Sex Differences in Association of Sedentary Behavior and Suicide Risk, and the Modifying Roles of Social Support Factors

Abstract Introduction: The study aimed to evaluate whether the association of sedentary behavior on suicide risk differs by sex and the modifying roles of social support and universal health coverage (UHC) index. Methods: We analyzed data from the Global School-based Student Health Survey across 53 countries (2013–2022). We examined the associations between sedentary time and suicide behaviors by binary logistic regression models and explored the modifying roles of social support by restricted cubic spline analysis. Stratified analyses were conducted based on overall social support and UHC groups. Results: A total of 190,329 adolescents (53.6% of girls) aged 12–17 years were included. The prevalence of suicidal ideation, plans, and attempts increased with daily sedentary time, with a more pronounced increase observed among girls. In boys, sedentary time of >8 h was associated with a 44% increase in higher risk suicide behavior (odds ratio [OR]: 1.44, 95% confidence interval [CI]: 1.36–1.53), while in girls, the increase was 88% (OR: 1.88, 95% CI: 1.79–1.97). In addition, compared to those with high support, both boys and girls with low social support showed a more pronounced increase in the risk of suicide behaviors as sedentary time increased. However, stratified analysis by UHC showed no significant differences between sedentary time and suicidal behavior among different social support groups. Conclusions: This study underscores the significant association between sedentary time and suicide behaviors among adolescents, particularly in girls. Furthermore, bolstering social support systems emerges as a promising approach to alleviate the negative associations of sedentary behavior.