Suicide is a global public health problem that kills about 800,000 people each year and is one of the leading causes of death worldwide (O’Connor & Kirtley, 2018). Suicide risk (SR) is defined as an individual’s past, present, and future propensity to develop suicidal ideation or plans, or to make attempts at suicide (Hao et al., 2023). In China, suicide is the second leading cause of death among people aged 15–29 years, with annual suicide deaths accounting for 42% of global suicide deaths; further, the suicide rate among college students is 2–4 times higher than the rate among their peers who are not college students (Y. Li et al., 2022). Therefore, it is important to investigate the possible underlying mechanisms of SR in college students.

Physical exercise (PE) refers to an activity with certain intensity, frequency, and duration with the purpose of enhancing physical and mental health (Zhao et al., 2022). PE is an effective way to promote mental health, and a study has shown that students who engage in PE every day have a better mental state than those who do not (M. Wang, 2021). Emotion management theory states that suicidal behavior is closely related to emotions, and the higher an individual’s level of negative emotions, such as depression and anxiety, the more likely they are to manage their negative emotions through self-harm or even suicide, creating a higher risk of suicide (Lan et al., 2022). PE not only promotes the development of mental health and is negatively associated with suicidal ideation, but it may also be a protective factor against suicide (Ning et al., 2022). In summary, we proposed the following hypothesis:

Hypothesis 1: Physical exercise will have a negative correlation with suicide risk.

Anxiety is defined as a compound emotion consisting of tension, restlessness, and annoyance, and this internal conflict may have a negative impact on behavior and physiology (Tang & Kuang, 2009). PE can prevent and treat anxiety problems with similar efficacy to medication and psychotherapy (Arbinaga et al., 2018). Individuals who participate in regular PE are both less at risk of developing an anxiety disorder and able to improve existing anxiety symptoms (S. E. Baumeister et al., 2017). Anxiety is one of the most prevalent psychological disorders among college students and is an important risk factor for suicidal behavior, which is positively associated with SR (J. Li et al., 2022; Zhu et al., 2021). Further, individuals with anxiety disorders may experience greater mental burdens, which increases the risk of suicide (Hill et al., 2017). Unlike depression, anxiety is often characterized by high arousal and hypervigilance, and this may trigger impulsive responses to distress, including suicidal behaviors (McLean et al., 2011). As anxiety may represent an early intervention target in the relationship between physical exercise and reduced SR, it is theoretically and clinically meaningful to investigate anxiety as a mediator. In summary, we proposed the following hypothesis:

Hypothesis 2: Anxiety will mediate the relationship between physical exercise and suicide risk.

Self-control (SC) refers to an individual’s ability to regulate personal behavior, particularly their capacity to manage thoughts, emotions, and actions when facing anxiety or temptation (Qu et al., 2006). It is a self-regulatory process through which individuals inhibit impulsive behaviors in pursuit of long-term goals (Hofmann et al., 2009). Those with high levels of SC tend to view problems more rationally, experience less frustration when encountering difficulties, and are less affected by negative stimuli (Qu et al., 2006). These individuals are also more likely to engage in regular PE over extended periods, thereby obtaining substantial psychological benefits, including improved emotional regulation, stress relief, and reduced vulnerability to anxiety (Valencia-Agudo et al., 2018). Moreover, those with high SC tend to adopt PE as an adaptive coping strategy (Zhu et al., 2021), which further enhances its protective effect against SR. Further, SC has been found to be positively associated with the intensity, duration, and frequency of PE (Pesce et al., 2009), indicating that individuals with higher SC are less likely to be exposed to negative emotional states, thereby lowering their SR (O’Connor & Kirtley, 2018). By contrast, individuals with lower SC often lack behavioral persistence, are less likely to maintain consistent exercise routines, and, consequently, may fail to derive significant psychological benefits from PE, which weakens its protective role against SR (de Ridder et al., 2012). Additionally, deficits in SC have been linked to higher levels of psychological distress, which may further exacerbate SR (Bertrams et al., 2013). In summary, we proposed the following hypotheses:

Hypothesis 3: Self-control will moderate the relationship between physical exercise and suicide risk.

