Domain-specific physical activity and risk of suicidal ideation in adults: a population-based study

It remains unclear whether all physical activity (PA) domains (occupational PA [OPA], transportation PA [TPA], and leisure-time PA [LTPA]) have equivalent beneficial effects. We aimed to investigate the associations of OPA, TPA, and LTPA with suicidal ideation in adults.

We included and analyzed 25,497 participants (aged ≥ 18 years) from the National Health and Nutrition Examination Survey (NHANES) 2007-2018. The domain-specific PA was assessed by a self-report questionnaire and categorized based on the PA guidelines. Suicidal ideation was measured by item nine of the nine-item Patient Health Questionnaire.

Participants achieving PA guidelines (≥ 150 min/week) had a 21% (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.63-0.98) and 32% (OR 0.68, 95% CI 0.53-0.89) reduced likelihood of suicidal ideation depending on total PA and LTPA, respectively, while OPA or TPA did not correlated with suicidal ideation. The mediation analysis revealed that 74.1% of this association was mediated by the severity of depressive symptoms. In subgroup analyses, LTPA was associated with suicidal ideation in participants who were aged ≥ 60 years, those with BMI < 30 kg/m², sedentary time < 360 min/day, smoking, hypertension, depression and proportion of vigorous exercise ≥ 0.5. These connections indicate that LTPA could be especially beneficial for older individuals and those with specific lifestyle or health risks. LTPA at levels of 150-299 and ≥ 300 min/week was associated with 31% (OR 0.69, 95% CI 0.49-0.97) and 30% (OR 0.70, 95% CI 0.52-0.94) lower odds of suicidal ideation, respectively. Stratified by exercise intensity, vigorous-intensity LTPA, but not moderate-intensity LTPA, was negatively associated with the risk of suicidal ideation (OR 0.61, 95% CI 0.44-0.86).

When the amount achieving the PA guidelines, LTPA, but not OPA or TPA, was associated with a lower risk of suicidal ideation through the mediation of depressive symptoms. These findings indicate that engaging in LTPA, especially vigorous intensity LTPA, may provide substantial benefits for mental health.