Handgrip strength as an indicator of psychological status in hospitalized intensive care unit patients: a cross-sectional study

Background: Anxiety and depression are common among intensive care unit (ICU) patients, yet routine bedside assessment can be challenging. Whether handgrip strength can serve as a practical indicator of anxiety and depression in the ICU remains unclear. Methods: We consecutively enrolled patients admitted to the cardiac intensive care unit (CICU) of a large public hospital in South China between July 2022 and October 2023. Handgrip strength was measured using a calibrated dynamometer, and anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Logistic regression was used to examine associations between handgrip strength and anxiety/depression adjusting for relevant covariates. Results: A total of 308 CICU inpatients were ultimately included in this cross-sectional analysis. The median age was 60 years (IQR: 50-69), and mean handgrip strength was 29.5 ± 11.3 kg. In multivariate logistic regression, lower handgrip strength was independently associated with anxiety (OR: 0.94 [95% CI: 0.90-0.98]) and depression (OR: 0.94 [95% CI: 0.90-0.99]). In addition, administration of sedatives was associated with high odds of anxiety (OR: 2.24 [95% CI: 1.16-4.31]). Strengths and limitations: Multivariate logistic regression was used to adjust for potential confounding factors. As a single-center cross-sectional study, selection and center-specific biases were unavoidable; further details are provided in the Limitations and Future Directions section. Conclusions: Handgrip strength is a non-invasive, readily accessible measure that may help identify patients at risk of anxiety and depression in the ICU. Potential mechanisms include impaired self-efficacy and inflammatory activation. Future studies should validate predictive thresholds and clarify temporal and mechanistic relationships.