Hypothesis 4: Self-control will moderate the relationship between anxiety and suicide risk.

 

The proposed model for this study is shown in Figure 1.

We used random sampling to recruit students at Chengdu University, China. Of 500 questionnaires we distributed, 482 valid forms were returned from 216 men and 266 women (M_age = 20.3 years). The inclusion criteria were as follows: (a) currently enrolled as full-time undergraduate students, (b) aged between 18 and 25 years, and (c) willing to participate and provide informed consent. Exclusion criteria were as follows: (a) a self-reported diagnosis of severe psychiatric disorders, such as schizophrenia or bipolar disorder, or (b) unable to independently complete the online questionnaire. The study was conducted according to the guidelines of the Declaration of Helsinki, and it was approved by the Ethics Committee of Chengdu University (HR213-2024). Study information was communicated to each participant before the start of the questionnaire, and informed consent was obtained from the participants themselves.

We used the Physical Exercise Rating Scale developed by Liang (1994). The scale measures three single-item dimensions of PE: intensity (e.g., “How intensely do you perform physical activity?”), duration (e.g., “How many minutes at a time do you engage in physical activity at the above intensity?”), and frequency (e.g., “How many times a month do you do the above-mentioned physical activities?”). Responses are rated on a 5-point Likert scale ranging from 1 = low to 5 = high for the intensity and frequency dimensions, and on a 4-point Likert scale ranging from 0 = low to 4 = high for the dimension of duration. In this study Cronbach’s alpha was .78.

 

We used the Chinese version (Shi et al., 2021) of the Suicidal Behavior Questionnaire, developed by Osman et al. (2001). The scale consists of four single-question dimensions. Suicide planning (“Have you ever considered or attempted suicide?”) is measured on a 4-point Likert scale ranging from 1 = never to 4 = frequently, disclosure of suicide attempts (“Have you ever told anyone that you were going to or might commit suicide?” is measured on a 5-point scale ranging from 1 = never to 5 = always), suicidal ideation in the last year (“How many times have you considered suicide in the last year?”) is measured on a 3-point Likert scale ranging from 1 = never to 3 = frequently, and likelihood of suicide (“How likely is it that you will try to commit suicide in the future?”) is measured on a 6-point Likert scale ranging from 0 = not at all likely to 6 = highly likely. In this study Cronbach’s alpha was .83.

 

We used the Generalized Anxiety Scale developed by Spitzer et al. (2006). The scale consists of seven items (e.g., “Worrying too much about various things”), which were measured on a 3-point Likert scale ranging from 0 = never to 3 = almost every day. Higher scores indicate more severe anxiety in the individual. In this study Cronbach’s alpha was .93.

 

We used the self-control measure developed by Tan and Guo (2008). It contains 19 items across five dimensions: impulse control (six items, e.g., “People say I have good self-control”), resisting temptation (four items, e.g., “I can resist temptation well”), healthy habits (three items, e.g., “I sometimes drink alcohol or surf the internet to excess”), abstaining from entertainment (three items, e.g., “It’s hard for me to change bad habits”), and focusing on work (three items, e.g., “I can work efficiently for a long-term goal”). All except Items 1, 5, 11, and 14 are reverse scored. In this study Cronbach’s alpha was .89.

We conducted a Pearson correlation analysis and mediated moderation modeling using SPSS 26.0 and PROCESS 4.1.

Common method bias is generally assessed with Harman’s single-factor test. In this study the first factor explained 35.74% of the variance (< 40%), indicating no significant common method bias in our data.

As shown in Table 1, PE was significantly and negatively correlated with SR and significantly and negatively correlated with anxiety. Anxiety was significantly and positively correlated with SR. In addition, SC was significantly correlated with PE, SR, and anxiety.

