The Relationship between Suicidal Behavior, Ideation, and Binge Drinking among College Students

Abstract

Suicidal ideation and behavior among college students are serious and prevalent problems that warrant considerable attention. While a variety of situational and personality factors have been linked to suicidal behavior, alcohol use is one of the most commonly cited factors. As alcohol consumption is a frequent activity for many college students, the association between alcohol use and suicidal behavior may have particularly lethal consequences for students. Yet, to date, few studies have examined the relationship between drinking and suicidal ideation and behavior in this population. This study provides empirical support for this relationship. That is, significant relationships were found between past alcohol use and past suicide attempt(s) and between past binge drinking and past suicidal behavior and ideation. The results are discussed in light of their implications for intervention with and assessment of students presenting with suicidal ideation, behavior, and/or binge drinking.

Full text

The Relationship between
Suicidal Behavior, Ideation,
and Binge Drinking among
College Students
Megan Schaffer, Elizabeth L. Jeglic, and Barbara Stanley
Suicidal ideation and behavior among college students are serious and prevalent
problems that warrant considerable attention. While a variety of situational and
personality factors have been linked to suicidal behavior, alcohol use is one of the most
commonly cited factors. As alcohol consumption is a frequent activity for many college
students, the association between alcohol use and suicidal behavior may have
particularly lethal consequences for students. Yet, to date, few studies have examined
the relationship between drinking and suicidal ideation and behavior in this popu-
lation. This study provides empirical support for this relationship. That is, significant
relationships were found between past alcohol use and past suicide attempt(s) and
between past binge drinking and past suicidal behavior and ideation. The results
are discussed in light of their implications for intervention with and assessment of
students presenting with suicidal ideation, behavior, and=or binge drinking.
Keywords drinking, Hispanic students, suicidality
Suicide is the second leading cause of death
among college students (Silverman, 1993).
It is estimated that there are approximately
1,088 college student suicides each year
(National Mental Health Association &
the Jed Foundation, 2002). Further, studies
have found that up to 55%of college
students have experienced suicidal ideation
at some point in their lives, and as many as
32%of students seriously considered
attempting suicide while in college (Rudd,
1989; Salmons & Harrington, 1984; van
Heeringen, 2001; Westefeld, Homaifar,
Spotts et al., 2005). Research examining
suicidal behavior among college students
with suicidal ideation found that 8.3%for-
mulated a plan to end their lives, and 5.5%
made a suicide attempt (CDC, 1997; Rudd,
1989; Westefeld, Homaifar, Spotts et al.,
2005). While rates of suicide attempts and
completions among college students are
consistently lower than the rates among
their non-collegiate peers, suicidal behavior
in college students remains a serious prob-
lem that warrants considerable attention
(Kessler, Borges, & Walters, 1999; Kisch,
Leino, & Silverman, 2005; Silverman,
Meyer, Sloane et al., 1997; Stephenson,
Pena-Shaff, & Quirk, 2006; Witte, Fitzpatrick,
Joiner et al., 2005). Suicidal behavior in the
context of a college environment affects
not only the approximately 1,100 college-
student victims whose lives are claimed by
suicide each year and their families, but it
Archives of Suicide Research, 12:124–132, 2008
Copyright #International Academy for Suicide Research
ISSN: 1381-1118 print/1543-6136 online
DOI: 10.1080/13811110701857111
124

