Caffeine use disorder: An item-response theory analysis of proposed DSM-5 criteria

Exploring the link between physicians' caffeine use disorders with sleep quality and professional burnout: a cross-sectional study

BACKGROUND

The objective of this research was to examine how caffeine use disorder among physicians across different specialties relates to both sleep quality and professional burnout.

METHODS

This research represents a single-center, prospective, cross-sectional study involving 240 physicians meeting inclusion criteria and working within a training and research hospital. Participants were enrolled in the study after obtaining informed consent. A web-based survey methodology was employed, administering a participant information form crafted following an exhaustive literature review, alongside assessments utilizing the Caffeine Use Disorder Questionnaire, the Pittsburgh Sleep Quality Index, and the Maslach Burnout Inventory. A significance level of p < 0.05 was considered statistically significant.

RESULTS

In our study, participants had a median age of 30.0 years, and 60% reported poor sleep quality. A positive and statistically significant relationship (rho=0.148, p = 0.022) was found between the Caffeine Use Disorder Questionnaire and Pittsburgh Sleep Quality Index scores. In the generalized linear model analysis, setting the Caffeine Use Disorder Questionnaire score as the dependent variable, statistically significant contributions were observed for gender (women), daily total caffeine intake, and Maslach-depersonalization score variables (p = 0.012, p < 0.001, 0.035, respectively).

CONCLUSIONS

Higher levels of caffeine use disorder have been observed among women, smokers, and individuals with increased caffeine intake. Notably, an increase in professional depersonalization is associated with a rise in caffeine use disorder. Studying physicians' professional depersonalization could aid in addressing caffeine use disorders. Additionally, exploring the caffeine consumption patterns of healthcare professionals displaying depersonalization towards patients' needs is also worthwhile.

Estimate the prevalence of daily caffeine consumption, caffeine use disorder, caffeine withdrawal and perceived harm in Iran: a cross-sectional study

One of the informal diagnoses in DSM-5 is Caffeine Use Disorder (CUD). CUD and high levels of caffeine consumption could impact mental health conditions. This study aimed to estimate the prevalence of CUD, caffeine consumption, caffeine-related harms, and related psychiatric symptoms in Iran. A cross-sectional survey with a convenience sample of 1228 adults were conducted in Iran. Caffeine consumption was assessed across 20 products in Iran. Caffeine Use Disorder Questionnaire (CUDQ), Caffeine Withdrawal Symptoms Questionnaire (CWSQ), 14-item Caffeine-related Harm Screening (CHS), and Symptom Checklist-25 (SCL-25) were used in the present study. We used SPSS (desktop version 26.0) to analyze the data using descriptive statistics, chi-square, and the least significant difference (LSD) post hoc test. The daily average caffeine consumption was 146.67 mg. The prevalence of CUD and caffeine withdrawal (C.W.) were estimated at 19.5% and 46.62%, respectively. Also, 12.9% of responders received CUD and C.W.s simultaneously. The prevalence of CUD was higher in men than females (25.08% vs. 13.93%). 95% of participants (n = 1166) reported using at least one caffeine product yesterday. Moreover, the most reported caffeine-related harms were the desire for sugar (42.9%), insomnia (39.3%), and caffeine dependence (38.3%). Age significantly correlates with CUD (- 0.07) and daily caffeine intake (0.08). Moreover, all SCL-90 subscales had a significant correlation with daily caffeine intake. Finally, responders at younger ages reported higher levels of CUD and caffeine consumption than older adults(P < 0.05). High rates of C.W. and CUD in the Iranian population suggest that it is necessary to develop evidence-based treatments.

Problematic coffee use and associated factors among medical and health science students in Dilla University, Ethiopia

Objective

Coffee holds a cherished place in Ethiopian culture, its consumption among students raises concerns despite its perceived benefits for alertness and productivity. Moderate caffeine intake remains unproblematic, but exceeding 400 mg daily can trigger detrimental health effects such as fatigue, memory impairment, and even attention-deficit disorder. Research on problematic coffee use among young adults, specifically Ethiopian students, remains limited, hindering our understanding of its potential scope and impact. To address this knowledge gap, researchers at Dilla University, Ethiopia, undertook a comprehensive study in 2022, focusing on the university's student population. This investigation holds significant potential to unveil the previously obscured landscape of excessive coffee consumption in this demographic and inform future research and potential interventions.

