Moderate-to-Vigorous Physical Activity and Suicidal Ideation in Adolescents with Attention Deficit/Hyperactivity Disorder: the Mediating Effects of Mental Health

This study aimed to (a) examine whether device-assessed moderate-to-vigorous physical activity (MVPA) was associated with suicidal ideation (SI) in adolescents with attention-deficit/hyperactivity disorders (ADHD), (b) investigate whether the association was mediated by depression, and (c) assess whether anxiety, stress, and resilience would work with depression to constitute chain mediation paths between MVPA and SI. Sixty adolescents with ADHD aged 12-17 (Mage = 14.33 ± 1.43 years) met the inclusion criteria. MVPA data were assessed using accelerometers worn around the waist for seven consecutive days. SI, depression, anxiety, stress, and resilience were examined using self-report questionnaires. Bivariate correlations were estimated for all variables. Lavaan package was used to examine the association between MVPA and SI, and the mediating effects of depression, anxiety, stress, and resilience by adjusting for a minimally sufficient confounder set and applying the bootstrap method. MVPA was negatively associated with SI. Depression fully mediated this association. Anxiety, stress, and resilience combining with depression formed three chain mediation paths between MVPA and SI, respectively. The integrative mediation model, including anxiety, stress, resilience, and depression, revealed that anxiety and depression explained 38.2% of the variance in the association between MVPA and SI, and resilience and depression explained 22.1%, while stress did not. MVPA could serve as an alternative or adjunctive approach, particularly in conjunction with depression-focused interventions, to increase resilience, decrease anxiety and depression, and in turn to prevent or attenuate SI in adolescents with ADHD.