Sex difference in the association between physical activity and suicide attempts among adolescents from 48 countries: A global perspective

Background: Adolescent suicide is a global public health concern. Given that physical activity has a positive effect in the prevention and treatment of common psychiatric disorders, it may also protect against suicides. However, global data examining associations between physical activity and suicide attempts among adolescents are lacking, and sex-specific associations remain poorly understood. Thus, we assessed the association between physical activity and suicide attempts among adolescents aged 12-15 year from 48 countries. Methods: Cross-sectional data from the Global School-based Student Health Survey, which included 136,857 adolescents [mean age (SD) 13.8 (1.0) years; 48.9% girls] were analyzed. Suicide attempt was defined as at least one suicide attempt in the past 12 months. Physical activity was assessed by the PACE + Adolescent Physical Activity Measure and participants were dichotomized into those who do and do not comply with the World Health Organization physical activity recommendations (60 min of moderate-to-vigorous intensity physical activity daily). Multivariable logistic regression analysis and meta-analysis were conducted to assess the associations. Results: Meeting physical activity guidelines was associated with lower odds for suicide attempts in boys (OR = 0.78; 95%CI= 0.70-0.86), but higher odds for suicide attempts in girls (OR = 1.22; 95%CI = 1.10-1.35). The associations for boys and girls were relatively consistent across countries. Limitations: Causality or temporal associations cannot be established due to the cross-sectional nature of the study. Conclusions: Engagement in physical activity may be an effective strategy for prevention of suicide attempts for boys but not for girls. Future studies should investigate the factors that lead to this sex difference.