also gravely affects the many students,
faculty members, and administrators who
are part of each victim’s tightly knit college
community (Joffe, 2003).
In an effort to better understand suici-
dal behavior among college students, a few
studies have examined factors that are
related to suicidal ideation and attempts
in this population. Many studies have
examined such factors in a more general
population. Suicidal behavior is rarely
underlain by a single cause. Rather, indivi-
duals who experience suicidal thoughts
and engage in suicidal behaviors usually
are plagued by a variety of situational
and=or personality factors that lead them
to such behavior. Primary psychopath-
ology, including depressive symptoms
and=or the presence of one or more mood
disorders within an individual (Chioqueta
& Stiles, 2005; Gibb, Andover & Beach,
2006; Haas, Hendin, & Mann, 2003;
Kessler, Borges, Walters et al., 1999; Kisch,
Leino & Silverman, 2005; Stephenson,
Pena-Shaff & Quirk, 2006; Westefeld,
Homaifar, Spotts et al., 2005; Zweig,
Phillips & Lindberg, 2002), has been asso-
ciated with increased suicidal behavior.
Certain personality traits, such as hope-
lessness, helplessness, impulsivity, and
aggression, also have been associated with
suicidal behavior (Stephenson, Pena-Shaff
& Quirk et al., 2006; Zweig, Phillips, &
Lindberg, 2002), as have criminogenic
behavior (Duane, Stewart, & Bridgeland,
2003), and ineffective problem solving
and=or coping skills (Heisel, Flett, &
Hewitt, 2003; McAuliffe, Corcoran, Keeley
et al., 2003; Zweig, Phillips, & Lindberg,
2002). Situational factors that have been
found to be associated with suicidal beha-
vior include recent sexual victimization or
assault (Kisch, Leino, & Silverman, 2005;
Stephenson, Pena-Shaff, & Quirk, 2006),
physical victimization (Stephenson, Pena-
Shaff & Quirk et al., 2006), being in an
emotionally or physically abusive relation-
ship (Kisch, Leino, & Silverman, 2005),
troubles with relationships (including
family problems like feeling rejected by or
distant from a parent or witnessing spousal
abuse between parents; Duane, Stewart, &
Bridgeland, 2003; Westefeld, Homaifar,
Spotts et al., 2005; Zweig, Phillips, &
Lindberg, 2002), having a familial history
that includes mental illness (Duane, Stewart,
& Bridgeland, 2003), exposure to trauma
(Zweig, Phillips, & Lindberg, 2002), feeling
highly stressed (i.e., being subjected to
acute and chronic negative life experiences
or perceiving experiences as such and=or
feeling stressed by school or finances;
Westefeld, Homaifar, Spotts et al., 2005),
and feelings of loneliness or social isolation
(Westefeld, Homaifar, Spotts et al., 2005).
One of the risk factors that has been
most frequently associated with suicidal
behavior among all individuals is alcohol
use. Numerous studies have found a strong
association between alcohol use, suicide
attempts (Borges, Walters, & Kessler,
2000; Hawton, Simkin, & Fagg, 1997;
Petronis, Samuels, Moscicki et al., 1990;
Vajda & Steinbeck, 2000) and completed
suicide (Hawton, Fagg, Platt et al., 1993;
Hawton, Simkin, & Fagg, 1997; Young,
Fogg, Scheftner, & Fawcett, 1994). Studies
have found that individuals who have
attempted suicide have had both high rates
of alcohol intoxication in the months pre-
ceding the attempt and a high incidence
of alcohol use during the incident. Specifi-
cally, Flavin, Franklin, and Frances (1990)
estimated that approximately one-third of
individuals who completed suicide were
also alcoholics. In a retrospective review
of hospital records of adolescents that
had been admitted for a suicide attempt,
Withers and Kaplan (1987) found that in
the year prior to the suicide attempt, the
majority of attempters had used alcohol
or drugs. In a more recent study of high
school students, Miller and colleagues
(2007) found a connection between current
binge drinking, defined as consuming five
or more drinks in a row for men and four
M. Schaffer et al.
ARCHIVES OF SUICIDE RESEARCH 125

