relevant to neurobiological features implicated in depression. Sex hormones also influence skeletal muscle physiology, muscle protein synthesis, recovery and neuromuscular function, potentially contributing to both the observed strength differences and their relationship with symptoms. Differences in habitual physical activity, perceived stress and coping could influence muscular performance and psychological wellbeing in parallel. Hormone concentrations, brain imaging, body composition, activity and stress were not measured here, so these remain hypotheses rather than demonstrated pathways. A reverse pathway is also possible: distress could affect sleep, motivation or activity and thereby accompany weaker grip, or common factors could influence both strength and mood.

The student results extend an existing literature that has mainly examined middle-aged and older populations. Prior population studies and reviews cited by the researchers reported links between lower handgrip strength and anxiety or depressive symptoms, but evidence specific to younger adults was limited, and relatively few studies had focused on anxiety alongside depression. The current study does not represent newly conducted evidence for those older groups; instead, it shows that a similar association pattern was observed in a university sample with a mean age of 20.62 years and a standard deviation of 4.66 years. Its contribution is therefore an extension of the relationship into a younger population, not proof that the relationship begins in youth or develops progressively over time. No longitudinal comparison was conducted to test either possibility.

Overall, the study found small, statistically significant associations between left-hand grip strength and questionnaire-measured anxiety or depression symptoms in the combined sample, with clearer associations for depression among female students. The findings support further investigation of muscle performance as a possible correlate of psychological wellbeing in young adults, but they do not identify a causal mechanism or establish clinical utility. Recruitment at a single UAE university limits generalizability, self-report questionnaires may introduce reporting bias, and a single assessment cannot determine whether strength changes before symptoms, symptoms precede strength changes, or shared factors influence both. Larger longitudinal studies with prespecified sample-size calculations, clinical assessments and measurements of body composition, physical activity, hormonal status, stress and sleep would be needed to clarify the direction and significance of the relationship.

Subject of Research: Handgrip strength and anxiety and depression symptoms in university students

Article Title: Association between handgrip strength and symptoms of anxiety and depression among university students: A cross‐sectional study

Article References: Khadeeja, L., Goud, B. K. M., Dube, R., Kar, S. S., & Patanwala, B. M. (2026). Association between handgrip strength and symptoms of anxiety and depression among university students: A cross‐sectional study. Physiological Reports, 14(20), Article e71143. https://doi.org/10.14814/phy2.71143

Image Credits: AI Generated

DOI: 10.14814/phy2.71143

Keywords: handgrip strength, anxiety symptoms, depression symptoms, university students, young adults, neuromuscular function, cross-sectional study, mental health, Association, between, handgrip, strength