We tested the moderated mediation model as a whole, and Table 2 shows that PE was negatively associated with SR, thereby supporting Hypothesis 1. Further, PE was negatively associated with anxiety, while anxiety was positively associated with SR. Bootstrapping analysis was used to verify the mediating effect with 5,000 resamples and 95% confidence intervals. As can be seen in Table 3, anxiety had a significant mediating effect on the relationship between PE and SR, thereby supporting Hypothesis 2.

 

Table 2 shows that the interaction term of PE and SC significantly predicted SR, suggesting that SC moderated the relationship between PE and SR. Further, the interaction term between anxiety and SC significantly predicted SR, suggesting that SC moderated the relationship between anxiety and SR, thereby supporting Hypotheses 3 and 4.

We conducted a slope analysis to further explain the moderating effect (see Table 4 and Figures 2 and 3). When SC was high (M + 1 SD), the negative association between PE and SR was stronger; when SC was low (M − 1 SD), the negative association between PE and SR was relatively weaker. That is, as SC levels increased, the protective effect of PE on SR became more pronounced. When SC was high (M + 1 SD), the positive association between anxiety and SR was weaker; when SC was low (M − 1 SD), the positive association between anxiety and SR was stronger. That is, the impact of anxiety on SR decreased as SC levels increased.

In addition, we performed a moderated mediation analysis (see Table 5). At the low level (M − 1 SD) the 95% confidence interval contained zero, implying that there was no significant mediating effect; however, at the mean (M) and high levels (M + 1 SD) the 95% confidence interval did not contain zero, and the effect sizes indicated that there was a mediating effect. In summary, mediated regulation was inconsistent at different levels, suggesting a moderated mediation effect.

We found that PE was negatively associated with SR. A previous study showed that regular participation in PE helped reduce suicidal ideation, suicide planning, and suicide attempts (Southerland et al., 2016). Further, PE was found to reduce the risk of suicide among college students by relieving anxiety, reducing the impact of negative emotions (Biddle & Asare, 2011), facilitating making friends, and establishing good interpersonal relationships (Lubans et al., 2016). Therefore, PE can be a potential intervention to reduce the risk of suicide among college students.

The results of this study showed that anxiety mediated the relationship between PE and SR. PE effectively reduced the anxiety level of college students, potentially through stimulating the central nervous system. This increases the secretion of β-endorphin and epinephrine, which has a positive impact on the generation of pleasurable emotions, and can improve activity and individual excitability, which is conducive to the alleviation of anxiety (Chen et al., 2021). Lower anxiety reduces the level of perceived life and psychological problems, and enhances the ability to approach problems calmly instead of avoiding them or engaging in undesirable behaviors, which reduces the risk of suicidal behaviors (Kuang & Feng, 2017; McLean et al., 2011).

We found that SC moderated the relationship between PE and SR. Specifically, the higher the level of SC, the stronger the negative effect of PE on SR, whereas lower levels of SC weakened this negative association. Individuals with lower SC are more prone to impulsive behaviors and the development of suicidal thoughts (C. Wang et al., 2022), while those with higher SC tend to adopt more adaptive coping strategies when encountering difficulties, such as shifting their attention away from negative emotions and adverse life events, and engaging in PE, thereby strengthening the protective effect of PE against SR (Pu et al., 2024). The negative association we observed between PE and SR was significant only among individuals with high levels of SC, which may be attributed to their greater behavioral persistence, superior emotional regulation, and stronger goal-directed cognitive processing (de Ridder et al., 2012; Tangney et al., 2004). Individuals with higher SC can maintain consistent exercise routines even in the absence of external motivation, and effectively integrate PE into their broader coping strategies, thereby maximizing its psychological benefits in alleviating anxiety, regulating emotions, and fostering social participation (Boat & Cooper, 2019). By contrast, individuals with lower SC tend to engage in PE in an impulsive or sporadic manner, lacking continuity and deep psychological engagement, which limits their ability to derive substantial mental health benefits from this activity, thereby weakening its protective effect on SR (Xie et al., 2020). Furthermore, lower SC has been associated with a stronger tendency toward maladaptive coping strategies, such as avoidance and substance use, which further constrain the positive impact of PE (R. F. Baumeister et al., 2006).

