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Objective measures of physical performance associated with depression and/or anxiety in midlife Singaporean women

Ganasarajah, Shamini MSc1; Sundström Poromaa, Inger MD, PhD2; Thu, Win Pa Pa MBBS1; Kramer, Michael S. MD, FRSC, FCAHS3; Logan, Susan MD, FRCOG, MFSRH1; Cauley, Jane A. DrPH4; Yong, Eu-Leong FRCOG, PhD1

doi: 10.1097/GME.0000000000001355
Original Study: PDF Only

Objectives: The aim of this study was to identify correlates of depression and anxiety in midlife Asian women, with a special focus on the potential role of objectively measured physical performance.

Methods: Sociodemographic characteristics, reproductive health, menopause status, medical history, lifestyle choices, physical activity, and physical performance of healthy women aged 45 to 69 attending routine gynecologic care were collected. Depressive symptoms were assessed utilizing the Center for Epidemiologic Studies for Depression Scale (CES-D) and anxiety symptoms by the General Anxiety Disorder Scale (GAD-7). Upper body physical performance was assessed by handgrip strength, and lower body physical performance was assessed by the Short Physical Performance Battery. Chi-square tests and multivariable models were used to assess the crude and adjusted associations, respectively, between the studied risk factors and depression and/or anxiety. The main outcome measures were elevated depressive symptoms ≥16 on the CES-D, and/or elevated anxiety symptoms >10 on the GAD-7 score.

Results: Of 1,159 women (mean age 56.3 ± 6.2), 181 (15.9%) were identified as having depressive and/or anxiety symptoms. Weak upper body (handgrip strength) and poor lower body strength (longer duration to complete the repeated chair stand test) were associated with elevated depressive and/or anxiety symptoms (adjusted odds ratio [aOR], 1.68; 95% CI, 1.18-2.40) and (aOR, 1.33; 95% CI, 1.09-1.63), respectively.

Conclusions: Weak upper and lower body physical performances were associated with depressive and anxiety symptoms in midlife Singaporean women. Future trials are required to determine whether strengthening exercises that improve physical performance could help reduce depressive and anxiety symptoms in midlife women.

Video Summary: Supplemental Digital Content 1,

1Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore

2Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden

3Departments of Epidemiology, Biostatistics and Occupational Health and of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada

4Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.

Address correspondence to: Eu-Leong Yong, FRCOG, PhD, Department of Obstetrics and Gynaecology, National University of Singapore, Yong Loo Lin School of Medicine, NUHS Tower Block, 1E Kent Ridge Road, Level 12, Singapore 119228. E-mail:

Received 25 January, 2019

Revised 14 March, 2019

Accepted 14 March, 2019

SG and ISP are joint first authors.

Authors’ contributions: ELY, SL, and JAC conceived and designed the study, provided methodological inputs and statistical analyses, and wrote the manuscript. SG, ISP, and MSK performed statistical analysis, provided methodological inputs, and wrote the manuscript. WPPT contributed to project administration, data acquisition, and study design, and wrote the manuscript. All authors saw and approved the final manuscript.

Funding/support: This study was partially funded by a Singapore National Medical Research Council Grant (Number: NMRC/CSA-SI/0010/2017) to ELY.

Financial disclosure/conflicts of interest: None reported.

Data Statement: Due to the confidential nature of the data collected in the study, the data cannot be made publicly available. Data sharing and collaboration is available on application to Integrated Women's Health Governance Committee by email to the corresponding author at

ORCID identifier: 0000-0001-6511-770X

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© 2019 by The North American Menopause Society.