Social Psychiatry and Psychiatric Epidemiology

, Volume 49, Issue 9, pp 1379–1387 | Cite as

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

  • Holly B. Herberman Mash
  • Carol S. Fullerton
  • Holly J. Ramsawh
  • Tsz Hin H. Ng
  • Leming Wang
  • Ronald C. Kessler
  • Murray B. Stein
  • Robert J. Ursano
Original Paper



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.


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.


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.


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


Suicidality Alcohol use Energy drink use Military Substance use 



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.

Conflict of interest

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


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Holly B. Herberman Mash
    • 1
  • Carol S. Fullerton
    • 1
  • Holly J. Ramsawh
    • 1
  • Tsz Hin H. Ng
    • 1
  • Leming Wang
    • 1
  • Ronald C. Kessler
    • 2
  • Murray B. Stein
    • 3
    • 4
    • 5
  • Robert J. Ursano
    • 1
  1. 1.Department of Psychiatry, Center for the Study of Traumatic StressUniformed Services University of the Health SciencesBethesdaUSA
  2. 2.Department of Health Care PolicyHarvard Medical SchoolBostonUSA
  3. 3.Department of PsychiatryUniversity of CaliforniaSan DiegoUSA
  4. 4.Department of Family and Preventive MedicineUniversity of CaliforniaSan DiegoUSA
  5. 5.Psychiatry Service, Veterans Affairs, San Diego Healthcare SystemSan DiegoUSA

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