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

## TL;DR

Leisure-time physical activity, especially vigorous exercise, is linked to lower suicidal thoughts in adults, possibly by reducing depression.

## Contribution

This study identifies leisure-time physical activity as uniquely beneficial for reducing suicidal ideation compared to other activity types.

## Key findings

- Leisure-time PA meeting guidelines reduces suicidal ideation by 32%.
- Vigorous-intensity leisure-time PA is more effective than moderate intensity in lowering suicidal ideation.
- Leisure-time PA benefits older adults and those with specific health or lifestyle risks.

## Abstract

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.

The online version contains supplementary material available at 10.1186/s12889-025-23815-9.