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Risk for suicidal behaviors associated with alcohol and energy drink use in the US Army

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Suicidal behaviors have increased in the US Army since 2005. To identify potential interventions for suicide risk, we examined the relationship between alcohol and energy drink use, independently and in combination, and rates of seriously considering and/or attempting suicide in US Army soldiers.

Methods

This study used the DoD Survey of Health Related Behaviors Among Active Duty Military Personnel (DoD HRB), which sampled 10,400 Army soldiers, with 5,927 responses representing 508,088 soldiers. Use of energy drinks in combination with alcohol (A/ED) and average daily amount of alcohol consumption over the past 30 days and history of seriously considering and/or attempting suicide in the past year were assessed via self-report questions.

Results

Six percent of Army service members reported either seriously considering and/or attempting suicide in the past year. Twenty-six percent of soldiers reported A/ED. Those who reported the highest level of alcohol use were more likely to have seriously considered and/or attempted suicide. Soldiers who reported daily A/ED were over three times more likely to have reported suicidal ideation or attempts, and even after adjusting for overall alcohol consumption and energy drink use alone remained approximately two times (OR = 1.99) more likely to report suicidality.

Conclusions

Combination alcohol and energy drink use and heavy alcohol use contribute to suicidality and may be targets for potential intervention to address suicide risk.

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References

  1. Armed Forces Health Surveillance Center (2012) Deaths by suicide while on active duty, active and reserve components, US Armed Forces, 1998–2011. MSMR 19(6):7–10

    Google Scholar 

  2. Black SA, Gallaway S, Bell MR, Ritchie EC (2011) Prevalence and risk factors associated with suicides of Army soldiers 2001–2009. Mil Psychol 23:433–451

    Article  Google Scholar 

  3. Hyman J, Ireland R, Frost L, Cottrell L (2012) Suicide incidence and risk factors in an active duty US military population. Am J Public Health 102:S138–S146

    Article  PubMed Central  PubMed  Google Scholar 

  4. Eaton KM, Messer SC, Garvey Wilson AL, Hoge CW (2006) Strengthening the validity of population-based suicide rate comparisons: an illustration using US military and civilian data. Suicide Life Threat Behav 36:182–191

  5. Hoge CW, Castro CA (2012) Preventing suicides in US service members and veterans: concerns after a decade of war. JAMA 308(7):671–672

    Article  CAS  PubMed  Google Scholar 

  6. Guerra VS, Calhoun PS (2011) Examining the relation between posttraumatic stress disorder and suicidal ideation in an OEF/OIF veteran sample. J Anxiety Disord 25:12–18

    Article  PubMed Central  PubMed  Google Scholar 

  7. Gadermann AM, Gilman SE, McLaughlin KA, Nock MK, Petukhova M, Sampson NA, Kessler RC (2012) Projected rates of psychological disorders and suicidality among soldiers based on simulations of matched general population data. Mil Med 177(9):1002–1010

    Article  PubMed Central  PubMed  Google Scholar 

  8. Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S (2008) Suicide and suicidal behavior. Epidemiol Rev 30:133–154

    Article  PubMed Central  PubMed  Google Scholar 

  9. Joiner TE, Conwell Y, Fitzpatrick KK, Witte TK, Schmidt NB, Berlim MT, Fleck MP, Rudd MD (2005) Four studies on how past and current suicidality relate even when “everything but the kitchen sink” is covaried. J Abnorm Psychol 114(2):291–303

    Article  PubMed  Google Scholar 

  10. Nock MK, Deming CA, Fullerton CS, Gilman SE, Goldenberg M, Kessler RC, McCarroll JE, McLaughlin KA, Peterson C, Schoenbaum M, Stanley B, Ursano RJ (2013) Suicide among soldiers: a review of risk and protective factors. Psychiatry 76(2):97–125

    PubMed Central  PubMed  Google Scholar 

  11. Oquendo MA, Bongiovi-Garcia ME, Galfavy H, Goldberg PH, Grunebaum MF, Burke AK, Mann JJ (2007) Sex differences in clinical predictors of suicidal acts after major depression: a prospective study. Am J Psychiatry 164(1):134–141

