Table 2.
Studies That Have Examined Associations Between Chronic Energy Drink Use and Mental Health Outcomes
| Study | Variables of interest | Design | Sample | Effects |
|---|---|---|---|---|
| Arria et al.56 | Depression (BDI) | Cross-sectional interviews and questionnaires (collected as part of a longitudinal study) | 1097 fourth year US university students | No difference in BDI scores between frequent users and either infrequent users or nonusers |
| Azagba, Langille and Asbridge57 | Depression (12-item version of the CES-D) | Cross-sectional survey (two-stage stratified cluster sample from three provinces) | 8210 public school students (grades 7, 9, 10, and 12) in Canada | Higher depression associated with frequent (once a month or more) use |
| Evren and Evren51 | Anxiety (PSTA) Depression (PSTA) Self-mutilation (unspecified) Suicidal thoughts (unspecified) |
Cross-sectional online questionnaire | 4957 10th grade students from 45 schools in 15 districts of Istanbul, Turkey (representative sample) | Frequency of energy drink use positively associated with anxiety. Frequency of energy drink use positively associated with depression. Frequency of energy drink use positively associated with self-harming behavior Frequency of energy drink use positively associated with suicidal thoughts Multivariate level: no association with anxiety or depression. Multivariate level: self-harming behavior and suicidal thoughts associated with consuming energy drinks every day |
| Hofmeister et al.39 | Stress (DASS-21) Anxiety (DASS-21) Depression (DASS-21) |
Cross-sectional online questionnaire | 456 US veterinary students: University of Georgia (UOG; N = 227): Colorado State University (CSU; N = 229) | UOG: energy drink users had higher anxiety than nonusers (no differences for stress or depression); regular users had higher stress than nonregular users (no differences for anxiety or depression) CSU: energy drink users had higher anxiety than nonusers (no differences for stress or depression); regular users had higher depression, anxiety, and stress scores than nonregular users |
| Malinauskas et al.53 | Jolt and crash episodes | Cross-sectional questionnaire | 496 randomly surveyed US students | 29% reported weekly jolt and crash episodes from energy drink use (significant dose-dependent effect) |
| Heart palpitations | 19% reported heart palpitations from energy drinks (marginally significant dose-dependent effect, p = 0.09) | |||
| Peters et al.47 | PTSD symptoms after Hurricane Ike | Cross-sectional questionnaire | 170 low-income at-risk African American/Latino male youth (9–19) from Houston, Texas | Initial associations between PTSD symptoms and 30-day prior use of antienergy drinks (significant) and energy drinks (marginally significant, p = 0.09) |
| Multivariate: no associations between PTSD symptoms and energy drink or antienergy drink use | ||||
| Pettit and DeBarr44 | Stress (items from PSS) | Cross-sectional online questionnaire | 136 US undergraduate students | Significant positive relationships between perceived stress and three measures of energy drink consumption |
| Relationships between perceived stress and three other measures of energy drink consumption were not significant | ||||
| Richards et al.37 | General health (WPQ single-item) | Cross-sectional questionnaire | 2030 British secondary school children | High consumption of caffeinated soft drinks/gum factor (comprising energy drinks, cola, and chewing gum) derived from the DABS was associated with low general health; remained significant after controlling for other dietary, demographic, and lifestyle factors |
| Richards and Smith46 | Stress (WPQ single-item) | Cross-sectional questionnaire | 2307 British secondary school children | Caffeine from energy drinks not associated with stress, anxiety, or depression at the univariate level |
| Anxiety (WPQ single-item) | Marginally significant associations between low caffeine consumption (0.1–133 mg/w) from energy drinks and high stress and anxiety after controlling for additional dietary, demographic, and lifestyle factors; no effects for high ≥133 mg/w consumption | |||
| Depression (WPQ single-item) | No association between caffeine from energy drinks and depression at the multivariate level | |||
| Ríos et al.45 | Academic Stress (questionnaire Adapted from the Systemic Cognitive Model of Academic Stress) | Cross-sectional questionnaire (administered in August, participants asked to answer retrospectively for January–May). Representative stratified sample of medical-based subjects | 275 first- and second-year Puerto Rican students | Energy drink consumption not associated with academic stress |
| Soft drink and coffee consumption increased in times of high stress (although no effects regarding energy drinks, tea, and hot chocolate) | ||||
| 49% reported that consuming caffeinated beverages was useful for coping with stress, with 42.6% admitting they would probably use caffeinated beverages as a stress coping strategy in the future | ||||
| Rizvi et al.43 | Increased consumption of caffeine/energy drinks (did not isolate energy drinks) | Cross-sectional questionnaire (although asked if participants had experienced increases/decreases in consumption in relation to pre-examination stress) | 226 second-year medical students in Karachi, Pakistan | Increased consumption of coffee, tea, and energy drinks in 38.94% of respondents at pre-examination time |
| Snipes et al.55 | Anxiety sensitivity (SURPS) | Cross-sectional online questionnaire | 757 US undergraduate students | AmED users scored lower on anxiety sensitivity compared to alcohol-only users |
| Hopelessness (SURPS) | No difference between AmED users and alcohol-only users for hopelessness | |||