 

Additionally, we found that SC moderated the relationship between anxiety and SR. Specifically, when SC was low, the positive association between anxiety and SR was stronger, whereas high SC buffered this effect. Individuals with high SC were more capable of thinking calmly when experiencing anxiety, and able to formulate reasonable plans to mitigate their anxious feelings, whereas those with low SC were more vulnerable to the detrimental effects of anxiety, thereby increasing their risk for psychological harm and even suicidal ideation (Liu et al., 2018).

The data in this study came from subjective surveys completed by the participants and we lacked data from objective tests such as evaluations from classmates or family members. These tests can be considered for future studies. Second, we used a cross-sectional research method to explore the mechanism between PE on SR. However, causal relationships between variables could not be inferred using this research method. Future in-depth studies could be conducted using longitudinal follow-up or experimental intervention designs. Third, the small sample size of this study limits the generalizability of the findings, and larger samples could be used in the future.

This study provides new insights and contributes to the literature by integrating mediating and moderating mechanisms in an examination of the relationship between PE and SR among college students. The results emphasize the value of promoting regular PE as a suicide-prevention strategy, especially among students with higher SC. Interventions aimed at increasing SC may amplify the mental health benefits of PE and more effectively reduce SR.

Arbinaga, F., Fernández-Ozcorta, E., Sáenz-López, P., & Carmona, J. (2018). The psychological effects of physical exercise: A controlled study of the placebo effect. Scandinavian Journal of Psychology, 59(6), 644–652. https://doi.org/10.1111/sjop.12482

 

Baumeister, R. F., Gailliot, M., DeWall, C. N., & Oaten, M. (2006). Self-regulation and personality: How interventions increase regulatory success, and how depletion moderates the effects of traits on behavior. Journal of Personality, 74(6), 1773–1801. https://doi.org/10.1111/j.1467-6494.2006.00428.x

 

Baumeister, S. E., Leitzmann, M. F., Bahls, M., Dörr, M., Schmid, D., Schomerus, G., Appel, K., Markus, M. R. P., Völzke, H., Gläser, S., & Grabe, H.-J. (2017). Associations of leisure-time and occupational physical activity and cardiorespiratory fitness with incident and recurrent major depressive disorder, depressive symptoms, and incident anxiety in a general population. The Journal of Clinical Psychiatry, 78(1), e41–e47. https://doi.org/10.4088/JCP.15m10474

 

Bertrams, A., Englert, C., Dickhäuser, O., & Baumeister, R. F. (2013). Role of self-control strength in the relation between anxiety and cognitive performance. Emotion, 13(4), 668–680. https://doi.org/10.1037/a0031921

 

Biddle, S. J. H., & Asare, M. (2011). Physical activity and mental health in children and adolescents: A review of reviews. British Journal of Sports Medicine, 45(11), 886–895. https://doi.org/10.1136/bjsports-2011-090185

 

Boat, R., & Cooper, S. B. (2019). Self-control and exercise: A review of the bi-directional relationship. Brain Plasticity, 5(1), 97–104. https://doi.org/10.3233/BPL-190082

 

Chen, M., Zhang, X., Luo, Y., Hu, Z., & Sun, J. (2021). Progress in the study of neurobiological mechanisms related to the improvement of depression by sports exercise [In Chinese]. China Sport Science and Technology, 57(4), 89–97. https://doi.org/10.16470/j.csst.2020137

 

de Ridder, D. T. D., Lensvelt-Mulders, G., Finkenauer, C., Stok, F. M., & Baumeister, R. F. (2012). Taking stock of self-control: A meta-analysis of how trait self-control relates to a wide range of behaviors. Personality and Social Psychology Review, 16(1), 76–99. https://doi.org/10.1177/1088868311418749

 

Hao, Y., Qiao, H., Shi, X., & Huang, G. (2023). Relationship between life events and adolescents’ suicide risk and the mechanism of moderated chain mediation [In Chinese]. Chinese Preventive Medicine, 24(10), 1026–1032. https://doi.org/10.16506/j.1009-6639.2023.10.004

