College students experience heightened exposure to heightened stress, isolation, and substance experimentation, thereby demonstrating elevated risks for both alcohol misuse and suicidal behaviors. Although alcohol misuse and suicidal thoughts and behaviors are strongly linked, prior research has relied exclusively on cross-sectional designs that cannot capture the dynamic nature of these phenomena. Despite evidence suggesting that both urges to drink and suicidal urges fluctuate considerably throughout the day and that suicidal ideation tends to intensify on days when alcohol is consumed, the moment-to-moment interplay between these urges remains unexplored. Therefore, the present study investigates the reciprocal momentary associations between urges to drink alcohol and urges to engage in suicidal behaviors among college students, aiming to establish the temporal ordering of these phenomena and elucidate how they may dynamically influence one another at a momentary timescale.
This study surveyed 605 college students at Wave 1 and Wave 2. Participants completed surveys six times per day, delivered randomly within 3–4 hours windows, over a period of 6–8 weeks. Each survey included items assessing suicide urges and urges to drink alcohol. Dynamic structural equation modeling (DSEM) was used to examine the autoregressive and cross-lagged relationships between suicide urges and alcohol urges over time. Because both variables showed strong floor effects, a two-part modeling approach was applied by estimating separate models for urge presence and urge intensity.
The findings revealed that the presence of suicidal urges at the previous time point demonstrated a large positive association with the presence of suicidal urges at the current time point, and the presence of alcohol urges exhibited the same pattern. Cross-lagged analyses confirmed bidirectional associations, with previous suicidal urges showing moderate positive associations with current alcohol urges, and previous alcohol urges demonstrating moderate positive associations with current suicidal urges. Similar patterns emerged in analyses of urge intensity, wherein previous suicidal and alcohol urge intensity showed moderate positive associations with their respective current urge intensity in autoregressive pathways. Cross-lagged pathways also revealed that previous suicidal urge intensity demonstrated moderate positive associations with current alcohol urge intensity, and previous alcohol urge intensity showed moderate positive associations with current suicidal urge intensity.
Takeaway: The bidirectional relationship between alcohol urges and suicidal urges among college students unfolds at a momentary timescale, underscoring the importance of considering moment-to-moment intervention strategies.