or more drinks in a row for women
(NIAAA, 1998), and past suicidal behavior.
They found that high school students who
had engaged in binge drinking in the past
30 days were significantly more likely to
have attempted suicide in the past year than
students who were non drinkers and stu-
dent drinkers who had not engaged in
binge drinking in the past month. Miller
and colleagues also found a dose effect
for the relationship between binge drinking
and suicidal behavior. That is, they found
that high school students who engaged in
binge drinking more frequently were more
likely to have made a suicide attempt in
the last year. Acute alcohol use has also
been associated with suicidal behavior.
Powell and colleagues (2001) found an
odds ratio of 7.0 for the relationship
between a near lethal suicide attempt and
alcohol consumption within 3 hours of
the suicide attempt (indicating that the risk
was 7 times higher for those who con-
sumed alcohol). They also found that
50%of suicide victims had consumed
some alcohol before their suicide attempt,
and 25%of individuals who completed
suicide were intoxicated at the time they
killed themselves. While research has estab-
lished the link between suicidal behavior
and alcohol consumption, few studies have
examined this phenomenon among college
students.
This association between alcohol
consumption and suicidal behavior has
potentially lethal implications for college
students who are notorious for engaging
in binge drinking. In a 2001 survey of
120 four-year colleges in the United States
(approximately 25,000 college students),
Wechsler and colleagues (2002) found
44.4%of college students reported they
had engaged in binge drinking during the
two weeks prior to completing the ques-
tionnaire. While the prevalence of binge
drinking among college students has been
reported to be relatively stable over the
last decade (CDC, 1997; Wechsler, Lee,
Kuo et al., 2002), the survey by Wechsler
and colleagues (2002) found that the num-
ber of frequent binge drinkers has increased.
Given the prevalence of binge drinking
among college students and the relation-
ship between substance use and suicidal
behavior, it would seem that studies
examining the relationship between binge
drinking and suicidal behavior in college
students would be warranted. Yet, few such
studies exist (Miller, Naimi, Brewer et al.,
2007). One of the few studies that has
examined the relationship between binge
drinking and suicidal behavior among
college students found support for the idea
that such an association exists. Brener and
colleagues (1999) found that even after
controlling for demographic characteristics
that have been found to be related to binge
drinking, students who had thoughts of
suicide were significantly more likely to
engage in episodic heavy drinking than
their peers who did not have any suicidal
ideation. Such findings provide preliminary
support for the intuitive, yet understudied,
idea that suicidal ideation and behavior
and binge drinking are related in the
college student population. The purpose
of this study is to add empirical support
for this relationship by exploring the rela-
tionships between alcohol use and suicidal
behavior in a sample of undergraduate col-
lege students. The relationships will also be
explored within different gender and ethnic
sub-groups of the sample.
METHOD
Sample and Participants
A summary of the demographic
characteristics of the sample are presented
in Table 1. Data were collected from 388
students at an urban university who partici-
pated in the study as part of a research
requirement for their introductory psycho-
logy course.
Suicidality and Binge Drinking
126 VOLUME 12 NUMBER 2 2008