 

Hill, R. M., del Busto, C. T., Buitron, V., & Pettit, J. W. (2017). Depressive symptoms and perceived burdensomeness mediate the association between anxiety and suicidal ideation in adolescents. Archives of Suicide Research: Official Journal of the International Academy for Suicide Research, 22(4), 555–568. https://doi.org/10.1080/13811118.2018.1427163

 

Hofmann, W., Friese, M., & Strack, F. (2009). Impulse and self-control from a dual-systems perspective. Perspectives on Psychological Science, 4(2), 162–176. https://doi.org/10.1111/j.1745-6924.2009.01116.x

 

Kuang, L., & Feng, X. (2017). The moderating role of college students’ emotion regulation strategies in the relationship between nonadaptive perfectionism and suicide risk [In Chinese]. Chinese Mental Health Journal, 31, 885–889.

 

Lan, Z., Pau, K., Yusof, H. M., Zhao, Q., Liang, F., & Huang, X. (2022). Influence of adolescents’ tendency to catastrophise on non-suicidal self-injury behaviour: A moderated mediation model. Frontiers in Psychology, 13, Article 936286. https://doi.org/10.3389/fpsyg.2022.936286

 

Li, J., Zhang, Y., Siu Man Chan, B., Tan, S. N., Lu, J., Luo, X., Shen, Y., & Zhang, X. Y. (2022). Associations between anxiety, depression, and risk of suicidal behaviors in Chinese medical college students. Frontiers in Psychiatry, 13 Article 1012298. https://doi.org/10.3389/fpsyt.2022.1012298

 

Li, Y., He, K., Xue, C., Li, C., & Gu, C. (2022). The impact of self-consistency congruence on non-suicidal self-injury in college students: The mediating role of negative emotion and the moderating role of gender. International Journal of Environmental Research and Public Health, 19(19), Article 11898. https://doi.org/10.3390/ijerph191911898

 

Liang, D. (1994). Stress levels of students in higher education and their relationship with physical activity [In Chinese]. Chinese Journal of Mental Health, 2, 5–6.

 

Liu, Z.-Z., Chen, H., Bo, Q.-G., Chen, R.-H., Li, F.-W., Lv, L., Jia, C.-X., & Liu, X. (2018). Psychological and behavioral characteristics of suicide attempts and non-suicidal self-injury in Chinese adolescents. Journal of Affective Disorders, 226, 287–293. https://doi.org/10.1016/j.jad.2017.10.010

 

Lubans, D., Richards, J., Hillman, C., Faulkner, G., Beauchamp, M., Nilsson, M., Kelly, P., Smith, J., Raine, L., & Biddle, S. (2016). Physical activity for cognitive and mental health in youth: A systematic review of mechanisms. Pediatrics, 138(3), Article e20161642. https://doi.org/10.1542/peds.2016-1642

 

McLean, C. P., Asnaani, A., Litz, B. T., & Hofmann, S. G. (2011). Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness. Journal of Psychiatric Research, 45(8), 1027–1035. https://doi.org/10.1016/j.jpsychires.2011.03.006

 

Ning, K., Yan, C., Zhang, Y., & Chen, S. (2022). Regular exercise with suicide ideation, suicide plan and suicide attempt in university students: Data from the health minds survey 2018–2019. International Journal of Environmental Research and Public Health, 19(14), Article 8856. https://doi.org/10.3390/ijerph19148856

 

O’Connor, R. C., & Kirtley, O. J. (2018). The integrated motivational-volitional model of suicidal behaviour. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 373(1754), Article 20170268. https://doi.org/10.1098/rstb.2017.0268

 

Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The Suicidal Behaviors Questionnaire-Revised (SBQ-R): Validation with clinical and nonclinical samples. Assessment, 8(4), 443–454. https://doi.org/10.1177/107319110100800409

 

Pesce, C., Crova, C., Cereatti, L., Casella, R., & Bellucci, M. (2009). Physical activity and mental performance in preadolescents: Effects of acute exercise on free-recall memory. Mental Health and Physical Activity, 2(1), 16–22. https://doi.org/10.1016/j.mhpa.2009.02.001