| Stasio et al.52 | Anxiety (BAI) | 7-day retrospective survey (questionnaire) | 107 young adults (college student athletes, Reserve Officers Training Corps cadets, and psychology students) | Energy drink use explained 29% of variance in anxiety scores (after controlling for sleep quality, coffee, tea, and soft drink consumption) |
| Toblin et al.41 | Sleep disruption due to stress | Cross-sectional questionnaire (although design is not formally stated) | 988 male US Army and Marine combat platoons deployed in Afghanistan in 2010 (initially 1249 surveyed using a cluster sample, 1000 consented to their data being used for research purposes, 988 answered energy drink question) | Those consuming ≥3/d more likely to report sleep disruption related to stress |
| No differences between 0, 1–2, and ≥3/d on level of concern regarding not getting enough sleep | ||||
| Those consuming ≥3/d more likely to report sleep disruption on more than half the nights in the past 30 days because of stress related to combat, personal life, and illness | ||||
| Trapp et al.40 | Stress (DASS-21) | Cross-sectional questionnaire (population-based sample from the Western Australian Pregnancy Cohort (Raine) Study, a prospective cohort followed from gestation to early adulthood) | 1062 young adult Australians | Univariate: energy drink consumption associated with depression (total sample, and males, but not females), anxiety (total sample, males, females), and stress (total sample, males, females) |
| Anxiety (DASS-21) | Multivariate (most conservative model): only significant relationship was between energy drink use and anxiety in males | |||
| Depression (DASS-21) | Multivariate: ≥250 mL/d energy drink users (compared to 0 mL/d) had higher anxiety and stress (total sample, and males, but not females), but not depression | |||
| Multivariate: total sample: 100 mL/d energy drink consumption associated with anxiety and depression, but not stress | ||||
| Multivariate: males: 100 mL/d energy drink consumption associated with stress and anxiety, but not depression | ||||
| Multivariate: females: 100 mL/d energy drink consumption not associated with stress, anxiety, or depression | ||||
| Vilija and Romualdas49 | PTSD symptoms after lifetime traumatic experiences (IES-R) | Cross-sectional questionnaire (10 secondary schools randomly selected from 15 city districts in Kaunas, Lithuania) | 1747 eighth grade pupils from Lithuania | PTSD symptoms associated with energy drink use (controlled for gender, index trauma, physical activity, smoking, and sense of coherence) |
| Waits et al.42 | Change in energy drink use from predeployment to deployment in Operation Enduring Freedom | Cross-sectional questionnaire | 183 deployed International Security Assistance Force personnel in Afghanistan | Increase in weekly consumption of Rip-It® (significant) and Tiger® (not significant) and decreases in Red Bull®, Monster®, and Rockstar® (not significant) |
| Overall change in total number of consumers of energy products from predeployment to deployment was not significant (although this also included other energy products, such as soda, coffee, Hydroxycut®), although number of servings per week increased from 16.6 (predeployment) to 24 (deployment) | ||||
| Walther et al.36 | Well-being (based on questions from the HBSC, KIGGS, and MDMQ) | Cross-sectional online questionnaire | 500 adolescents and young adults (14–24 years old) from all provinces in Austria | Proportion with high well-being (55%) was higher in those who consumed energy drinks and alcohol once a week or less |
| Proportion with low well-being was higher in those who consumed energy drinks and alcohol two to six times a week, daily, or several times daily | ||||
| Wing et al.38 | Mental health status (GHQ-12) | Cluster randomized controlled trial with 14 schools in Hong Kong | 3713 (1545 intervention, 2168 control) secondary school (7th–11th grade: 12–18-year-old) students from Hong Kong | Lower incidence of consuming energy drinks in the intervention group |
| Emotional problems (SDQ) | Improvement in GHQ-12 score in intervention group compared to control | |||
| Conduct problems (SDQ) | Improvements in total difficulty, conduct, and hyperactivity in intervention group compared to control | |||
| Peer relationships (SDQ) | No differences between groups for peer relationships, emotional problems, or prosocial behavior | |||
| Hyperactivity/inattention (SDQ) | ||||
| Prosocial behaviors (SDQ) | ||||
| Yudko and McNiece54 | Depression (BDI II) | Prospective quasiexperimental | 69 polydrug users (19 males, 50 females) receiving substance abuse treatment in a rural area of Hawaii | No association between having had an energy drink in the previous hour and BDI |
| State anxiety (STAI) | No association between having had an energy drink in the previous hour and state anxiety | |||
| Trait anxiety (STAI) | No association between having had an energy drink in the previous hour and trait anxiety |
This table does not include case reports (Table 1) or studies that only investigated short-term effects (see Acute effects of energy drink consumption on mood section).
AmED, alcoholic energy drink; BDI, Beck Depression Inventory; CES-D, The Center for Epidemiologic Studies Depression Scale Revised; DABS, Diet and Behavior Scale; DASS-21, Depression Anxiety Stress Scale-21; GHQ-12, General Health Questionnaire-12; HBSC, health behavior in school-aged children; IES-R, impact of event scale-revised; KIGGS, Study on the Health of Children and Adolescents in Germany; MDMQ, Multidimensional Mood Questionnaire; PSS, Perceived Stress Scale; PSTA, Psychological Screening Test for Adolescents; PTSD, post traumatic stress disorder; SDQ, Strength and Difficulties Questionnaire; STAI, State-Trait Anxiety Inventory; SURPS, Substance Use Risk Profile Scale; WPQ, Well-being Process Questionnaire.