Alcohol consumption is prevalent in the daily lives of millions of people worldwide. Europe is the region with the highest per capita alcohol consumption, with over 50% of the population being consumers, reaching 15 L of pure alcohol per adult per year (Farke & Anderson, 2007 Dec 1; Global status report on alcohol & health, 2018). Binge drinking is a widespread public health issue among young people, particularly in the university environment (Glosario de términos de alcohol y drogas - World Health Organization [Internet], 2024; Parada et al., 2011 Mar 1). This behavior is characterized by the consumption of large quantities of alcohol in a short period of time, with the goal of achieving rapid intoxication and intense psychoactive effects. Binge drinking has been associated with a range of negative consequences for physical and mental health, including an increased risk of injuries, risky sexual behaviors, chronic diseases, and psychological problems (Barbería-Latasa et al., 2022; Hammett et al., 2019; Moure-Rodríguez et al., 2014; Moure-Rodríguez et al., 2016).

Among the potentially serious psychological consequences of binge drinking, special attention has been given to its potential association with suicidal thoughts and suicidal attempts in university students. The transition to university life involves significant changes in the lives of young people, such as increased independence, academic stress, social adjustment, and exposure to new experiences and social pressures (Abar & Maggs, 2010; Norman et al., 2018). These factors can influence alcohol consumption and the emergence of mental health problems, including suicidal ideation.

Despite the growing concern about this issue, the World Health Organization estimates that more than 700,000 people die by suicide each year, with many more attempting it. In 2019, suicide was the fourth leading cause of death in the age group of 15 to 29 years worldwide (Suicide worldwide in, 2019). Research on the association between binge drinking and suicidal thoughts and suicidal behavior in university students is limited and shows inconsistencies in the results (Gonzalez, 2012; Sher, 2006). Furthermore, most existing studies have focused on small local samples, limiting the generalizability of the findings (Murthy & Narasimha, 2021; Sher et al., 2005). Additionally, harmful habits related to alcohol consumption have shifted after the COVID-19 pandemic (Bonar et al., 2021; Zysset et al., 2022). Therefore, it is interesting to present new studies that provide insights into the relationship between alcohol consumption, binge drinking, and the risk of suicide in this new global social context.

This study aims to determine the prevalences of binge drinking and suicidal thoughts and suicidal attempts in the university population, as well as to examine the correlation between binge drinking and the increased occurrence of suicidal thoughts and suicidal attempts in this demographic.

Materials and Methods

This is a cross-sectional analysis of a multicenter cohort comprising 2178 university students. The study was conducted in January 2023 at the University of Vigo (UVigo), which includes three campuses: Vigo, Pontevedra, and Ourense, as well as at the University of Coruña (UDC), which has two campuses, one in La Coruña and another in Ferrol. Data were collected through an online questionnaire. Participants were divided into two groups: those who engaged in binge drinking and those who did not. The study aimed to evaluate the relationship between binge drinking, suicidal thoughts, and suicidal attempts. The study population consisted of all students enrolled in the 2022/2023 academic year at these two public universities who responded to the survey and met the inclusion and exclusion criteria.

Inclusion criteria: Men and women who are over 18 years of age. Students enrolled at the UVigo or the UDC. Students in undergraduate (bachelor’s), master’s, and doctoral programs. Exclusion criteria: Students who are over 40 years of age.

Binge drinking has been broadly defined for the Spanish population as the consumption of 6 (60 g) alcohol units for men and 5 (40 g) alcohol units for women within a 4–6-h period (Jl & I G, F RA., 2007; Parada et al., 2011). For this study, question 3 of this questionnaire, “How often do you consume 6 or more alcoholic drinks in a single day?” has been employed to define the variable binge drinking. Responses indicating “never” were classified as non-binge drinking, while all other responses were considered indicative of binge drinking.

Suicidal ideation was assessed by a combination of thoughts, desires, or concerns related to death and suicide that have occurred within the last year (Harmer et al., 2023). Suicidal attempts were identified as instances of actively attempting suicide within the past year.

Sample Size

For the objective of determining the prevalence of binge drinking in university students, the sample size was calculated using the formula to estimate the occurrence proportion of a specific event in finite populations. Data on the prevalence of binge drinking in this population range from 30 to 40%, and an expected proportion of 35% was considered to maximize the sample size, ensuring a sample size (n) sufficient to estimate the desired prevalence and cover the other objectives. An error margin of ± 3% was assumed for estimating a proportion using a two-sided 95% normal asymptotic confidence interval. With these parameters, it has been calculated that at least 924 students will need to be included in the study.