    Article  PubMed Central  PubMed  Google Scholar 

  12. Carter G, Reith DM, Whyte IM, McPherson M (2005) Repeated self-poisoning: increasing severity of self-harm as a predictor of subsequent suicide. Br J Psychiatry 186:253–257

    Article  PubMed  Google Scholar 

  13. Borges G, Walters EE, Kessler RC (2000) Associations of substance use, abuse, and dependence with subsequent suicidal behavior. Am J Epidemiol 151(8):781–789

    Article  CAS  PubMed  Google Scholar 

  14. Cherpitel CJ, Borges GLG, Wilcox HC (2004) Acute alcohol use and suicidal behavior: a review of the literature. Alcohol Clin Exp Res 28:18S–28S

    Article  PubMed  Google Scholar 

  15. Langhinrichsen-Rohling J, Snarr JD, Slep AMS, Heyman RE, Foran HM, United States Air Force Family Advocacy Program (2011) Risk for suicidal ideation in the US Air Force: an ecological perspective. J Consult Clin Psychol 79(5):600–612

    Article  PubMed  Google Scholar 

  16. Oteri A, Salvo F, Caputi AP, Calapai G (2007) Intake of energy drinks in association with alcoholic beverages in a cohort of students of the School of Medicine of the University of Messina. Alcohol Clin Exp Res 31(10):1677–1680

    Article  PubMed  Google Scholar 

  17. Price SR, Hilchey CA, Darredeau C, Fulton HG, Barrett SP (2010) Energy drink co- administration is associated with increased reported alcohol ingestion. Drug Alcohol Rev 29:331–333

    Article  PubMed  Google Scholar 

  18. Howland J, Rohsenow DJ (2013) Risks of energy drinks mixed with alcohol. JAMA 309(3):245–246

    Article  CAS  PubMed  Google Scholar 

  19. O’Brien MC, McCoy TP, Rhodes SD, Wagoner A, Wolfson M (2008) Caffeinated cocktails: energy drink consumption, high-risk drinking, and alcohol-related consequences among college students. Acad Emerg Med 15(5):453–460

    Article  PubMed  Google Scholar 

  20. Reissig CJ, Strain EC, Griffiths RR (2009) Caffeinated energy drinks—a growing problem. Drug Alcohol Depend 99:1–10

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Brener ND, Hassan SS, Barrios LC (1999) Suicidal ideation among college students in the United States. J Consult Clin Psychol 67:1004–1008

    Article  CAS  PubMed  Google Scholar 

  22. Gonzalez VM, Bradizza CM, Collins RL (2009) Drinking to cope as a statistical mediator in the relationship between suicidal ideation and alcohol outcomes among underage college drinkers. Psychol Addict Behav 23:443–451

    Article  PubMed Central  PubMed  Google Scholar 

  23. Levy JC, Deykin EY (1989) Suicidality, depression, and substance abuse in adolescence. Am J Psychiatry 146:1462–1467

    CAS  PubMed  Google Scholar 

  24. Stephenson H, Pena-Shaff J, Quirk P (2006) Predictors of college student suicidal ideation: gender differences. Coll Stud J 40:109–117

    Google Scholar 

  25. Kessler RC, Nelson CB, McGonagle KA, Edlund MJ, Frank RG, Leaf PJ (1996) The epidemiology of co-occurring addictive and mental disorders: implications for prevention and service utilization. Am J Orthopsychiatry 66(1):17–31

    Article  CAS  PubMed  Google Scholar 

  26. Milliken CS, Auchterlonie JL, Hoge CW (2007) Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. JAMA 298:2141–2148

    Article  CAS  PubMed  Google Scholar 

  27. Pietrzak RH, Goldstein MB, Malley JC, Rivers AJ, Johnson DC, Southwick SM (2010) Risk and protective factors associated with suicidal ideation in veterans of Operations Enduring Freedom and Iraqi Freedom. J Affect Disord 123:102–107

