A mixed methods study on barriers and facilitators to exercise for suicidal ideation management

Abstract

Suicide is a leading cause of premature death. Innovative and effective interventions are needed to prevent suicide deaths. Randomized controlled trials (RCTs) have demonstrated that a variety of structured exercise programs (e.g., aerobic exercise, resistance training exercise) improve mental health, including reducing anxiety and depressive symptoms. Moreover, failure to meet established guidelines for physical activity is associated with increased odds of experiencing suicidal behaviours. Exercise may, therefore, be one intervention option to reduce the suicidal behaviours (i.e., suicidal ideation [SI] and plans for suicide) that often precede suicide. In order to benefit from the effects of exercise, individuals with suicidal ideation must perceive exercise as an accessible, acceptable, and effective treatment option, otherwise they are unlikely to initiate and sustain an exercise program. This mixed-methods dissertation includes two studies that explored how individuals with SI perceive and experience exercise, with an emphasis on identifying facilitators and barriers to exercise. In Study 1, grounded theory methods were used to analyze data from semi-structured interviews with 17 adult Canadian participants with past-month SI. The overall theory derived from Study 1 suggests that exercise for individuals with SI is complex and should be tailored to each individual. This theory is made up of a core category of individualization, as well as four key concepts that relate to three major categories. The four key concepts of the theory are that facilitators and barriers to exercise (a) have individualized weights/impacts on exercise decisions, (b) are cumulative, interactive, and opposing forces, (c) are dynamic, and (d) exist on a spectrum from internal to external. The three major categories included in the study theory are (a) the cognitive-behavioural cycle, (b) priorities, values, and identity, and (c) interpersonal factors. In Study 2, 261 Canadian adult participants with past-month SI completed an online survey. The survey included measures of suicidal behaviour, facilitators and barriers to exercise (open-ended and closed-ended questions), past-week physical activity, and demographic and health questions. Due to the exploratory nature of the study, quantitative analyses were restricted to descriptive statistics. The qualitative and quantitative results of Study 2 supported and added to the theory developed in Study 1, including offering additional evidence of the core category, the four key concepts, and the three major categories. Most participants thought exercise can reduce SI. Improved health, both mental and physical, was a commonly reported motivator to exercise, and poor mental health was also a commonly reported barrier to exercise. Overall, the results of both studies demonstrated the importance of individualization when it comes to exercise for individuals with SI. Exercise may or may not be an accessible, acceptable, and/or effective intervention for any given individual with SI. The results may be used by clinicians, researchers, policy makers, and advocacy groups considering whether exercise might be an intervention option for individuals with SI. The results may assist future researchers who endeavor to develop exercise-based interventions for individuals with SI by providing a theoretical framework to guide intervention development and study planning (e.g., by highlighting the need to anticipate and address individual and fluctuating facilitators and barriers). Keywords: suicidal ideation, exercise, physical activity, facilitators and barriers to exercise, exercise adherence, grounded theory