A Systematic Review of the Impact of the Alcohol Hangover Upon Negative Affect

Alcohol hangovers can occur after a single episode of drinking and begin as blood alcohol concentration returns to zero. While hangovers are widely known for their physical symptoms, they also include psychological symptoms such as a depressed mood. These psychological impacts, particularly negative affect (e.g., anxiety, stress), remain less well understood, yet may contribute to maladaptive drinking behaviours and reinforce the cycle of excessive alcohol consumption.

This systematic review, pre-registered and reported in alignment with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Synthesis without Meta-analysis guidelines, aimed to comprehensively examine the association between alcohol hangovers and negative affect. Searches were performed in MEDLINE, Embase, PsycNET, Scopus and CINAHL from inception to January 2025. Two independent reviewers screened articles, assessed the risk of bias and extracted data.

Twenty-two studies (n = 6152; mean age 26.9 years, 57% female) demonstrated a significant association between hangovers and increased negative affect, including anxiety, stress and depression. Maladaptive emotional regulation, avoidant coping styles, repetitive negative thinking and greater baseline anxiety exacerbated these negative experiences, while social support and mental resilience offered potential protective factors.

The findings highlight the clinical importance of addressing psychological factors in alcohol-related harm. The tendency to return to binge drinking despite negative hangover experiences suggests that psychological factors may perpetuate unhealthy alcohol consumption.

This review supports a strong link between alcohol hangovers and heightened negative affect. Effective interventions must address both the reduction of negative affect and the underlying drivers of binge drinking to promote healthier alcohol consumption patterns.