Alcohol consumption and anxiety, depression and suicidal ideation: an updated systematic review

Background

Alcohol consumption is a major global risk factor for mortality and adverse mental health outcomes. This systematic review updates a 2022 Cochrane Canada Review (CCR) to investigate the associations between alcohol consumption and depression, anxiety and suicidal ideation (SI) among the general population.

Methods

Six databases were searched for studies published between December 2021 (last search date in the CCR) and August 2025. Longitudinal studies were included for depression and anxiety, with cross-sectional studies also included for SI. Adults, older adults and adolescents were investigated as age groups. Relative effect measures were extracted by amount or frequency of alcohol intake. Certainty of evidence was assessed.

Results

3,728 records were screened, resulting in 104 studies included in the update, 26 of which were new. Overall findings were mixed for depression (n = 63 studies) and anxiety (n = 12 studies), across all age groups. For SI in adolescents, across 13 cross-sectional studies, a small to large positive association between the quantity and or frequency of alcohol consumption (including binge drinking), and suicidal ideation was identified. Similarly, across eight cross-sectional studies, a small to large positive association between increased alcohol intake (including monthly binge drinking), and or age of initiation of drinking, and suicidal ideation, was identified. However, substantial methodological heterogeneity across all included studies, including a wide variation in how alcohol exposure and mental health outcomes were measured, limited the comparability of findings. Additionally, certainty of evidence across all outcomes was low or very low due to high or moderate risk of bias, inconsistency and imprecision.

Conclusions

Methodological heterogeneity limited conclusions on associations between alcohol consumption and mental health outcomes.

Key messages

• Evidence from longitudinal studies suggests mixed associations of alcohol use with depression and anxiety, whereas cross-sectional studies show positive associations with suicidal ideation.

• Certainty of evidence on the association between alcohol and mental health is low or very low due to mixed results and heterogeneity in methods.