    Article  PubMed  Google Scholar 

  28. Harrell MC, Berglass N (2011) Losing the battle: the challenge of military suicide. Center for a New American Security Policy Brief. Center for a New American Security, Washington, DC

    Google Scholar 

  29. US Army (August, 2010) Health Promotion Risk Reduction Suicide Prevention Report, 43

  30. Sepkowitz KA (2013) Energy drinks and caffeine-related adverse effects. JAMA 309(3):243–244

    Article  CAS  PubMed  Google Scholar 

  31. Griffiths RR, Juliano LM, Chausmer A (2003) Caffeine: pharmacology and clinical effects. In: Graham AW, Schultz TK, Mayo-Smith MF, Ries RK, Wilford BB (eds) Principles of addiction medicine, 3rd edn. American Society of Addiction Medicine, Chevy Chase, pp 193–224

    Google Scholar 

  32. IsHak WW, Ugochukwu C, Bagot K, Khalili D, Zaky C (2012) Energy drinks: psychological effects and impact on well-being and quality of life—a literature review. Innov Clin Neurosci 9(1):25–34

    PubMed Central  PubMed  Google Scholar 

  33. Arria AM, Caldeira KM, Kasperski SJ, Vincent KB, Griffiths RR, O’Grady KE (2011) Energy drink consumption and increased risk for alcohol dependence. Alcohol Clin Exp Res 35(2):365–375

    Article  PubMed Central  PubMed  Google Scholar 

  34. Ferreira SE, de Mello MT, Pompeia S, DeSouza-Formigoni MLO (2006) Effects of energy drink ingestion on alcohol intoxication. Alcohol Clin Exp Res 30:596–605

    Google Scholar 

  35. Thombs DL, O’Mara RJ, Tsukamoto M, Rossheim ME, Weiler RM, Merves ML, Goldberger BA (2010) Event-level analyses of energy drink consumption and alcohol intoxication in bar patrons. Addict Behav 35(4):325–330

    Article  PubMed  Google Scholar 

  36. Bray RM, Pemberton MR, Hourani LL, Witt M, Olmstead KL, Brown JM, Weimer B, Lane ME, Marsden ME, Scheffler S (2009) 2008 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel. Research Triangle Park, NC, Research Triangle Institute

    Google Scholar 

  37. Bray RM, Pemberton MR, Lane ME, Hourani LL, Mattiko MJ, Babeu LA (2010) Substance use and mental health trends among US military active duty personnel: key findings from the 2008 DoD Health Behavior Survey. Mil Med 175:390–399

    Article  PubMed  Google Scholar 

  38. Rehm, J (2013) The risks associated with alcohol use and alcoholism. Alcohol Research Health 34(2). Available at pubs.niaaa-nih.gov/publications;arh342/135-143.htm. Accessed 27 Nov 2013

  39. Centers for Disease Control and Prevention. Alcohol and public health. Available at http://www.cdc.gov/alcohol/faqs.htm. Accessed 27 Nov 2013

  40. US Department of Agriculture and US Department of Health and Human Services (2010) Foods and food components. Dietary Guidelines for Americans, 7th edn. U.S. Government Printing Office, Washington, D.C, pp 30–32

    Google Scholar 

  41. Hill JV, Johnson RC, Barton RA (2006) Suicidal and homicidal soldiers in deployment environments. Mil Med 171:228–232

    PubMed  Google Scholar 

  42. Kuehn BM (2009) Soldier suicide rates continue to rise: military, scientists work to stem the tide. JAMA 301(11):1111–1113

    Article  CAS  PubMed  Google Scholar 

  43. Bray RM, Hourani LL, Olmstead KLR, Witt M, Brown JM, Pemberton MR, Marsden ME, Marriott B, Scheffler S, Vandermaas-Peeler R (2006) 2005 Department of Defense Survey of Health related behaviors among Active Duty Military Personnel. Research Triangle Park, NC, Research Triangle Institute