Methodology

An institutional-based cross-sectional study design was conducted in August-July, 2022. To measure problematic coffee use, this study used the Diagnostic Statistical Manual five criteria for substance use disorder. Those who scored >2 out of 11 criteria were considered to have problematic coffee use. To measure a significant association between the outcome and independent variable, a multivariable logistic regression analysis at p < 0.05 and 95% confidence interval was employed.

Result

This study included 414 respondents. More than half of the respondents, 347 (59.7%) were male. Out of all respondents, 182 (44.0%) had a boy/girlfriend. Nearly half of the respondents, 218 (52.7%) were orthodox, Christian religion followers. According to this study's findings, 137 (33.1%) respondents were considered to have problematic coffee use. Multivariable logistic regression analysis showed that 5-10 years duration of coffee use (AOR = 4.62, 95% CI: 2.96-7.85; p = 0.001), start to use coffee before joining university (AOR = 2.977, 95% CI: 1.332-6.653; p = 0.008) and 6-9 cups of daily coffee use (AOR = 3.26, 95% CI: 2.14-5.89; p = 0.00) were associated with problematic coffee use.

Conclusion

This study showed that one-third of the respondents had problematic coffee use. The starting point, duration, and amount of use had a strong association with problematic coffee use. Hence, focusing on addressing the mental health challenges associated with problematic/excessive coffee consumption among higher education students is advisable. Additionally, promoting awareness of problematic/excessive coffee use and its potential remedies is recommended.

The caffeine dilemma: unraveling the intricate relationship between caffeine use disorder, caffeine withdrawal symptoms and mental well-being in adults

OBJECTIVE

This study aimed to explore the relationship between caffeine use disorder (CUD), caffeine withdrawal symptoms and the prevalence of depression, anxiety and stress (DASS) in adults.

DESIGN

The study utilised a cross-sectional design to assess the relationships between CUD, caffeine withdrawal symptoms and DASS.

SETTING

Participants' CUD was evaluated through the Caffeine Use Disorder Questionnaire (CUDQ), while the Depression Anxiety Stress Scale-21 (DASS-21) measured DASS levels. Caffeine withdrawal symptoms and total caffeine intake were calculated based on self-reported consumption of caffeine-rich products.

PARTICIPANTS

The study involved 618 participants with an average age of 27·8 (sd 7·8) years.

RESULTS

Participants consumed an average of 461·21 (sd 11·09) mg/d of caffeine, showing a positive correlation between CUD and total caffeine intake. The risk of CUD increased alongside levels of DASS. Individuals with caffeine withdrawal symptoms had higher CUDQ and DASS scores. A multiple linear regression model revealed significant associations between total caffeine intake (P < 0·001) and DASS-21 score (P < 0·001) with CUDQ score.

CONCLUSIONS

The study concluded that caffeine, while recognised for its potential health benefits, also exhibits properties that may lead to addiction. The development of caffeine use disorder and cessation of caffeine intake can increase DASS levels in adults, indicating the need for awareness and appropriate interventions in public health nutrition.

Whole Exome Sequencing Study Identifies Novel Rare Risk Variants for Habitual Coffee Consumption Involved in Olfactory Receptor and Hyperphagia

Habitual coffee consumption is an addictive behavior with unknown genetic variations and has raised public health issues about its potential health-related outcomes. We performed exome-wide association studies to identify rare risk variants contributing to habitual coffee consumption utilizing the newly released UK Biobank exome dataset (n = 200,643). A total of 34,761 qualifying variants were imported into SKAT to conduct gene-based burden and robust tests with minor allele frequency <0.01, adjusting the polygenic risk scores (PRS) of coffee intake to exclude the effect of common coffee-related polygenic risk. The gene-based burden and robust test of the exonic variants found seven exome-wide significant associations, such as OR2G2 (PSKAT = 1.88 × 10−9, PSKAT-Robust = 2.91 × 10−17), VEZT1 (PSKAT = 3.72 × 10−7, PSKAT-Robust = 1.41 × 10−7), and IRGC (PSKAT = 2.92 × 10−5, PSKAT-Robust = 1.07 × 10−7). These candidate genes were verified in the GWAS summary data of coffee intake, such as rs12737801 (p = 0.002) in OR2G2, and rs34439296 (p = 0.008) in IRGC. This study could help to extend genetic insights into the pathogenesis of coffee addiction, and may point to molecular mechanisms underlying health effects of habitual coffee consumption.

