Between-person alcohol consumption was associated with more intense suicidal ideation across severities, and within-person alcohol consumption was associated with greater overnight inertia of suicidal ideation at all severities, suggesting the morning following alcohol consumption may be a critical period of heightened risk.
Key Findings
Results
Between-person alcohol consumption was associated with more intense suicidal ideation across all severity levels.
Study included 70 participants with recent suicidal ideation (mean age 35.2 ± 10.9 years, 70% female, 17.1% non-white, 8.6% Hispanic, 50% non-heterosexual)
SI severities assessed included passive SI, active SI, and suicide desire
Participants completed six daily surveys for 28 days, generating a substantial ecological momentary assessment dataset
Bayesian multilevel models were used to examine between-person relationships
Results
Between-person suicidal ideation across all severity levels was associated with a greater likelihood of alcohol consumption.
All three SI severity levels (passive SI, active SI, and suicide desire) showed this association at the between-person level
This suggests a bidirectional between-person relationship: those who drink more have more SI, and those with more SI are more likely to drink
Bayesian multilevel models were used to examine whether daily average SI predicted next-day drinking
Results
Within-person alcohol consumption was associated with greater overnight inertia of suicidal ideation at all severity levels.
Overnight inertia refers to the persistence of SI from one evening to the next morning following alcohol consumption
This effect was detected across all three SI severities: passive SI, active SI, and suicide desire
Within-person analyses isolate the effect of an individual's own variation in alcohol use from stable between-person differences
The authors highlight that 'the morning following alcohol consumption may be associated with heightened risk for SI'
Results
Sleep quality did not show evidence of mediating the relationship between alcohol consumption and next-day suicidal ideation.
Two-level dynamic structural equation modelling (DSEM) was used to investigate the potential mediating role of sleep quality
Sleep rating was assessed as part of the six daily surveys over the 28-day period
The authors report they 'did not detect evidence that sleep rating mediated the relationship between alcohol consumption and next-day SI'
This null mediation finding suggests the overnight SI inertia effect operates through mechanisms other than sleep quality
Methods
The study design used ecological momentary assessment with six daily surveys over 28 days to capture real-time fluctuations in suicidal ideation, alcohol use, and sleep.
70 participants with recent suicidal ideation completed the protocol
Variables assessed included intensity of SI across three severities, sleep quality, and alcohol consumption
Analytical methods included Bayesian multilevel models and two-level dynamic structural equation modelling
The within-person design allowed examination of whether fluctuations in an individual's alcohol use predicted fluctuations in their next-day SI
What This Means
This research suggests there is a complex, bidirectional relationship between drinking alcohol and having thoughts of suicide. Using a method where 70 people with recent suicidal thoughts answered survey questions six times a day for 28 days, researchers found that people who tend to drink more alcohol also tend to experience more intense suicidal thoughts — and conversely, people who have more intense suicidal thoughts are also more likely to drink. These patterns held across different types of suicidal thinking, from passive thoughts (such as wishing one were dead) to more active desires.
One of the more specific findings was that on days when a person drank more than they typically do, their suicidal thoughts in the morning were more persistent — meaning alcohol appeared to make it harder for suicidal thinking to 'fade overnight.' This effect was found for all levels of suicidal thinking severity. Interestingly, sleep quality did not appear to explain this connection, suggesting the morning-after risk operates through some other pathway not captured in this study.
This research suggests that the morning after drinking may be a particularly vulnerable time for people who already experience suicidal thoughts. The authors point to a potential need for targeted safety planning and coping strategies specifically designed for this period. For people who experience both alcohol use and suicidal thinking, this work highlights that the two issues may reinforce each other in ways that merit attention in mental health care and crisis support.
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Blacutt M, Jacobucci R, Ammerman B. (2026). The dynamic relationship between alcohol and suicidal ideation: Between-person associations and overnight inertia.. Journal of affective disorders. https://doi.org/10.1016/j.jad.2026.121975