Data Collection and Definition of Variables

Data collection was carried out via email, inviting students to complete the questionnaire anonymously and voluntarily. The email invitations were sent from the various university administrations, and Microsoft Forms was used as the platform for data collection, which complies with current data protection laws. The questionnaire begins with sociodemographic questions, followed by two sections. The first section addresses alcohol consumption, utilizing the AUDIT test validated for the Galician population (Catálogo de publicaciones 2024). This section comprises 10 questions related to alcohol consumption, frequency, quantity, and its impact on daily life (Supplementary Material 1). The questions follow a Likert scale model with five response options, except for the last two questions, which have three response options. Each response is associated with a score ranging from 0 to 4 points. Based on the results obtained from analyzing the questionnaires, participants’ alcohol consumption was categorized into three groups: low risk consumption [0–7 points), risk consumption [7–15 points), and alcohol use disorder (16 points).

The second part of the questionnaire collects data regarding suicidal attempts or suicidal thoughts and utilizes the validated Suicide Behaviors Questionnaire-Revised (SBQ-R) Spanish population (Extremera et al., 2018; Quintana-Orts et al., 2019; Rey et al., 2019) (Supplementary Material 2). This questionnaire consists of 4 questions with a Likert scale format, where the scores range from 0 to 6 points. To calculate the final score, the numbers selected for each response (ranging from 0 to 6) have been summed. For the university population, a score of ≥ 7 implies a high risk of suicidal attempts, with a sensitivity of 93% and specificity of 95%.

Statistical Analysis

The study conducted a descriptive analysis of key variables. Categorical variables were presented as frequencies and percentages, while continuous variables were expressed as means and standard deviations if normally distributed, and as median and interquartile range (IQR) if not. Statistical tests such as the chi-squared test and Kruskal–Wallis test were used for comparisons, and odds ratios (OR) measured associations. The Mann–Whitney U test compared categorical and continuous variables. A bivariate logistic regression model predicted the risk of suicidal attempts under the influence of alcohol. The study utilized the negative binomial distribution, resulting in wider confidence intervals. To assess the presence of multicollinearity in our regression analysis, we performed several checks using standard statistical techniques. These methods included calculating the variance inflation factor (VIF), analyzing correlation matrices, evaluating condition indices, and assessing tolerance. Additionally, we conducted sequential regression analyses by excluding one variable at a time and assessed how this affected the model results. In all these methods, no substantial evidence of multicollinearity was found, as all VIF values, correlations, condition indices, and tolerances were within the established thresholds. Various models were generated, and final models included all relevant and significant variables, with the analysis conducted using SPSS version 25.

Ethical and Legal Aspects

This study was conducted in compliance with current legal and ethical standards. The research team followed Good Clinical Practice Guidelines, the Declaration of Helsinki. The study received approval from the Ethics Committee of Pontevedra-Vigo-Ourense, code 2022/484.

Results

The response rate to the questionnaire is at approximately 6.1%. A total of 2099 university students participated in the study; 79 participants were excluded due to being over 40 years old. Most of them are female, enrolled in undergraduate programs, living away from their family homes, and have mothers who have pursued university studies. Among these participants, 38.2% had a pattern of binge drinking. The median score on the AUDIT questionnaire was 3 (IQR: 1–7). About 25.2% of the participants had a score of ≥ 7 on the SQB-R questionnaire. Additional characteristics are presented in Table 1.

Table 1 General characteristics of the population 
Full size table

Drinking Problems

The prevalence of binge drinking in the studied sample is 832 individuals (38.2%). Among them, 424 (51.0%) are female, with a statistically significant difference (p < 0.001). Regarding the results from the AUDIT questionnaire, 492 (22.6%) participants were classified as at risk consumptions. In the AUDIT questionnaire, 824 individuals (39.3%) reported consuming one or two alcoholic drinks on a typical drinking day. In the past year, 317 individuals (15.1%) found it difficult to stop drinking once they had started on at least one occasion. Furthermore, 327 participants (15.6%) were unable to fulfill their duties due to alcohol consumption the night before, and 674 (32.1%) felt guilty for drinking alcohol less than once a month in the past year. Additional values are available in Supplementary Material 1.