Stress, caffeine and psychosis-like experiences-A double-blind, placebo-controlled experiment

OBJECTIVE

Psychosis-like perceptual distortions can occur in the general population, and both stress and caffeine can enhance the proneness to psychosis-like experiences, such as hallucinations. The current study aims to explore the effects of acute caffeine intake and acute stress on perceptual distortions in a double-blind, placebo-controlled experiment.

METHODS

Regular caffeine consumers (n = 92) and non/low consumers (n = 89) were assigned to 100 mg caffeine/placebo and stress/no stress conditions. The White Christmas Paradigm (WCP) was used to measure hallucination-like symptoms, and bias towards threat-related words was used as an indicator of persecutory ideation. Participants reported their daily caffeine intake, and completed the State-Trait Anxiety Inventory, the Launay-Slade Hallucination Scale, the Persecutory Ideation Questionnaire and the Marlow-Crowne Social Desirability Scale.

RESULTS

Acute stress slightly increased hallucination-like experiences, but not recall bias, while the small amount of caffeine had a time-dependent effect on recall bias. Proneness to persecutory ideation was positively and social desirability was negatively correlated with recall bias towards threat-related words, while proneness to hallucinations positively correlated with hallucination-like experiences.

CONCLUSIONS

Our results indicate that psychosocial stress-in line with the diathesis-stress model-can lead to the enhancement of hallucination-like experiences.

Self-Medication of ADHD Symptoms: Does Caffeine Have a Role?

OBJECTIVE

Stimulants are the most effective treatment for Attention Deficit/ Hyperactivity disorder (ADHD). In addition, studies have shown that nicotine dependence in patients with ADHD is probably best explained by self-medication. The question is whether this is also true for caffeine use and caffeine dependence. The aim of our study was, therefore, to examine the relationship of ADHD symptoms, caffeine consumption, caffeine use disorder (CUD) and well-being. We hypothesized that those who have more ADHD symptoms and regularly consume caffeine have higher psychological well-being than those who have more ADHD symptoms, but do not consume caffeine.

METHODS

A general population sample (N = 2,259, 70.5% male, mean age 34.0) filled out the 10-item Caffeine Use Disorder Questionnaire (CUDQ), the Adult ADHD Self-report Scale (ASRS) and the WHO-5 Well-Being Index (WHO-5) and were asked about their caffeine consumption habits in an online survey.

RESULTS

There were no associations between ADHD and coffee, tea, energy drink or cola consumption or daily caffeine consumption. However, the results of the path analysis showed that the level of ADHD symptoms was positively associated with the level of CUD (β = 0.350) and negatively with the WHO-5 (β = -0.259).

CONCLUSIONS

Caffeine consumption was not associated with ADHD symptom severity and thus not likely to represent self-medication. On the contrary, caffeine use disorder severity is associated with more ADHD symptoms and both caffeine use disorder and ADHD are associated with lower well-being.

Validation of the Turkish Version of the Caffeine Use Disorder Questionnaire in an Adult Population

The aim of this study was to examine the reliability and validity of the Turkish version of the Caffeine Use Disorder Questionnaire (CUDQ) in an adult population. In this instrument validation study, a total of 310 individuals (253 female, 57 males), with a mean age of 25.96 ± 6.29 years were included. The questionnaire consisted of 4 parts, comprising the sociodemographic characteristics, CUDQ, caffeine withdrawal symptoms, and caffeine consumption. For the evaluation of the data, confirmatory factor analysis (CFA), descriptive statistics, and the t test were used. In the reliability analysis, the Cronbach alpha internal consistency coefficient was 0.86, and the intraclass correlation coefficient was 0.83 for CUDQ. The CMIN/df was 0.54, and the model generally fits well to the structure (RMSEA = 0.08, CFI = 1, NFI = 1, GFI = 0.99, AGFI = 0.99, TLI = 1, NNFI = 1, RFI = 0.98). The findings suggested that the CUDQ has validity of structure, internal consistency, and construct validity for assessing Caffeine Use Disorder the tendency in the Turkish adult population.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11469-021-00688-8.

