New research investigates physical activity’s role in suicide prevention

In the ongoing quest to unravel the complexities of mental health, a recent study published in Neuroscience & Biobehavioral Reviews embarks on a exploration of how physical activity might serve as an intervention for individuals grappling with suicidal thoughts and behaviors. With an increasing recognition of the intertwined nature of mental and physical health, this systematic review sheds light on the potential of exercise to mitigate the risk of suicide attempts among those suffering from mental or physical illnesses.

If you or someone you know is struggling with suicidal thoughts or mental health matters, please call the National Suicide Prevention Lifeline at 988 (or 800-273-8255) or visit the NSPL site.

Despite the known correlation between mental and physical health issues and an increased risk of suicide, traditional approaches to suicide prevention have predominantly centered around pharmacological treatments and psychological therapies. These methods, while effective, do not fully address the multifaceted nature of suicide risk factors.

Physical inactivity, recognized as a modifiable risk factor with a direct link to increased depression, anxiety, and suicidal ideation, presents a significant opportunity for intervention. Given the rising prevalence of mental disorders and corresponding suicide rates globally, there’s a pressing need to explore comprehensive, accessible, and preventive strategies that encompass lifestyle modifications like exercise.

Previous research has extensively documented the benefits of exercise in improving mental health outcomes and even suggested its comparable efficacy to pharmacological interventions. However, the direct relationship between exercise and reduced suicidal behaviors has not been as thoroughly investigated.

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“Exercise is a medicine for mental health, and the potential benefits in suicide has been studied much less than other outcomes,” said study author Marco Solmi, an associate professor and research director at the University of Ottawa.

Employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, the team meticulously searched databases like MEDLINE, EMBASE, and PsycINFO for observational studies examining the link between various forms of physical activity and suicidal outcomes. The inclusion criteria were specific, targeting studies that assessed the impact of exercise on individuals with mental and/or medical disorders, focusing on suicidal ideation, attempts, and deaths.

By synthesizing data from seven observational studies, encompassing a diverse participant base of 141,691 individuals, the researchers highlighted the complex relationship between exercise and suicidal outcomes such as ideation, attempts, and deaths.

Regarding suicidal ideation, the researchers found revealed mixed results. Three studies, incorporating a total of 67,508 participants, explored this aspect with varying conclusions. One significant observation came from a prospective cohort study of active-duty soldiers experiencing chronic pain. This study found that regular exercise was associated with a reduced risk of suicidal ideation in certain subgroups based on the number of exercise therapy visits.

However, two other studies — one involving patients with chronic mental illnesses and the other with major depressive disorder — did not find a significant relationship between physical activity levels and suicidal ideation. These findings suggest that while there may be potential benefits of physical activity in reducing suicidal thoughts in specific contexts, the overall evidence remains inconclusive.

The relationship between physical activity and suicide attempts appears more straightforward, with both studies included in the review indicating a protective effect of exercise. A case-control study among psychiatric inpatients revealed that those with a history of suicide attempts were significantly less likely to engage in mild or moderate/intense physical activity compared to controls without such a history.

Similarly, another case-control study found that lack of physical activity was associated with a higher odds of suicide attempts among individuals with depression, hopelessness, alcoholism, or serious medical conditions. These findings underscore the potential of physical activity as a mitigative factor against the risk of suicide attempts, highlighting its importance in mental health interventions.

“Exercise, exercise, exercise, unless physical health or mental health contraindications exist, such unstable angina, or anorexia nervosa with compulsory exercise,” Solmi advised.

However, when it came to suicide deaths, the review found no significant association with physical activity. Two studies, one involving individuals with obesity and the other with chronic pain, showed that exercise intensity or duration did not significantly impact the risk of suicide deaths. This indicates that while physical activity may influence factors leading up to suicide attempts, it does not appear to affect the likelihood of suicide deaths directly.

“Despite physical activity seeming to decrease suicide attempts, there was not a change in death by suicide,” Solmi said. “This may reflect that physical activity reduces the impulsivity associated with low-lethality attempts. However, it may not impact high-lethality and planned attempts.”

A notable aspect of the review is its acknowledgment of the methodological heterogeneity among the included studies, which precluded a quantitative synthesis of the data through meta-analysis. This heterogeneity, along with a modest number of studies and their varying quality, underscores the challenges in drawing definitive conclusions about the relationship between physical activity and suicidal outcomes. Moreover, the review points out the significant underrepresentation of female participants and the limited focus on mental disorders beyond depression and physical conditions other than chronic pain.

“The analysis of death by suicide only included male participants,” Solmi said. “Previous research has demonstrated that although males make less suicide attempts than females, their attempts are of higher lethality. This may have impacted our results if the association is moderated by sex, gender, or attempt severity.”

Despite these limitations, the systematic review provides valuable insights into the potential benefits of physical activity as part of a multifaceted approach to suicide prevention. It underscores the importance of addressing modifiable risk factors, like physical inactivity, to improve mental health outcomes. However, the nuanced findings also highlight the complexity of suicidal behaviors and the need for further research to fully understand the mechanisms through which physical activity may exert its protective effects.

The researchers advocate for more high-quality, observational studies that can offer deeper insights into how different types of exercise, intensity levels, and frequencies might affect various suicidal outcomes. Such research is crucial for developing targeted interventions that can be integrated into broader mental health and suicide prevention strategies.

“I would like to continue to expand my research into the field of ‘Lifestyle Psychiatry,’ by addressing mental disorders through exercise, diet and sleep,” said first author Nicholas Fabiano, a resident psychiatry doctor at the University of Ottawa. “I can personally speak to the benefits of regular exercise from both a mental health and cognitive perspective. I find that maintaining a regular exercise routine has greatly improved my mood and provided me with a sense of mental clarity.”

The study, “Physical activity, suicidal ideation, suicide attempt and death among individuals with mental or other medical disorders: A systematic review of observational studies“, was authored by Nicholas Fabiano, Arnav Gupta, Stanley Wong, Jason Tran, Ibrahim Yz Mohammad, Shan Bal, Jess G Fiedorowicz, Joseph Firth, Brendon Stubbs, Davy Vancampfort, Felipe B Schuch, Lucas J Carr, Risa Shorr, Samuele Cortese, Mirko Manchia, Catharina A Hartman, Anne Høye, Paolo Fusar-Poli, Ai Koyanagi, Eduard Vieta, René Ernst Nielsen, Richard Ig Holt, Christoph U Correll, Ebba Du Rietz, Heidi Taipale, Kelli Lehto, Henrik Larrson, Merete Nordentoft, Elena Dragioti, Karolina Skonieczna-Żydecka, Marco Solmi and the ECNP Physical And meNtal (PAN-)Health group.