Kim So Young, Sim Songyong, Choi Hyo Geun
Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Department of Statistics, Hallym University, Chuncheon, Korea.
PLoS One. 2017 Nov 14;12(11):e0187759. doi: 10.1371/journal.pone.0187759. eCollection 2017.
Although an association between energy drinks and suicide has been suggested, few prior studies have considered the role of emotional factors including stress, sleep, and school performance in adolescents. This study aimed to evaluate the association of energy drinks with suicide, independent of possible confounders including stress, sleep, and school performance.
In total, 121,106 adolescents with 13-18 years olds from the 2014 and 2015 Korea Youth Risk Behavior Web-based Survey were surveyed for age, sex, region of residence, economic level, paternal and maternal education level, sleep time, stress level, school performance, frequency of energy drink intake, and suicide attempts. Subjective stress levels were classified into severe, moderate, mild, a little, and no stress. Sleep time was divided into 6 groups: < 6 h; 6 ≤ h < 7; 7 ≤ h < 8; 8 ≤ h < 9; and ≥ 9 h. School performance was classified into 5 levels: A (highest), B (middle, high), C (middle), D (middle, low), and E (lowest). Frequency of energy drink consumption was divided into 3 groups: ≥ 3, 1-2, and 0 times a week. The associations of sleep time, stress level, and school performance with suicide attempts and the frequency of energy drink intake were analyzed using multiple and ordinal logistic regression analysis, respectively, with complex sampling. The relationship between frequency of energy drink intake and suicide attempts was analyzed using multiple logistic regression analysis with complex sampling.
Higher stress levels, lack of sleep, and low school performance were significantly associated with suicide attempts (each P < 0.001). These variables of high stress level, abnormal sleep time, and low school performance were also proportionally related with higher energy drink intake (P < 0.001). Frequent energy drink intake was significantly associated with suicide attempts in multiple logistic regression analyses (AOR for frequency of energy intake ≥ 3 times a week = 3.03, 95% CI = 2.64-3.49, P < 0.001).
Severe stress, inadequate sleep, and low school performance were related with more energy drink intake and suicide attempts in Korean adolescents. Frequent energy drink intake was positively related with suicide attempts, even after adjusting for stress, sleep time, and school performance.
尽管有人提出能量饮料与自杀之间存在关联，但此前很少有研究考虑压力、睡眠和学业成绩等情感因素在青少年中的作用。本研究旨在评估能量饮料与自杀之间的关联，独立于包括压力、睡眠和学业成绩在内的可能混杂因素。
总共对来自2014年和2015年韩国青少年风险行为网络调查的121,106名13 - 18岁青少年进行了调查，内容包括年龄、性别、居住地区、经济水平、父母教育水平、睡眠时间、压力水平、学业成绩、能量饮料摄入频率和自杀企图。主观压力水平分为严重、中度、轻度、有点压力和无压力。睡眠时间分为6组：<6小时；6≤小时<7；7≤小时<8；8≤小时<9；≥9小时。学业成绩分为5个等级：A（最高）、B（中高）、C（中等）、D（中低）和E（最低）。能量饮料消费频率分为3组：每周≥3次、1 - 2次和0次。分别使用多重和有序逻辑回归分析以及复杂抽样，分析睡眠时间、压力水平和学业成绩与自杀企图以及能量饮料摄入频率之间的关联。使用多重逻辑回归分析以及复杂抽样分析能量饮料摄入频率与自杀企图之间的关系。
较高的压力水平、睡眠不足和学业成绩低与自杀企图显著相关（各P<0.001）。这些高压力水平、异常睡眠时间和低学业成绩变量也与较高的能量饮料摄入量成比例相关（P<0.001）。在多重逻辑回归分析中，频繁饮用能量饮料与自杀企图显著相关（每周能量摄入频率≥3次的比值比=3.03，95%置信区间=2.64 - 3.49，P<0.001）。
严重压力、睡眠不足和学业成绩低与韩国青少年更多地饮用能量饮料和自杀企图有关。即使在调整了压力、睡眠时间和学业成绩后，频繁饮用能量饮料与自杀企图呈正相关。
