Physical activity and suicide-related outcomes: an umbrella review of systematic reviews

Background While suicide represents a global health crisis, evidence examining the associations between physical activity and suicide-related outcomes remains fragmented. This umbrella review synthesized systematic reviews and meta-analyses examining relationships between physical activity and suicidal ideation, suicide attempts, and suicide death. Methods We systematically searched PubMed, Embase, PsycINFO, Cochrane Library, and Web of Science from database inception to March 2025. Eligible studies included systematic reviews and meta-analyses examining physical activity or sports participation and suicide-related outcomes. Meta-analysis was not feasible due to methodological heterogeneity; narrative synthesis was performed. Evidence validity was assessed using established criteria (convincing, highly suggestive, suggestive, weak, nonsignificant), and methodological quality was evaluated using AMSTAR2 (A Measurement Tool to Assess Systematic Reviews version 2). The protocol was preregistered on PROSPERO (CRD420251020494). Results Six reviews met inclusion criteria. For suicidal ideation, physical activity showed potentially protective associations in general populations, adolescents, and athletes, but nonsignificant effects in clinical populations. For suicide attempts, potentially protective effects were observed across adolescents, clinical populations, and athletes, though no evidence was available for the general population. Evidence for suicide death was limited, showing mixed findings among athletes by sport type and nonsignificant associations in clinical populations. Most evidence was graded as weak validity due to small event sizes, modest statistical significance, and high heterogeneity. Conclusions Physical activity shows potentially protective associations most consistently for suicidal ideation. In contrast, the evidence is more limited for suicide attempts and sparse for suicide death. The evidence base remains limited due to weak validity, small event sizes, methodological heterogeneity, and critical research gaps. Large-scale longitudinal studies with standardized protocols are needed to establish a more robust evidence base.