Screening for suicidal thoughts, attempts, and associated factors in endurance and ultra-endurance runners

BACKGROUND: Suicide is one of the leading causes of premature death. Prevalence of suicidal thoughts in the general adult population is approximately 4%, with lifetime prevalence of 5.6%, and suicidal attempts of 2.7%. No data are available on endurance runners (ER) and ultra-endurance runners (UER). METHODS: Prospective cohort study of ER (distance of ≥21.1 km-42.2 km) and UER (≥42.2 km), collecting self-reported data on biometrics, social, psychological, medical, and training history. Suicidal risk was assessed via the Patient Health Questionnaire (PHQ-9) and open questions. Statistical analysis included descriptive, predictive techniques, and regression analysis. RESULTS: A total of N.=601 runners participated in the study (female N.=222; male N.=379; mean age [standard deviation (SD)] 42.8 (10.1) years). Suicidal thoughts were present in 8.0%, with a lifetime prevalence of 14.1% (P<0.001). Previous suicidal attempts occurred in 2%. Associated factors for suicidal thoughts included previous diagnosis of depression (P<0.001), anxiety (P=0.015), age (P=0.013), and participating in fewer (<9) competitions per year (P=0.026). Associated factors of lifetime risk of suicidal thoughts included previous diagnoses of depression (P<0.001) and age (P=0.015). Runners aged less <30 years of age presented with a higher risk of suicide (P<0.001) than older runners. Associated factors for previous suicidal attempts included previous diagnosis of depression (P=0.01) and stress (P=0.028). CONCLUSIONS: We present novel data on prevalence of suicidal thoughts in ER/UER, which were 2-2.5-fold higher than in the general population. Creating awareness among athletes, families, coaches, medical teams, and race organizers and providing education, screening and access to appropriate support are important to reduce the burden of suicide in this sport.