A Case Series of 44 Completed Gambling-Related Suicides

Gambling-related suicide in Victoria, Australia: a population-based cross-sectional study

Background

Gambling is associated with serious harms to health, including suicide. Yet public health systems for recording the role of gambling in suicide deaths are relatively underdeveloped. This study contributes to the understanding of this relationship.

Methods

A population-based cross-sectional study of suicides reported to the Coroners Court of Victoria between 2009 and 2016 was performed to identify the incidence and characteristics of gambling-related suicides (GRS).

Findings

From 2009 to 2016 there were 4788 suicide deaths in Victoria. Of these, 184 were identified as direct GRS and a further 17 were GRS by 'affected others'. Together, these GRS comprise 4.2% of all suicides in Victoria over this eight-year period. Direct GRS account for an annual average rate of 5.13 GRS per million Victorian adults. GRS were significantly more likely to be male (n = 153, 83%), than the Victorian population of total suicide deaths and significantly more likely to occur among those most disadvantaged. Family members and friends were more likely than clinicians to know about the deceased gambling.

Interpretation

Given that gambling is not routinely investigated by coroners and may be hidden from family, friends, and health professionals, this is an underestimate of the true scale of the GRS in Victoria. A range of measures should be introduced to prevent, screen, support, and treat gambling harm. Family members and friends should also be provided with help services. Preventing gambling-related harm through public health measures could significantly reduce suicidality and suicide, both in Australia and globally.

Funding

Federation University Australia, Coroners Court of Victoria, Suicide Prevention Australia.

Gender and maladaptive personality correlates in problem gambling and over-indebtedness: Novel findings from a cross-sectional study in Sweden

Although most individuals consider gambling to be an innocent and fun activity, when it develops into problem gambling, it can have detrimental outcomes to one's life, such as over-indebtedness. This cross-sectional study explores the role of maladaptive personality traits and gender in both problem gambling and over-indebtedness, in an online sample of 1479 adult gamblers (65% males) in Sweden. Participants were administered the Problem Gambling Severity Index (PGSI), the Personality Inventory for DSM-5-Brief Form (PID-5-BF), and questions addressing subjective over-indebtedness and other risk factors. Quasi-Poisson loglinear models and logistic regression analyses demonstrated that Disinhibition (OR = 1.38, 95% CI [1.24, 1.53]), and Antagonism (OR = 1.23, 95% CI [1.14, 1.34]) showed the strongest associations to problem gambling, and that only Disinhibition (OR = 1.72, 95% CI [1.22, 1.43]) and Antagonism (OR = 2.00, 95% CI [1.52, 2.66]) were significantly related to over-indebtedness. The prevalence of problem gambling and over-indebtedness was more common among women, and gender moderated the univariate relationships of Negative Affectivity, Disinhibition and Psychoticism to problem gambling. These findings call for future research addressing maladaptive personality traits, problem gambling and over-indebtedness, and highlight the need for tailored interventions and prevention strategies, particularly for women who may be at higher risk.

Gambling-related suicides and suicidality: A systematic review of qualitative evidence

The relationship between gambling and suicides or suicidality has received much research attention in recent years. Review studies have already mapped the quantitative occurrence of suicide attempts, suicides, and self-harm among gamblers, and found a positive association. Related comorbidities and conditions have also been charted in previous reviews. However, there is still a gap in knowledge regarding the actual processes that connect gambling and suicidal behavior. To understand these processes, the current paper conducts a systematic review of qualitative evidence on gambling-related suicides and suicidality. The aim was to identify the role of gambling as well as of confounding factors in suicidality, and what kind of support suicidal individuals have received or would need. We searched for relevant literature in seven scientific databases. We included all studies that presented empirical qualitative evidence on gambling-related suicide, suicidality and/or self-harm (N = 20). The results show two main processes that connect gambling and suicidal behavior: indebtedness and shame. At the same time, suicide is a multifactorial phenomenon, and related to other confounding factors. These include psychiatric conditions, personality traits, and life conditions. In many cases, these appear to emerge as a consequence of gambling. Treatment for suicidality has been effective in some cases, but indebtedness and shame may also function as barriers to help-seeking. We conclude that effective prevention is needed by adapting a more comprehensive public health approach and population-level interventions.

Gambling-related suicide in East African Community countries: evidence from press media reports

Background

Gambling activities and associated mental health problems have become a topic of increased concern globally. Many individuals with a severe gambling disorder have gambling-related suicidality. However, no study has explored gambling-related suicide in East African Community (EAC) countries. The present study investigated the press media reporting of gambling-related suicide cases from EAC countries.

Methods

As there is no established suicide database in that region, media reports were utilized to collect gambling-related suicide data. Gambling-related suicide case reports were searched for in EAC countries’ press media websites using Google. After removing duplicates, a total of 18 suicides were found.

Results

The victims were all males aged 16 to 40 years. The most prevalent reason for the death was university students who had used their university tuition fees for gambling and losing the money (n = 4/17). All the suicide deaths were in Kenya (10/18), Uganda (7/18), and Tanzania (1/18). Betting on soccer was the most common type of gambling reported (n = 11/15), and hanging was the most used mode of suicide (n = 10/16).

