Physical Activity Interventions in Suicide Prevention: A Systematic Review

Abstract

Background: Regular physical activity helps manage several chronic or recurring conditions; however, a previous review found insufficient studies to evaluate the effect of physical activity interventions on suicidal ideation. This review considers new evidence and expands the scope of inquiry to include any type of self-harm or suicide-related behaviour, such as self-poisoning, self-injury, including “non-suicidal self-injury”, and attempted suicide. Method: This review followed a systematic approach; I searched the relevant databases for randomised controlled trials of physical activity interventions that reported self-harm or suicide-related outcomes. After initial screening, study inclusion was determined by consensus. The Physiotherapy Evidence Database (PEDro) rating scale informed the quality appraisal. We double-checked the extracted outcome data and used Review Manager (RevMan) statistical software to calculate risk ratio and standardised mean difference. Results: There were ten eligible studies of a broad geographical spread. There were 681 participants in total, recruited from clinical and non-clinical settings and representing most age groups. Most studies used a parallel design. The most common trial duration was 6 weeks but settings, type and “dosage” varied widely. The reported outcomes were of suicidal ideation only, usually assessed by self-report. Quality varied but there were several indicators of acceptable trial conduct. Meta-analysis showed a probable favourable effect of physical activity interventions, measured dichotomously (RR 0.43, 95% CI 0.23, 0.79). The effect was in the same direction when measured continuously, although highly heterogeneous. Unfortunately, follow-up data is scarce and several potentially relevant studies did not report crucial outcomes. Conclusion: There is uncertain evidence that physical activity interventions may have a positive impact on suicidal ideation. Its base is small and inherently heterogeneous. High-quality trials that report suicide prevention specific outcomes are urgently required.