The majority of participants were
freshmen in college (60.8%;n¼236).
The average age of participants was 19.6
years, though participants’ ages ranged from
17 to 46 years of age. Sixty-nine percent
(n¼268) of participants were female.
Forty-one percent of participants identified
themselves as Hispanic (n¼160), while
approximately 18%of participants ident-
ified themselves as non-Hispanic Cauca-
sians (18.3%,n¼71) and 25%identified
themselves as non-Hispanic Africans or
African Americans (25.5%,n¼99). The
remainder of the students identified them-
selves as either American Indian or Alaskan
Native (.8%,n¼3), Asians or Pacific
Islanders (5.7%,n¼22), or as another,
unspecified race and ethnicity (7.2%,
n¼28). Almost half of all participants
affiliated themselves with the Catholic
religion (49.0%,n¼190).
Measures
Suicide Behaviors Questionnaire (SBQ; Cole, 1988). The
shortened version of the SBQ is a four-
item self-report measure that employs a
Likert scale to assess an individual’s attitude
towards, history of, and expectations for
suicidal ideation and behavior. The SBQ
has been found to have good internal con-
sistency and adequate concurrent validity
(Brown, 2002).
Alcohol Screen (APA, 2000). The alcohol screen
is a questionnaire version of the DSM-
IV-TR criteria for alcohol abuse. This
measure contains questions that capture
the frequency and consequences of an indi-
vidual’s alcohol use. For this study, two
items concerning binge drinking, defined
as drinking 5 or more drinks in one day,
were of particular interest. These items cap-
tured respondent’s lifetime binge drinking
behavior and their binge drinking behavior
in the past three months. These items
were scored as dichotomous (i.e., ‘‘yes, I
have engaged in this behavior’’ or ‘‘no, I
have not’’) variables.
Demographic information was also
collected.
Statistical Analysis
In this study, correlational and
chi-square analyses were used to examine
the relationship between binge drinking
and suicidal behavior. Pearson product-
moment correlation coefficients were
calculated to quantify the relationship
between continuous variables, while Point-
biserial coefficients were calculated to
quantify the relationship between continu-
ous and dichotomous variables. Chi-square
TABLE 1. Demographic Characteristics
n%
Age
18–22 350 (90.4)
Over 22 37 (9.3)
Year in School
Freshman 236 (60.8)
Sophomore 112 (28.9)
Junior 28 (7.2)
Senior 7 (1.8)
Gender
Female 268 (69.1)
Male 116 (29.9)
Ethnicity
Hispanic 160 (41.2)
Caucasian 71 (18.3)
African American 99 (25.5)
Asian 22 (5.7)
American Indian 3 (0.8)
Other 28 (7.2)
Religion
Catholic 190 (49.0)
Jewish=Muslim=
Protestant=Buddhist 50 (13.0)
Other religion 90 (23.2)
No religion 49 (12.6)
M. Schaffer et al.
ARCHIVES OF SUICIDE RESEARCH 127

statistics were calculated to examine the
relationship between dichotomous vari-
ables. Correlational and chi-square analysis
were also used to examine if relationships
of interest remained significant for differ-
ent gender and ethnic sub-groups of the
sample. Chi-square analysis and t-tests were
used to capture group differences between
binge drinkers and non-binge drinkers.
Individuals with missing values on a vari-
able of interest were excluded from any
analysis that involved that variable.
RESULTS
Table 2 presents a picture of individuals
who had at least one episode of binge
drinking compared to individuals who had
never binge drunk. Binge drinkers were
significantly more likely to be male
(v
2
¼8.45, p¼.015) and of Hispanic
ethnicity or Caucasian race (as compared
to African American; v
2
¼29.92,
p¼.000). Binge drinkers were also signifi-
cantly more likely to have made a past
suicide attempt (v
2
¼8.15, p¼.004) and
experienced suicidal ideation (t¼3.21,
p¼.001). Binge drinkers also reported
consuming significantly more drinks in
the week prior to being interviewed than
non-binge drinkers (t¼6.27, p¼.000).
Binge drinkers also tended to be more
likely to believe they would make a future
suicide attempt than non-binge drinkers
(t¼1.91, p¼.057).
Alcohol Use
A significant relationship was found
between items assessing past alcohol use
(yes or no) and a past suicide attempt (yes
or no; v
2
¼3.687, p¼.055) and between
items that captured the number of drinks
an individual consumed in the week
TABLE 2. Comparison of Binge Drinkers and Non-Binge Drinkers
Non-Binge Drinkers Binge Drinkers
%/v%/vv
2
/t(p)
Age 19.50 19.77 .842 (.400)
Freshman 60.9%62.4%3.636 (.304)
Male 24.9%38.4%8.448 (.015)
Ethnicity 29.916 (.000)
Hispanic 37.2%49.0%
Caucasian 13.9%25.8%
African American 34.6%12.6%
Catholic 45.9%56.0%7.437 (.385)
Past suicide attempt 7.3%16.6%8.152 (.004)
Past suicidal ideation .60 1.16 3.213 (.001)
Suicidal ideation in the past year .44 .46 .202 (.840)
Likelihood of future attempt .14 .29 1.913 (.057)
Depression 12.02 14.35 1.619 (.106)
Alcohol use in the past year 51.3%96.7%89.175 (.000)
Drinks consumed in past week .299 5.26 6.274 (.000)
Note:p<.05; p<.001.
Suicidality and Binge Drinking
128 VOLUME 12 NUMBER 2 2008

