Running head: CAFFEINE AND ANXIETY

Caffeine Consumption and Anxiety Levels: A Convenience Sample

Ian Sande, Johnny Rider, Dani Goddard, Natalie Noss, Josh Hensley, and Gary Pearson
Touro University Nevada

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Methods

Information on Participants and Data Collection

Participants were graduate students recruited from the first year occupational therapy
program at Touro University Nevada in Henderson, Nevada. The students (26 females, 5 males)
were recruited during their Introduction to Research and Quantitative Research Methods course
during the summer 2013 semester. The age of participants ranged from 22 years to 55 years old.
Students received a donut as compensation for participation in the study in hopes to motivate
accurate and complete participation. Of the 31 total participants who initially accepted the packet
to participate in our study, 29 participants completed and turned the packet in on Monday
October 7th, 2013. The mortality rate was 6% with 2 of the 31 participants dropping out of the
study.
Materials
The Zung Self-Rating Anxiety Scale is a brief, 20-question anxiety assessment which
was taken online and then scores were reported on the provided survey. An example of a
question is I feel more nervous and anxious than usual and was answered according to a Likert
scale spanning from a little of the time to most of the time. Scores were generated by the
online system and then displayed to the participant after choosing Score my Answers. Scores
between 20-44 indicate normal anxiety, 45-59 mild to moderate anxiety, 60-74 marked to
severe anxiety and 75-80 indicate extreme anxiety according to the Zung Scale.
The Caffeine Survey Self Report was used to collect frequency and serving size of
caffeinated sources including beverages, soft drinks, energy drinks and shots, over the counter
(OTC), weight loss drugs and foods were self-reported. Beverages included but were not limited
to coffee, tea and hot chocolate. Soft drinks included Coke, Dr. Pepper, Pepsi and Mountain

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Dew, to name a few. Energy drinks and shots included Monster, Red Bull and 5-Hour Energy for
example. OTC and weight loss drugs included Midol, Excedrin, Trimspa and Xenadrine. Some
caffeinated foods were also included such as chocolate candy, chocolate cookies and many other
chocolate foods.
Procedure
Surveys were preassembled in packets and handed out to participants on Monday
September 30, 2013 at 12:00pm. The surveys contained a cover letter with detailed instructions
as well as the experimenters contact information. Participants were instructed to complete the
Zung Self-Rating Anxiety Scale each day for a period of one week between the hours of 5:006:00pm. Participants were to report any caffeine consumed for a 24 hour period from 12:00am11:59pm. The team of experimenters collected the packets on Monday October 7, 2013 between
the hours of 8:30-11:30am. There was no control group assigned.
Results
Method of Data Analysis
The topic of caffeine use in relation to anxiety is relevant because many people use
caffeine in order to get through their day. It is important to understand the potential implications
of caffeine use and how it affects stress. Many college and graduate level students utilize
caffeine to help them retain focus and stay on task when studying for exams. It is believed that
anxiety levels tend to increase throughout the course of a school semester. Research suggests that
there are mixed findings regarding caffeine and stress level. According to a study conducted by
Farag, Lovallo, Thomas & Wilson (2006), caffeine intake impacted physiological responses to
stress, such as increased cortisone levels in saliva. On the contrary, research by Rios et al. (2013)

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which used self-reported surveys of stress indicated that participants were found to have
decreased levels of stress with caffeine consumption.
For this study, we compared caffeine use in relation to self-reported stress level. After
gathering the results, we were able to compare the average caffeine consumption over a week
long period to the average Zung anxiety score over that same period for each participant. In
comparing these two surveys, we used Excel to attain the mean anxiety score, variance, find the
p-value, and to calculate the standard deviations (SD). Initially it was hypothesized that above
300 mg of caffeine consumption would correlate to higher anxiety scores. However, after
collecting the data, there were no subjects that reported taking over 300 mg of caffeine per day
and therefore we had to alter our level of caffeine consumption to 150 mg per day to obtain
statistical data. This will be further discussed as we address our limitations.
The results of the study failed to support our hypothesis. The results show an
insignificant correlation between caffeine intake and Zung anxiety scores. Additionally, results
indicated that caffeine intake correlated to a decreased anxiety score which is supported by
previous studies reviewed. The results included 22 subjects that reported consuming less than
150 mg and seven who reported consuming greater than 150 mg per day. The subjects who
consumed less than 150 mg a day reported an average anxiety score of 42.3 (normal anxiety
level range) with a SD of 8.5. The subjects who consumed more than 150 mg a day reported an
average anxiety score of 36.3 (normal anxiety level range) with a SD of 4.2 (see Table 1). The pvalue calculated was .086, finding the results to be insignificant; p>.05 (see Table 1).
Due to the p-value being greater than .05, the correlation between the amount of caffeine
consumed and the anxiety score was found to be obsolete. There was no direct link between