Conclusions

Based on the press media reports, 18 males were identified as having carried out gambling-related suicides. The countries with the most widespread opportunities to gamble had more gambling-related suicides, although the number of suicides was very small.

Gambling Disorder in an Italian Population: Risk of Suicide Attempts and Associated Demographic-Clinical Factors using Electronic Health Records

To identify the demographic and clinical characteristics associated with access to Emergency Departments for Suicide Attempt in a cohort of patients with Gambling disorders. We used electronic health records of inpatient and outpatient services to identify individuals who received a diagnosis of gambling disorder (ICD-9 or ICD-10 codes) in the Metropolitan area of Bologna from 2009 to 2019. In this cohort we identified accesses to Emergency Departments for suicide attempt through cross-matching with electronic records. We calculated Crude Suicide Attempt Rates; we also included the demographic-clinical variables in a multivariate Poisson regression. We identified 692 patients with a diagnosis of gambling disorder and a total of 2733 Person Years. The Crude Suicide Attempt Rate per 1000 Person Years was 9.17 (95% CI 6.20-13.58), higher for females and much higher than the general population (incidence rate ratio = 93.72). The multivariate analysis showed a higher risk of suicide attempt in the year following the first contact with a clinical service, in patients younger than 45 years, with alcohol use disorders and personality disorders. This study evidenced a high risk of access to Emergency Departments for suicide attempt in individuals with a diagnosis of gambling disorder and highlighted important demographic and clinical factors that should be considered when evaluating suicide risk in this population.

The Level of Gambling Prediction Using Depression and Anxiety in the Romanian Population

The gambling addiction problem, one which is present worldwide and at all social levels, is one of the most pervasive problems in contemporary society. According to the research literature, gambling addiction is determined by other psychiatric disorders. In the present study, we investigate the degree to which gambling can be predicted by depression and anxiety in a Romanian sample. The study has been conducted on a sample of 920 persons in the general population. Results show that depression predicts gambling in proportion of 26.3 percent, while anxiety predicts 31.5 percent of gambling variance. In the discussion portion of the study, we provide a psyhological interpretation of the results.

Gambling Disorder Symptoms, Suicidal Ideation, and Suicide Attempts

OBJECTIVE

Gambling disorder (GD) patients have a higher suicide risk compared to the general population. The present study investigates the suicide-related risk factors of GD patients by analyzing GD diagnosis-related symptoms and suicide-related behaviors of subjects.

METHODS

This study investigated which symptoms among GD diagnosis criteria are related to suicide risk in 142 patients diagnosed with GD. To analyze the relationship between GD symptoms and suicidal ideation and suicide attempt, the odds ratio (OR) was determined through multivariate logistic regression.

RESULTS

The number of symptoms was significantly higher in the subjects who had suicidal ideation group and attempt group. In the cases of past suicide attempts, responses to withdrawal and escape questions were significantly higher; in the cases of ongoing suicidal ideation, responses to negative consequences and bailout questions were significantly higher. When depression was corrected, the 'bailout' item was, indicating that 'bailout' increased suicidal ideation (OR=4.937, 95% CI=1.009-24.164). In the suicide attempt group, 'relieve' item may increase suicide attempt (OR=6.978, 95% CI=1.300-35.562).

CONCLUSION

Past suicide attempts in GD patients correlated with withdrawal symptoms, and financial problem correlated with suicidal ideation. This suggests that evaluating suicide risk is important when evaluating GD patients, and evaluation of financial problems is important for GD patients with suicide risks.

Self-injurious behavior and gambling-related attitudes, perceptions and behaviors in adolescents

Gambling is prevalent among adolescents and adolescents are vulnerable to experiencing gambling-related problems. Although problem gambling and suicidal behavior have been linked in adults and self-injurious behaviors may predict future suicidality, prior studies have not investigated relationships between problem-gambling severity and self-injurious behavior in adolescents. Data from 2234 Connecticut high-school students were analyzed in chi-square tests and logistic regression models to examine self-injurious behaviors in relation to at-risk/problem gambling with respect to sociodemographic characteristics, gambling attitudes and perceptions, and extracurricular and health measures. Individuals who engaged in self-injurious behavior (versus those who did not) reported more permissive views towards gambling and were more likely to exhibit at-risk/problem gambling. Stronger relationships between problem-gambling severity and gambling in casinos (OR 4.85, 95%CI 1.94, 12.12) and non-strategic gambling (1.92, 95%CI 1.01, 3.66) were observed in adolescents who acknowledged engagement in self-injurious behavior versus those who did not. Links between self-injurious behaviors and more permissive gambling attitudes and perceptions and at-risk/problem gambling suggest the need for improved interventions targeting co-occurring self-injurious behaviors and gambling. Stronger relationships between problem-gambling severity and casino and non-strategic gambling among adolescents with self-injurious behaviors suggest adolescents with self-injurious behavior may engage in specific forms of gambling as maladaptive coping strategies to alleviate suffering. Prevention and treatment approaches targeting distress management and improving adaptive coping skills may be important for targeting self-injurious behaviors in adolescents with at-risk/problem gambling.

