Physical Activity, Sport Participation, and Suicidal Behavior: U. S. High School Students

David R. Brown; Deborah A. Galuska; Jian Zhang,; Danice K. Eaton; Janet E. Fulton; Richard Lowry; L. Michele Maynard

Disclosures

Med Sci Sports Exerc. 2007;39(12):2248-2257. 

In This Article

Abstract and Introduction

Purpose: To evaluate the associations of physical activity and sports team participation with suicidal behavior among U.S. high school students.
Methods: Data were from the 2003 Youth Risk Behavior Survey (N = 10,530 respondents). Exposure variables included physical activity (inactive, insufficient, moderately intensive, regular vigorously intensive, and frequent vigorously intensive) and sports team participation. Outcome variables were suicide ideation (seriously considering and/or planning suicide) and suicide attempts. Hierarchical logistic regressions were run, controlling for age, race, smoking, alcohol use, drug use, geographic region, unhealthy weight-control practices, and body mass index/weight perceptions.
Results: Compared with inactive students or sports team nonparticipants, the odds of suicide ideation were lower among boys reporting frequent vigorous-intensity physical activity (adjusted odds ratio (AOR) = 0.48; 95% confidence interval (CI) = 0.29, 0.79) and sports team participation, respectively (AOR = 0.65; 95% CI = 0.48, 0.86). The odds of suicide attempts were also lower among frequently vigorously active boys (AOR = 0.44; 95% CI = 0.21, 0.96) and sports team participants (AOR = 0.61; 95% CI = 0.40, 0.93). The odds of suicide attempts were lower for regular vigorously active girls compared with inactive girls (AOR = 0.67; 95% CI = 0.45, 0.99) and sports team participants compared with nonparticipants (AOR = 0.73; 95% CI = 0.57, 0.94). Associations with one exposure variable generally weakened when adjustment was made for the other exposure variable, or for feeling sad and hopeless.
Conclusions: The association of physical activity and sports team participation with suicide ideation and suicide attempts varied by sex. Further research is needed to clarify these different associations.

In the United States, suicide among youth is a major public health problem.[9] According to the U.S. Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Report System (Leading Causes of Death) (http://www.cdc.gov/ncipc), suicide was the third-leading cause of death among persons 10-14 and 15-24 yr of age in 2004. The magnitude of the problem has lead to a Healthy People 2010 national objective, 18-2, to reduce the rate of suicide attempts by adolescents.[35] Although predicting who will attempt suicide, and thus preventing suicide, remains elusive, several risk factors that may place persons at risk for attempting suicide are potentially modifiable. These include lifestyle behaviors such as smoking,[4,17,18,22] alcohol use,[2,10,17,18,22] and drug use.[2,17,18,22] It is possible that physical inactivity, like other modifiable lifestyle behaviors, is related to suicidal behaviors.

Numerous hypothetical mechanisms have been given as to why participation in physical activity or sports may be linked to reduced odds of suicide ideation or attempts.[5] Some explanations propose that active or athletic lifestyles are indirectly and not causally related with suicide ideation or attempts. For example, researchers have proposed that the interpersonal support that sports participants receive from coaches, teammates, parents, and friends may provide athletes with a therapeutic support base that reduces the risk of suicide during difficult times.[6,28,34] In addition, persons who engage in sports may also adopt other positive lifestyle behaviors, and this constellation of behaviors may predispose against suicidal behaviors.[28]

People who are regularly physically active may also gravitate to or possess other positive lifestyle behaviors that reduce their risk for suicide. Physical activity is also associated with numerous mental health benefits,[25] including enhanced emotional health,[13,24,30] improved cognitive functioning,[12,15] and better quality of life.[7] These benefits could mediate a lower risk of suicide among physically active people than people who are sedentary. Quite possibly, biological mechanisms may also directly mediate the relationship between physical activity with suicidal behaviors. For example, deficient serotonergic functioning may play a role in suicide and suicide attempts,[2,22,23] and mood improvements associated with physical activity may reflect increased levels of brain serotonin.[11,13,24] Theoretically, physical activity may be inversely related to suicidal behavior as a result of neurobiological alterations that occur with physical activity.

Researchers have evaluated the association of physical activity and sports participation with suicidal behaviors, and a review of this literature summarizes findings.[5] Some, but not all, studies show that physical activity and sports participation protect against suicidal behaviors.[5] The lack of uniform findings may partly be attributable to different definitions of the dependent and independent variables used across the studies. The number and type of variables adjusted for in each study also differ widely, and many of the studies do not account for mental health variables, such as distress or depression, that may mediate the relationship between physical activity/sports participation and suicidal behaviors.

The purpose of this study was to extend the research evaluating the association of physical activity and sports team participation with suicide ideation and suicide attempts among U.S. high school students, using data from the National 2003 Youth Risk Behavior Survey (YRBS). We evaluated physical activity and sports team participation separately to determine the independent effects of these activity domains with suicide ideation and suicide attempts. Unlike previous research on this topic pertaining to students in the 9th-12th grades, we also controlled for self-reported feelings of sadness or hopelessness to evaluate whether this measure confounded, perhaps mediated, the associations of physical activity/sports team participation with suicide ideation/suicide attempts. In addition, we evaluated several levels of physical activity to determine whether a dose-response relationship existed between physical activity and suicide ideation and suicide attempts.

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