Development and Validation of the Mukbang Addiction Scale

Recent literature has speculated that some individuals spend lots of time watching mukbang (i.e., combination of the South Korean words ‘eating’ [‘meokneun’] and ‘broadcast’ [‘bangsong’] that refers to eating broadcasts where a person eats a large portion of food on camera whilst interacting with viewers) and compensate different needs using this activity. However, compensating unattained offline needs using a specific online activity could lead to the addictive use of that activity. The present study investigated problematic mukbang watching by developing and validating the Mukbang Addiction Scale (MAS). An online survey was administered to 236 university students (Mage = 20.50 years; 62% female) who had watched mukbang at least once. Construct validity, criterion validity, and reliability analyses indicated that the MAS had good psychometric properties. Exploratory and confirmatory factor analyses confirmed the unidimensional structure of the scale. The Cronbach’s alpha (α = .95) and composite reliability (CR = .92) suggested that the MAS had excellent internal consistency. Latent class analyses (LCA) revealed two primary profiles, one with high endorsement and one with low endorsement of the items assessed. Item response theory (IRT) findings also indicated a good model fit. IRT findings provisionally supported a cut-off scale raw score of 22 (out of 30). Assessment and clinical-related implications of the findings are illustrated in accordance with other excessive behaviours.

Exploring the Relationship Between Mental Well-Being, Exercise Routines, and the Intake of Image and Performance Enhancing Drugs During the Coronavirus Disease 2019 Pandemic: A Comparison Across Sport Disciplines

Introduction: Physical distancing under the coronavirus disease 2019 (COVID-19) pandemic had a significant impact on lifestyles, including exercise routines. In this study, we examined the relationship between mental health and addictive behaviors, such as excessive exercise and the use of image and performance enhancing drugs (IPEDs) across 12 sport disciplines. Materials and methods: A large cross-sectional sample of the adult population (N = 2,295) was surveyed. The mean age was 33.09 (SD = 11.40). The number of male participants was 668 (30.0%). The use of IPEDs was assessed in conjunction with psychometric measures such as the Exercise Addiction Inventory (EAI) and the Appearance Anxiety Inventory (AAI). The participants were grouped into activity group (AG) and non-activity group (NAG) according to the presence or absence of their exercise habits. The results were compared between these groups, as well as across sport disciplines, while taking into account the relationship between different psychological measures and IPEDs consumption. Results: The frequency of IPEDs use was higher among AG (34.6%) than NAG (14.6%), although AG participants reported less history of addictions (7.1%) than NAG (11.8%). The logistic regression analysis revealed that scores equal to or above cutoff points, in both the EAI and AAI, predicted the IPEDs use. Regarding the differences across the various sport disciplines, those who were involved in practicing Weight Lifting and Cross Fit were found to be more at risk of excessive exercising and more inclined to use a wide range of IPEDs. Conclusions: Although exercise could help to increase well-being and prevent addictions during the COVID-19 pandemic, our results show that those in the AG are particularly vulnerable to excessive IPEDs use. Sport disciplines associated with higher EAI and AAI scores have also shown a higher tendency to excessive IPEDs use. Furthermore, the factor of having above the cutoff scores in EAI or AAI in each sport could indicate larger IPEDs consumption regardless of the discipline. In light of the current findings, it is necessary to better define the "non-excessive" levels of exercise in various sport disciplines and an adequate intake of IPEDs to ensure the safety and well-being of people during a pandemic.

Brief Version of Caffeine Expectancy Questionnaire in Brazil

The use of extensive questionnaires has the limitation of filling time bias, related to the ability to focus and accurately respond to many items, justifying the necessity for a brief version. This study aimed to build a brief version of the Caffeine Expectancy Questionnaire in Brazil (B-CaffEQ-BR) composed of 21 items divided into seven factors, with as adequate consistency and reproducibility as the full version. Quantitative procedures using statistical modeling were applied using the CaffEQ-BR (full version) database keeping the Mean Absolute Error (MAE) (based on the full version) <0.5 and Cronbach's α and Intraclass Correlation Coefficient (ICC) ≥0.7. The expert panel (n = 3), in a blind design, evaluated the semantic structuring within the options indicated by previous statistical modeling until the agreement of the expert panel. The participants (n = 62), Brazilian adults who were regular caffeine consumers (175.8 ± 94.4 mg/day), of whom 62.9% were women, 33.1 ± 9.7 years, 24.5 ± 3.8 kg/m², and 62.9% of whom self-identified as white, were asked to respond twice to the online questionnaire in 48-72 h. The first sample (n = 40) tested interobserver reproducibility with the double application of B-CaffEQ-BR. Another sample (n = 22) answered the CaffEQ-BR (full version) and B-CaffEQ-BR, and the last sample (n = 18) performed the reverse process. The B-CaffEQ-BR presented excellent internal consistency (Cronbach's α ≥ 0.729) and overall reproducibility (ICC ≥ 0.915) for the entire questionnaire and its seven factors. The B-CaffEQ-BR can be a valuable tool in caffeine research with the Brazilian adult population.