 

Pu, L., Shi, T., He, Y., Zheng, C., Wang, L., & Yang, B. (2024). The relationship between social exclusion and aggression and suicidal ideation of drug abstainers: The mediating role of self-control [In Chinese]. Chinese Journal of Applied Psychology, 30(2), 141–148. https://doi.org/10.20058/j.cnki.CJAP.023044

 

Qu, Z., Zou, H., & Zhang, Q. (2006). A study of juvenile delinquency based on self-control theory [In Chinese]. Chinese Mental Health Journal, 10, 650–652.

 

Shi, X., Zhu, Y., Dong, J., Wang, S., Xu, L., Cai, Y., & Zhang, Y. (2021). Reliability and validity of the Suicidal Behaviors Questionnaire-Revised (SBQ-R) in Chinese college students [In Chinese]. Chinese Journal of Health Psychology, 29(4), 593–597. https://doi.org/10.13342/j.cnki.cjhp.2021.04.025

 

Southerland, J. L., Zheng, S., Dula, M., Cao, Y., & Slawson, D. L. (2016). Relationship between physical activity and suicidal behaviors among 65,182 middle school students. Journal of Physical Activity and Health, 13(8), 809–815. https://doi.org/10.1123/jpah.2015-0315

 

Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092

 

Tan, S., & Guo, Y. (2008). Revision of the Self-Control Scale for college students [In Chinese]. Chinese Journal of Clinical Psychology, 5, 468–470.

 

Tang, H., & Kuang, C. (2009). A review of anxiety theory research [In Chinese]. Chinese Journal of Clinical Psychology, 17, 176–177 + 199.

 

Tangney, J. P., Baumeister, R. F., & Boone, A. L. (2004). High self-control predicts good adjustment, less pathology, better grades, and interpersonal success. Journal of Personality, 72(2), 271–324. https://doi.org/10.1111/j.0022-3506.2004.00263.x

 

Valencia-Agudo, F., Burcher, G. C., Ezpeleta, L., & Kramer, T. (2018). Nonsuicidal self-injury in community adolescents: A systematic review of prospective predictors, mediators and moderators. Journal of Adolescence, 65, 25–38. https://doi.org/10.1016/j.adolescence.2018.02.012

 

Wang, C., Zhao, J., & Qin, H. (2022). The impact of peer assault on adolescent suicidal ideation: A chain mediation model [In Chinese]. China Journal of Health Psychology, 30(2), 291–295. https://doi.org/10.13342/j.cnki.cjhp.2022.02.027

 

Wang, M. (2021). Effects of adolescent exercise behavior on depressive tendencies: Mediating effects based on motivation and subjective experience [In Chinese]. Sports and Science, 42(6), 78–85 + 110. https://doi.org/10.13598/j.issn1004-4590.2021.06.012

 

Xie, Q., Du, Y., Liu, N., & Yang, B. (2020). The impact of childhood abuse among prisoners on aggression and suicidal ideation: The mediating role of self-control [In Chinese]. Chinese Journal of Clinical Psychology, 28(2), 387–390. https://doi.org/10.16128/j.cnki.1005-3611.2020.02.035

 

Zhao, Z., Zhao, S., Wang, Q., Zhang, Y., & Chen, C. (2022). Effects of physical exercise on mobile phone addiction in college students: The chain mediation effect of psychological resilience and perceived stress. International Journal of Environmental Research and Public Health, 19(23), Article 15679. https://doi.org/10.3390/ijerph192315679

 

Zhu, J., Chen, Y., Su, B., & Zhang, W. (2021). Anxiety symptoms mediates the influence of cybervictimization on adolescent non-suicidal self-injury: The moderating effect of self-control. Journal of Affective Disorders, 285, 144–151. https://doi.org/10.1016/j.jad.2021.01.004

Yong Tang, College of Physical Education, Chengdu University, Chengdu, Sichuan 610106, People’s Republic of China. Email: [email protected]