a1 Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
a2 Department of Primary Health Care, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
a3 Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
a4 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
a5 Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
Background Cardiovascular fitness influences many aspects of brain function. However, the relationship between cardiovascular fitness and suicidal behaviour is unknown. Therefore, we aimed to determine whether cardiovascular fitness at age 18 years is associated with future risk of suicide attempt/death.
Method We performed a population-based Swedish longitudinal cohort study of male conscripts with no previous or ongoing mental illness (n = 1 136 527). The conscription examination, which took place during 1968–2005, included the cycle ergonometric test and tests of cognitive performance. Future risk of suicide attempt/death over a 5- to 42-year follow-up period was calculated with Cox proportional hazards models controlling for several confounders including familial factors.
Results At least one suicide attempt was recorded for 12 563 men. Death by suicide without a prior attempt was recorded in 4814 additional individuals. In fully adjusted models low cardiovascular fitness was associated with increased risk for future attempt/death by suicide [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.64–1.94]. The HR changed only marginally after exclusion of persons who received in-patient care for depression (HR 1.76, 95% CI 1.61–1.94). Poor performance on both the cardiovascular fitness and cognitive tests was associated with a fivefold increased risk of suicide attempt or suicide death (HR 5.46, 95% CI 4.78–6.24).
Conclusions Lower cardiovascular fitness at age 18 years was, after adjustment for a number of potential confounders, associated with an increased risk of attempt/death by suicide in adulthood. It remains to be clarified whether interventions designed to improve fitness in teens can influence the risk of suicidal behaviour later in life.
(Received January 25 2013)
(Revised May 02 2013)
(Accepted May 06 2013)
(Online publication June 06 2013)
c1 Address for correspondence: M. Waern, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Blå Stråket 15, Gothenburg, Sweden. (Email: [email protected])