Suicidal Thoughts and Self-Injurious Attempts

The prevalence of high risk of suicidal attempts is 528 individuals (25.2%). The analysis of the SBQ-R questionnaire provides additional information related to the likelihood of a self-harm attempt. Regarding suicidal ideation, 828 participants (38.1%) had a suicidal thought, 557 participants (26.5%) reported having thought about suicide at some point in the past year, and 83 (4.0%) of them admitted to having attempted it at some point in their lives. When asked about the likelihood of a suicidal attempt, even though most responded negatively, 103 (4.9%) participants considered it a possibility. The rest of the questionnaire results can be found in Supplementary Material 2.

The Relationship Between Binge Drinking, Suicidal Thoughts, and Suicidal Attempts

For the analysis of variables associated with suicidal attempts through the SQB-R questionnaire, a univariate analysis was conducted, revealing that being female (p < 0.001) and alcohol use disorder were variables associated with this event (Table 2). The female gender was also associated with suicidal thoughts (p = 0.001). On the other hand, the practice of binge drinking was not associated with suicidal thoughts and suicidal attempts (36.9%; p = 0.332 and 37.3%; p = 0.632, respectively). However, regarding binge drinking and gender, men were more strongly associated with this practice (50.4%; p < 0.001). To identify the correlation between certain variables and suicidal attempts, a logistic regression analysis was performed with a global prediction accuracy of 74.9% and Nagelkerke R-squared of 0.22. The accuracy percentage for the dependent variable with a score of 0 was 0%, achieving 100% accuracy for the outcome = 1. Female gender with an OR 1.62 (95% CI: 1.32–2.01; p < 0.001) and alcohol use disorder with an OR 2.23 (95% CI: 1.49–3.55; p < 0.001) were identified as independent predictive variables for suicidal behavior in the surveyed university students (Fig. 1).

Table 2 The relationship between binge drinking and other variables with high-risk suicidal attempts (questionnaire SBQ-R)
Full size table
Fig. 1
figure 1

Independent predictor variables of suicide attempt 

Full size image

Discussion

This study represents the largest sample size in European Union within the university population addressing the issue of suicidal thoughts and suicide attempts. The primary findings of the study can be summarized as follows: (a) a high prevalence of suicidal thoughts and suicide attempts risk and binge drinking exists in these populations. (b) No relationship has been found between binge drinking and increased suicidal thoughts and suicide attempts among university students, but a relationship has been observed with dependency. (c) An increased risk of suicidal thoughts and suicide attempts was showed in relation to the female gender.

The study population predominantly comprises 22-year-old female undergraduate students who reside away from their family homes. This characteristic may facilitate access to health-damaging behaviors due to the absence of parental supervision. Our data align with recent studies in university populations, highlighting the increasing presence of women in higher education (Herrero-Montes et al., 2019). The prevalence of binge drinking in our population is notably high, with nearly 4 out of every 10 students exhibiting this consumption pattern. Similar percentages have been reported in other consulted studies (Aizpurua et al., 2022; Kittel et al., 2019), indicating a persistent issue in this population. The prevalence of suicidal thoughts and suicidal attempts in our sample was 25.2%, a figure consistent with reports from other researchers (Cañón Buitrago et al., 2018; Lew et al., 2020; Reina-Aguilar et al., 2023), underscoring that self-injurious behaviors among young individuals have become a growing public health concern in recent years. Health authorities should, therefore, consider implementing corrective measures to address this issue, such as improving the detection and treatment of mental health disorders, reducing the stigma surrounding suicide, and facilitating access to crisis care.

