Loux, TravisBafageeh, Firas2026-07-212026Bafageeh, F. (2026). Understanding CrossFit participation and mental health: An investigation of causal effects, psychosocial factors, and geographic distribution in the United States [Doctoral dissertation, Saint Louis University]https://hdl.handle.net/20.500.14154/79622Background: CrossFit is a high-intensity, group-based exercise modality promoting distinctive features such as challenge, enjoyment, competition, and social connection. Although physical activity is generally associated with better mental health, limited research has examined whether CrossFit is associated with mental health outcomes, which psychosocial factors may help explain that relationship, and how access to CrossFit affiliates is distributed across communities. Objectives: This dissertation examined the relationship between CrossFit participation and mental health, evaluated psychosocial factors that may help explain this relationship, and assessed how the geographic distribution of CrossFit affiliates aligned with community-level mental health burden in the United States. Specifically, Aim 1 examined depressive and anxiety symptoms, Aim 2 examined psychosocial constructs related to CrossFit participation, and Aim 3 examined the geographic distribution of CrossFit affiliates in relation to ZIP-level mental health indicators. Methods: Aims 1 and 2 used a cross-sectional web-based survey of CrossFit and non-CrossFit participants and applied causal inference, mediation, psychometric, and regression-based approaches. Aim 3 used ZIP Code Tabulation Area–level data from the U.S. Census, CDC PLACES, the EPA Walkability Index, and CrossFit affiliate listings to conduct descriptive, predictive, and spatial analyses, including random forest modeling and local spatial autocorrelation analyses. Results: Across the three aims, findings suggested a possible pattern of somewhat lower depressive and anxiety symptom scores among CrossFit participants, but the estimates were modest and imprecise, and stress management did not clearly mediate the association. Psychosocial constructs were not clearly associated with mental health symptoms in adjusted analyses, while CrossFit affiliates were geographically concentrated in more populous, more walkable, and more socioeconomically advantaged ZIP codes, leaving many higher-burden communities without affiliate access. Implications for public health: These findings suggest that CrossFit may represent one component of a broader supportive physical activity environment, but that access to such environments is unevenly distributed. From a public health perspective, the results support further longitudinal and multilevel research and suggest that improving access to structured, socially supportive exercise opportunities may require attention not only to facility placement, but also to broader neighborhood conditions such as walkability, transportation, and community infrastructure.245enDepressionAnxietyPhysical ActivityExerciseCausal InferenceSpatial EpidemiologyCrossFitMental HealthThesis