    Google Scholar 

  44. McKibben JBA, Fullerton CS, Nock MK, Naifeh JA, Kessler RC, Stein MB, Ursano RJ (2013) Suicidal behaviors and the use of mental health services in the US Army. Psychiatr Serv. doi:10.1176/appi.ps.201200460

    PubMed  Google Scholar 

  45. Wechsler H, Davenport A, Dowdall G, Moeykens B, Castillo S (1994) Health and behavioral consequences of binge drinking in college: a national survey of students at 140 campuses. JAMA 272(21):1672–1677

    Article  CAS  PubMed  Google Scholar 

  46. Centers for Disease Control and Prevention (2012) Vital signs: binge drinking prevalence, frequency, and intensity among adults—United States, 2010. JAMA 307(9):908–910

    Google Scholar 

  47. Moreno M, Estevez AF, Zaldivar F, Montes JM, Gutierrez-Ferre VE, Esteban L, Sanchez-Santed F, Flores P (2012) Impulsivity differences in recreational cannabis users and binge drinkers in a university population. Drug Alcohol Depend 124(3):355–362

    Article  PubMed  Google Scholar 

  48. Mann JJ, Waternaux C, Hass GL, Malone KM (1999) Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry 156:181–189

    CAS  PubMed  Google Scholar 

  49. Fawcett J (2001) Treating impulsivity and anxiety in the suicidal patient. Ann NY Acad Sci 932:94–102

    Article  CAS  PubMed  Google Scholar 

  50. Zouk H, Tousignant M, Seguin M, Lesage A, Turecki G (2006) Characterization of impulsivity in suicide completers: clinical, behavioral, and psychosocial dimensions. J Affect Disord 92:195–204

    Article  PubMed  Google Scholar 

  51. Howland J, Rohsenow DJ, Calise TV, MacKillop J, Metrik J (2011) Caffeinated alcoholic beverages: an emerging public health problem. Am J Prev Med 40(2):269–271

    Google Scholar 

  52. Miller KE (2008) Energy drinks, race, and problem behaviors among college students. J Adolesc Health 43:490–497

    Article  PubMed Central  PubMed  Google Scholar 

  53. Miller KE (2008) Wired: energy drinks, jock identity, masculine norms, and risk taking. J Am Coll Health 56(5):481–489

    Article  PubMed Central  PubMed  Google Scholar 

  54. Arria AM, Caldeira KM, Kasperski SJ, O’Grady KE, Vincent KB, Griffiths RR, Wish ED (2010) Increased alcohol consumption, nonmedical prescription drug use, and illicit drug use are associated with energy drink consumption among college students. J Addict Med 4(2):74–80

    Article  PubMed Central  PubMed  Google Scholar 

  55. Jones HA, Lejuez CW (2005) Personality correlates of caffeine dependence: the role of sensation seeking, impulsivity, and risk taking. Exp Clin Psychopharmacol 13(3):259–266

    Article  PubMed  Google Scholar 

  56. Heinz AJ, de Wit H, Lilje TC, Kassel JD (2013) The combined effects of alcohol, caffeine, and expectancies on subjective experience, impulsivity, and risk-taking. Exp Clin Psychopharmacol 21(3):222–234

    Article  PubMed  Google Scholar 

  57. Bruce M, Scott N, Shine P, Lader M (1992) Anxiogenic effects of caffeine in patients with anxiety disorders. Arch Gen Psychiatry 49(11):867–869

    Article  CAS  PubMed  Google Scholar 

  58. Childs E, de Wit H (2006) Subjective, behavioral, and physiological effects of acute caffeine in light, nondependent caffeine users. Psychopharmacology 185(4):514–523

    Article  CAS  PubMed  Google Scholar 

  59. Lee MA, Flegel P, Greden JF, Cameron OG (1988) Anxiogenic effects of caffeine on panic and depressed patients. Am J Psychiatry 145:632–635