prior to completing the survey and their
likelihood of attempting suicide in the
future (0 ¼no chance at all to 4¼very likely;
r¼.147, p¼.004).
Binge Drinking
Significant relationships were found
between items assessing past binge drink-
ing incident(s) (yes or no) and a past suicide
attempt (yes or no; v
2
¼8.152, p¼.004)
and between items assessing a past binge
drinking incident (yes or no) and past suici-
dal ideation (0 ¼No to 6 ¼I attempted to
kill myself and I think I really hoped to die;
r
pb
¼.175, p¼.001).
Relationships within Specific Genders
and Ethnicities
The relationship between items asses-
sing past binge drinking incident(s) and a
past suicide attempt was found to be sig-
nificant for females (v
2
¼8.581,
p¼.003). However, the same significant
relationship was not found for males
(Fisher’s Exact Test,p¼.162). Differences
in the relationships between past suicidal
ideation and binge drinking for different
ethnic groups were also found: The
relationship between items assessing past
suicidal ideation and past binge drinking
was significant for Hispanics (r
pb
¼.184,
p¼.02) but not for Caucasians (r
pb
¼.140,
p¼.245). The relationships between other
variables of interest (such as the relation-
ship between past alcohol use and past
suicidal behavior) did not differ across
genders or ethnicities.
DISCUSSION
The results of this study show that alcohol
use and binge drinking are significantly
related to suicidal behavior among college
students. Furthermore, binge drinking is
related to suicidal ideation, and an
increased level of current consumption is
related to an increased belief in the likeli-
hood of engaging in suicidal behavior in
the future. There was also evidence that
the relationship between binge drinking
and suicidal ideation and behavior may be
stronger for females and Hispanics than
for males and Caucasians. These findings
provide support for the idea that alcohol
use, and specifically binge drinking, is
related to both suicidal ideation and beha-
vior among college students. These find-
ings have implications for the treatment
and assessment of college students who
present with either suicidal ideation and
behavior or binge drinking.
Because the cost of any suicide is so
great, systematic interventions aimed at
addressing alcohol use that include compo-
nents with even modest or no empirical
support, seem warranted. Yet, few pro-
grams designed to address and prevent sui-
cidal ideation and behavior in college
students exist or have even been proposed
(Joffe, 2003; Miller, Naimi, Brewer et al.,
2007). For instance, an intervention aimed
at individuals presenting with suicidal idea-
tion or behavior could incorporate aspects
of harm reduction. The principles of harm
reduction were developed by the Harm
Reduction Coalition, a not for profit
organization dedicated to reducing the
harm that results from drug, including alco-
hol, use. The principles, offered to com-
munities wishing to reduce the negative
impact of drug use in their community,
are as follows: accept that illicit drugs exist
and work to minimize their harmful effects;
don’t ignore the existence of drugs or con-
demn their use; acknowledge there are safe
ways to use drugs; provide services and
resources to people who use drugs;
empower drug users as the primary agents
of change and harm reduction for them-
selves and others; and, do not attempt to
minimize or ignore the harm associated
with drug use (Harm Reduction Coalition,
2007). They have applied the program to
alcohol by teaching students to drink
M. Schaffer et al.
ARCHIVES OF SUICIDE RESEARCH 129