Estimates of Caffeine Use Disorder, Caffeine Withdrawal, Harm and Help-seeking in New Zealand: A cross-sectional survey

BACKGROUND

Caffeine Use Disorder (CUD) is not yet formally recognized in the DSM-5, but emerging evidence suggests CUD could impact up to one in five people. The primary aim of this study was to estimate levels of caffeine consumption and its associations with CUD and withdrawal, taking socio-demographic characteristics (age, gender, ethnicity, income) into account. Secondary aims were to measure caffeine-related harm and treatment preferences.

METHODS

We administered an online cross-sectional survey via Facebook to a convenience sample of 2379 adults in New Zealand. Caffeine consumption was assessed across six products: coffee, tea, energy drinks, cola, alcohol mixed with caffeine, and other products (e.g., caffeine pills, sports supplements).

RESULTS

20% of participants met proposed criteria for CUD, with 30% meeting DSM-5 criteria for caffeine withdrawal. Moderate (200-400 mg per day) and high consumption (>400 mg per day) was associated with a three-fold increase in the odds of CUD and a two-fold increase in the odds of withdrawal. Women and current smokers were at higher risk of CUD and withdrawal even at moderate consumption levels. Nearly 85% of respondents experienced at least one caffeine-related harm in the past 12-months. The number of harms increased with level of caffeine consumption. Nearly 50% indicated a self-help treatment for caffeine reduction would be of interest.

CONCLUSIONS

High rates of CUD and caffeine withdrawal amongst moderate caffeine users, women and smokers suggests caffeine consumption guidelines may need refinement. Caffeine-related harm that is not clinically meaningful may still be of concern to individuals and warrants further investigation.

Prevalence and Correlates of Caffeine Use Disorder Symptoms Among a United States Sample

Background: The DSM-5 recognizes caffeine use disorder as a condition for further study, but there is a need to better understand its prevalence and clinical significance among the general population.

Methods: A survey was conducted among an online sample of 1006 caffeine-consuming adults using demographic quotas to reflect the U.S. population. Caffeine consumption, DSM-proposed criteria for caffeine use disorder, sleep, substance use, and psychological distress were assessed.

Results: Eight percent of the sample fulfilled DSM-proposed criteria for caffeine use disorder. These individuals consumed more caffeine, were younger, and were more likely to be cigarette smokers. Fulfilling caffeine use disorder criteria was associated with caffeine-related functional impairment, poorer sleep, some substance use, as well as greater depression, anxiety, and stress.

Conclusions: The prevalence of caffeine use disorder among the present sample suggests that the proposed diagnostic criteria would identify only a modest percentage of the general population, and that identified individuals experience significant caffeine-related distress.

Chemistry, pharmacology and new trends in traditional functional and medicinal beverages

Functional and medicinal beverages consumption plays an important role in human health, considering that metabolites, with a wide range of pharmacological effects, are inserted in the human diet. Nowadays, the most consumed beverages are obtained from Camellia sinensis leaves and coffee grain processing, and contain different classes of polyphenols and phenolic acids in their phytochemical composition. Besides C. sinensis and coffee, numerous plants have been receiving attention due to their phytochemical composition and pharmacological effects, such as yerba mate, hibiscus, chamomile, lemongrass, fennel and mentha. Furthermore, atomized or lyophilized medicinal plant extracts can be employed in many beverage formulations and the consumption of these products is an excellent delivery means for nutrients and bioactive compounds, such as: minerals, vitamins, terpenes, antioxidants, saponins, alkaloids and polysaccharides. Innovation in food processing in order to insert functional and medicinal beverages in the human diet poses a challenge for the coming years. The technological development of new processing forms and use of plants with bioactive metabolites could be an important tool in relation to this proposal. In this context, this review has aimed to summarize and analyze pharmacological, phytochemistry and technological aspects of species with classical ethnobotanical and traditional use.