Our study did not find a relationship between binge drinking and suicidal thoughts or suicidal attempts. This outcome contrasts with results in various publications that have reported an association between alcohol consumption and increased suicidal tendencies (Gonzalez et al., 2009; Kittel et al., 2019). Binge drinking has been linked to heightened suicidal ideation and self-harming behaviors in some studies conducted across diverse contexts (Byeon et al., 2018; Rossow & Norström, 2014). Studies such as the one conducted by Rosso et al. [2014] demonstrate a connection between binge drinking and suicidal behavior. However, it is worth noting that Rosso’s study is over 20 years old and involved a population that was not exclusively university students, which could account for the differences found (Rossow & Norström, 2014). Other studies, such as Schaffer et al. (Schaffer et al., 2008) involving a sample of 388 university students, and the one carried out by Glasheen et al. (Glasheen et al., 2015) present results that link binge drinking to prior suicidal attempts and suicidal ideation. The discrepancies found in these studies can be explained by various factors. One of them is the high prevalence of men associated with excessive alcohol consumption in the results of our research, but not with self-injurious behaviors. Conversely, females were identified as an independent predictor of suicidal thoughts and suicidal attempts. Furthermore, binge drinking among university students is associated with specific social interaction behaviors (the social phenomenon of party behavior) that are more common in sociable young individuals (Lundahl & Cannoy, 2021; Vallentin-Holbech et al., 2023). These individuals tend to experience fewer social interaction challenges and lower levels of isolation, loneliness, or difficulty in forming relationships. It is plausible that these factors are more closely linked to the increase in suicidal tendencies among university students (Calati et al., 2019; Zhou et al., 2023). This may, in part, explain our inability to establish a significant relationship between binge drinking and an elevated risk of suicidal attempts in our study population.

Our findings suggest a correlation between suicidal attempts and suicidal ideation with the female gender. When comparing our results with prior studies on the relationship between gender and suicidal ideation, as well as suicidal attempts, we identified several similarities. A study that examined the pattern of binge drinking noted that 14.2% of women engaging in binge drinking and 6.9% of men admitted to having attempted suicide (Byeon et al., 2018). Furthermore, another investigation employing the AUDIT questionnaire in adolescents also discovered a significant relationship between suicide attempts and the female gender (Salvo & Castro, 2013). A study on Colombian university students and their suicide risk identified that the female gender was a predictive variable for suicidal attempts (Castaño Castrillón et al., 2022). Although women exhibit a lower incidence of binge drinking compared to men, the consequences can be more severe due to factors such as gender discrimination, sexual harassment, and physical and psychological abuse, all of which may influence future suicidal behaviors (Balodis et al., 2009).

This study has also identified a correlation between students who scored as dependent on the AUDIT scale and suicidal attempts and suicidal thoughts. While binge drinking indeed entails the consumption of substantial amounts of alcohol in a short period, the AUDIT questionnaire allows for a comprehensive assessment of this disorder and has been validated for this purpose (Boubeta et al., 2017). It is important to note that in the university population, alcohol consumption in the form of binge drinking is associated with socialization and leisure activities, which may distance individuals from self-injurious risk situations. This underscores the importance of evaluating not only the pattern of binge drinking but also the total score on the AUDIT questionnaire to fully comprehend the impact that alcohol may have on the risk of suicidal attempts and suicidal thoughts in this population. Various studies have linked an increase in suicide thoughts or attempts with a binge drinking pattern, but without the social component, instead combined with solitary alcohol consumption. This aligns with our hypothesis for this university population (Byeon et al., 2018; Global status report2024; Gonzalez, 2012; Gonzalez et al., 2009). In a study by Pimentel et al. (Pimentel de Sousa Santos et al., 2021), patients with alcohol use disorder exhibited an increased prevalence of suicidal ideation and clinically significant suicidal ideation. Similar results were obtained in the works of Beghi et al. (Beghi et al., 2013). Further research in the university population may be required, focusing not only on binge drinking but also on the outcomes of the AUDIT questionnaire.

Strengths and Limitations

The response rate to the questionnaire, at approximately 6.1%, is a limitation, but it is consistent with response rates in self-administered online surveys (Anhang Price et al., 2022 ). The sample size is larger than many nationally and internationally reviewed publications on intensive alcohol consumption. However, a limitation is the definition of binge drinking, as it excludes women who consume 5 alcoholic drinks, potentially underestimating the prevalence of intensive alcohol consumption. Despite this limitation, using the AUDIT questionnaire aligns with previous research and provides a comprehensive assessment of intensive alcohol consumption patterns over the past year, not just regular or daily consumption. Additionally, the electronic distribution of the questionnaire through the UVigo and UDC may attract more university-involved participants, potentially skewing the results. There is also the possibility that individuals sensitive to self-harm risk may have chosen not to participate, leading to a potential underestimation of self-harm risk prevalence.

Conclusions

Binge drinking is common among university students but is not associated with suicidal attempts or suicidal thoughts. However, female gender and alcohol use disorder are identified as independent risk factors for suicidal attempts. These findings highlight two major public health issues among university students, emphasizing the importance of developing preventive interventions and support programs to promote mental well-being in the academic environment.