    CAS  PubMed  Google Scholar 

  60. Nardi AE, Lopes FL, Friere RC, Veras AB, Nascimento I, Valenca AM, de Melo-Neto VL, Soares-Filho GL, King AL, Araulo DM, Mezzasalma MA, Rassi A, Zin WA (2009) Panic disorder and social anxiety disorder subtypes in a caffeine challenge test. Psychiatry Res 169(2):149–153

    Article  PubMed  Google Scholar 

  61. Tanskanen J, Puska P (2000) Heavy coffee drinking and the risk of suicide. Eur J Epidemiol 169(9):789–791

    Article  Google Scholar 

  62. Hyman J, Ireland R, Frost L, Cottrell L (2012) Suicide incidence and risk factors in an active duty military population. Am J Public Health 102:138–146

    Article  Google Scholar 

  63. Hawton K, Houston K, Haw C, Townsend E, Harriss L (2003) Comorbidity of axis I and axis II disorders in patients who attempted suicide. Am J Psychiatry 160(8):1494–1500

    Article  PubMed  Google Scholar 

  64. Kessler RC, Berglund P, Borges G, Nock M, Wang PS (2005) Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003. JAMA 293(20):2487–2495

    Article  CAS  PubMed  Google Scholar 

  65. Nock MK, Hwang I, Sampson N, Kessler RC, Angermeyer M, Beautrais A, Borges G, Bromet E, Bruffaerts R, de Girolamo G, de Graaf R, Florescu S, Gureje O, Haro JM, Hu C, Huang Y, Karam EG, Kawakami N, Kovess V, Levinson D, Posada-Villa J, Sagar R, Tomov T, Viana MC, Williams DR (2009) Cross-national analysis of the associations among mental disorders and suicidal behavior: findings from the WHO World Mental Health Surveys. PLoS Med 6(8):e1000123

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

The authors wish to thank Deborah Probe, M.A. who provided valuable assistance to the undertaking of the research summarized here. The opinions expressed in this article are those of the authors and therefore do not necessarily reflect the views of the Department of Defense, the Uniformed Services University of the Health Sciences, or the Center for the Study of Traumatic Stress. Dr. Kessler has been a consultant for Analysis Group, AstraZeneca, Bristol-Myers Squibb, Cerner-Galt Associates, Eli Lilly and Company, GlaxoSmithKline, HealthCore, Health Dialog, Hoffman-LaRoche, Integrated Benefits Institute, John Snow, Inc., Kaiser Permanente, Matria, Mensante, Merck, Ortho-McNeil Janssen Scientific Affairs, Pfizer, Primary Care Network, Research Triangle Institute, Sanofi-Aventis Groupe, Shire US, SRA International, Takeda Global Research and Development, Transcept Pharmaceuticals, and Wyeth-Ayerst. Dr. Kessler has served on advisory boards for Appliance Computing II, Eli Lilly and Company, Johnson and Johnson, Mindsite, Ortho-McNeil Janssen Scientific Affairs, Plus One Health Management, and Wyeth-Ayerst. He has received research support for his epidemiological studies from Analysis Group, Bristol-Myers Squibb, Eli Lilly and Company, EPI-Q, GlaxoSmithKline, Johnson and Johnson Pharmaceuticals, Ortho-McNeil Janssen Scientific Affairs, Pfizer, Sanofi-Aventis Groupe, Shire US, and Walgreens Co. He also owns 25 % share in DataStat. Dr. Stein is coeditor-in-chief of Up To Date and a consultant for Care Management Technologies.

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The other authors declare that they have no conflict of interest.

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Correspondence to Holly B. Herberman Mash.

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Mash, H.B.H., Fullerton, C.S., Ramsawh, H.J. et al. Risk for suicidal behaviors associated with alcohol and energy drink use in the US Army. Soc Psychiatry Psychiatr Epidemiol 49, 1379–1387 (2014). https://doi.org/10.1007/s00127-014-0886-0

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  • DOI: https://doi.org/10.1007/s00127-014-0886-0

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