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caffeine consumption and the subjects reported anxiety scores. The p-value indicated that the
results could have been potentially attributed to chance.
Discussion and Implications for Practice
Although it was hypothesized that greater consumption of caffeine would result in a
higher anxiety score, it was found that the opposite occurred. Subjects who reported consuming
greater than 150 mg of caffeine a day actually had a lower mean anxiety score as opposed to
subjects who consumed less than 150 mg a day (see Figure 1 and 2). Based on these results,
further research may be conducted in order to see if caffeine consumption correlates to lower
anxiety scores.
Some possible limitations include the format of the survey. For example, the cover page
which included very detailed instructions may have appeared too dense and daunting to the
participants. Additionally, the survey was to be completed over a period of a week, which may
have been too long of a period of time for the subjects to maintain motivation to complete
accurately. Also, the results may have been compromised due to the enticement of donut
compensation. Subjects may have quickly completed the surveys at the last minute in order to
receive their donut compensation; which indicates that the anxiety survey may have not been
completed at the required time resulting in inaccurate data. Moreover, the amount of caffeine
consumed may be different than that which was actually reported. This may be attributed to
human error or a lack of truthful reporting on the surveys.
An additional limitation includes our sample size. Our p-value may have been more
significant if we had a larger number of subjects. It may be possible that although physiological
stress levels may have been elevated as seen in previous research, the effects of the caffeine may
cause participants to self-report lower levels of stress. We also adjusted our criteria for high

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doses of caffeine from a daily average intake of 300 mg to 150 mg. This was due to zero
participants reporting more than 300 mg of caffeine intake per day. Without the alteration we
would not have had two comparison groups to then discuss. Previous research reviewed in our
proposal had shown that a high percentage of graduate students did consume more than 300 mg
of caffeine per day which led us to our initial hypothesis and also leads us to believe the selfreported data of our participants was neither complete nor accurate.
Additionally, we are not considering the cumulative effects of caffeine over the entire day
versus acute symptoms just after caffeine intake. Also, anxiety rating scores may be altered if
the caffeine is already out of the participants system (i.e. caffeine effects depend on time of
consumption as well as time of test administration), and temporal aspects of caffeine
consumption are not factored into this study. This study is also administered over a short-period
of time (five days) and does not take into account other possible external sources of anxiety; for
example personal life challenges, pre-exam anxiety and other medications. This study is not
completely blind and participants may fail to properly report all daily caffeine intake. The survey
is a self-report, so there could be potential discrepancies with the recording of caffeine
consumption such as forgetting about a cup of coffee or not drinking the entire cup and reporting
the incorrect serving size. Our surveyed population is a convenience sample and is a small
sample of only Touro University Nevada Occupational Therapy graduate students, so the
generalizability is limited. Also, it is impossible to list every conceivable caffeine product since
there are literally thousands on the market. Additionally, the researchers are not aware of the
preexisting health or mental health conditions of participants. There is also no baseline taken by
participants with zero caffeine consumption measuring stress levels without any caffeine.
Considering the limitations there are plenty of opportunities to continue researching this

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correlation with graduate students or the general population. With this said, continuing research
can be particularly important to consider when working with clients in the future. Additionally,
knowing the effects that caffeine can have on a persons anxiety can allow occupational therapy
practitioners to address areas of occupations such as sleep and rest appropriately. Also, caffeine
effects on clients would be important to monitor as introducing new activities and exercises can
already increase anxiety in clients. Understanding the effects of caffeine on an individuals
anxiety (i.e. overall health and wellness) can help us address the client holistically.

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References

Farag, N.H., Lovallo, W.R., Thomas, T.C., Wilson, M.F. (2006). Cortisol Responses To Mental
Stress, Exercise, and Meals Following Caffeine Intake in Men and Women.
Pharmacology Biochemistry Behavior. Retreived from:
www.ncbi.nim.nih.gov/pubmed/116631247
Rios, J.L., Betancourt, J., Pagan, I., Fabian, C., Cruz, S.Y., Gonzalez, A.M. (2013). Caffeinatedbeverage consumption and its association with socio-demographic characteristics and
self-perceived academic stress in first and second year students at the University of
Puerto Rico Medical Sciences Campus (UPR-MSC). P R Health Sci Journal, 32(2):95100.
Salkind, N. J. (2012). Exploring research (8th ed.). Upper Saddle River, NJ: Pearson.

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Table 1.
t-Test: Two-Sample Assuming Equal Variances

Mean of anxiety score

Variance
Standard Deviation
Observations
Pooled Variance
Hypothesized Mean Difference
df
t Stat (t-Test value)
P(T<=t) one-tail
t Critical one-tail
P(T<=t) two-tail
t Critical two-tail

<150 mg weekly avg >150 mg weekly avg

42.3
36.28571429
72.90190476
17.71809524
8.538261226
4.209286785
22
7
60.63883598
0
27
1.779795028
0.043184368
1.703288446
0.086368737
2.051830516

Note. Mean, standard deviation, p-value and t-test values are listed for each group. The group
that consumed an average of <150 mg of caffeine weekly contained 22 subjects and the >150 mg
group contained seven subjects.

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10
300
250
200
Mg Caffeine

150

Zung Anxiety Score

100

50
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29

Figure 1. Shows the correlation between mg of caffeine consumed and scores from Zung SelfRating Anxiety Scale.

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Mean Zung Anxiety Scores

43
42
41
40
39
38

Mean Zung Anxiety Scores

37
36
35
34
33
<150 Mg. Caffeine

>150 Mg. Caffeine

Figure 2. Displays the comparison of mean Zung scores to the group of participants who
consumed a weekly average of <150 mg of caffeine or a weekly average of >150 mg of caffeine.