responsibly (see Brief Alcohol Intervention
and screening for college students; Dimeff,
Baer, Kivlahan et al., 1999). Such a com-
munity intervention is not unlike the solu-
tions proposed by the Institute of
Medicine (IOM) of the National Academy
of Sciences in their 2004 report Reducing
Underage Drinking: A Collective Responsibility.
However, in addition to encouraging com-
munity members to become more educated
about alcohol and drug use and to take a
more active role in educating users, the
IOM encouraged community enforcement
agencies to better enforce drinking age
requirements. Further, they called on busi-
nesses and governments, both near and
far, to assist in funding campaigns and edu-
cating the public (Miller, Naimi, Brewer
et al., 2007).
Our findings suggest that college
students who engage in binge drinking or
suicidal ideation or behavior should be
assessed for both. It is possible that suicidal
ideation may lead to heavy drinking,
that heavy drinking may precede suicidal
ideation or behavior, and=or that the two
behaviors co-occur. Further, it is unknown
if drinking precedes suicidal behavior for
certain individuals and if the behaviors
may be reversed in other individuals. That
is, we do not have a reliable system for
identifying a person whose drinking will
lead to suicidal ideation and behavior or
vice versa. Given this limited knowledge
and the difficulties parsing out which beha-
vior (if either) precedes the other, it may be
more prudent to assess for both behaviors.
Further, considering the high preva-
lence rates of suicidal behavior among
Latino adolescents (Zayas, Lester, Cabassa
et al., 2005), interventions may be more
efficacious and assessments could be more
poignant and focused if ethnic differences
and propensities are considered in the
development and implementation of such
tools. Like Miller and colleagues (2007),
we found both Hispanic and Caucasian
high school students were significantly
more likely to have engaged in binge
drinking in the past month than their
African American counterparts. However,
our findings showed a significant relation-
ship between binge drinking and suicidal
ideation in Hispanics but not in Caucasians.
Our results also suggested a stronger con-
nection between binge drinking and suici-
dal behavior in females as opposed to
males. While our results provide prelimi-
nary support for the idea that binge
drinking may indicate more serious patho-
logies for some groups than others, more
research examining alcohol use, suicidal
behavior, and the relationship between
these two behaviors in college students of
different genders and ethnicities is needed
as information is lacking (Zayas, Lester,
Cabassa et al., 2005). Future studies should
continue to examine the relationship
between binge drinking and suicidality in
individuals of different racial and ethnic
groups.
Finally, it appears one of the greatest
obstacles facing troubled college students
is a lack of knowledge about services that
are available to them on their campus.
For instance, Westefeld and colleagues
(2005) found only 26%of 1865 students
were aware of any resources on campus
for dealing with suicide. Considering
this pervasive lack of knowledge, interven-
tions targeting suicidal college students
should contain outreach and educational
components.
Limitations and Future Directions
Data for this project were gathered
from an urban sample. Future studies could
sample from various colleges around the
U.S. to increase the generalizability of the
findings. Further, much of our data was
based on retrospective reports, which may
be subject to recall problems. In this study,
the accuracy of reported data may also
have suffered because we asked students,
many of whom were underage, to disclose
Suicidality and Binge Drinking
130 VOLUME 12 NUMBER 2 2008

potentially uncomfortable and possibly
illegal behavior. Future studies could
employ a prospective design to improve
the accuracy of data, confirm the associa-
tions between binge drinking and suicidal
behavior, and improve our understanding
of the temporal relationship between binge
drinking and suicidal behavior and ideation.
However, our findings provide support for
an important relationship, which to date
has remained relatively unexplored. Our
findings suggest the relationship between
binge drinking and suicidal ideation and
behavior in college students warrants
further investigation.
AUTHOR NOTE
Megan Schaffer, Elizabeth L. Jeglic and
Barbara Stanley, John Jay College of
Criminal Justice, New York, NY, USA.
Correspondence concerning this article
should be addressed to Megan Schaffer,
M.A. 101 Cooper St, 1H, New York, NY
10034. E-mail: mschaffer@gc.cuny.edu.
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