Over-Indebtedness and Problem Gambling in a General Population Sample of Online Gamblers

BACKGROUND

Online gambling has increased in recent years, including online casino games and live sports betting which constitute rapid gambling activities with significant potential for gambling-related harm. There is a paucity of research examining whether specific gambling patterns are related to problem gambling and over-indebtedness, when controlling for psychological distress, gender, and other risk factors.

METHODS

A general population-based web panel of 1,004 online gamblers were examined in an online survey addressing problem gambling symptoms (the PGSI), psychological distress (Kessler- 6), past 30-day gambling activities, past 30-day gambling losses, history of subjective over-indebtedness and expected over-indebtedness in the near future, as well as socio-demographic data.

RESULTS

In logistic regression analyses, problem gambling was associated with psychological distress, recent online casino gambling, and recent combined online casino gambling and live sports betting. History of over-indebtedness was associated with recent combined online casino gambling and live sports betting, and expected over-indebtedness was associated with online casino gambling. Problem gambling, and a history of having borrowed money for gambling, were markedly higher in online casino gamblers, compared to subjects not reporting this gambling activity. Problem gambling was markedly more common in women, but was not associated with gender in the adjusted analysis.

CONCLUSIONS

In online gamblers, high rates of problem gambling and over-indebtedness were seen, and online casino gambling (alone or in combination with live sports betting), was associated with remarkably increased risk. Gender distribution of problem gamblers was clearly in contrast to that found in previous problem gambling literature. These findingsa suggest regulations in the market of online casino gambling, and prevention of over-indebtedness in gambling-related borrowing, in consumer credit counselling and in mental health care. In particular, female gender may need to be addressed as a stronger risk factor than previously described.

Struggling with Happiness: A Pathway Leading Depression to Gambling Disorder

A number of studies have suggested that depressive mood might lead to the development and/or maintenance of a gambling disorder (GD). The pathways by which such relationships are fostered may involve deficits in emotional regulation capacity and dysfunctional coping styles. This study aims to explore the role played by depressive symptomatology and the regulation of positive emotion in GD. We administered the South Oaks Gambling Inventory (SOGS, Lesieur and Blume in Am J Psychiatry 144(9):1184-1188, 1987), the 21-item Depression Anxiety Stress Scale (DASS-21, Lovibond and Lovibond in Manual for the depression anxiety stress scales. Psychology Foundation, Sydney, 1995) and the Kill-joy Thinking subscale of the Ways of Savouring Checklist (WOSC, Bryant and Veroff in Savoring: a new model of positive experience. Lawrence Erlbaum, Mahwah, 2007) to a sample of pathological gamblers (n = 91) and a sample of community participants (n = 105). The pathological gamblers scored higher on the DASS-21 subscales and obtained higher scores on the Kill-joy Thinking subscale of the WOSC compared to the controls. Moreover, the SOGS scores positively correlate with the DASS-21 subscales, and with the Kill-Joy Thinking measure. Finally, it is evident that Kill-joy Thinking fully mediates the relationship between depressive symptomatology and GD severity. Our results further confirm the roles of depression, anxiety and stress in GD. Moreover, this is the first study to explore the mediating role of dampening processes in the relationship between depression and GD. Future lines of research are also discussed.

Gambling disorder, increased mortality, suicidality, and associated comorbidity: A longitudinal nationwide register study

BACKGROUND AND AIMS

Gambling disorder (GD) appears to be an independent risk factor for suicide, and all-cause mortality has been sparsely studied in patients with GD. This study aims to explore mortality and suicide rates in individuals with GD compared to the general population as well as explore risk factors associated with all-cause mortality and suicide mortality.

METHODS

This is a nationwide register study on 2,099 individuals with a GD diagnosis in the Swedish inpatient and/or outpatient specialist health care system between the years of 2005-2016. Comorbid diagnoses from treatment episodes included in national registers were categorized into diagnostic groups according to the 10th revision of International Classification of Diseases, and prevalence rates (any occurrence during 2005-2016) were calculated for each diagnostic group. Multivariate Cox regression analyses on risk factors for death and suicide were performed, controlling for age, gender, and major categories of comorbidity. Standardized mortality ratios (SMRs) were calculated for men and women with regard to overall mortality and suicide compared to the general Swedish population.

RESULTS

The population consisted of 1,625 men and 474 women ranging from 18 to 83 years of age at first GD diagnosis (mean: 36.5 years). Sixty-seven individuals passed away, among whom 21 deaths were due to suicide. SMR calculations showed a 1.8-fold increase in mortality for individuals 20-74 years old with GD compared to the general population, and a 15-fold increase in suicide mortality. All-cause mortality was predicted by higher age and any treatment episode for cardiovascular disease, whereas suicide death was predicted by depression.

DISCUSSION AND CONCLUSIONS

Mortality and suicide rates are significantly elevated among individuals with GD. Although common mental health comorbidities did not predict overall mortality, depression predicted suicide death. Findings call for attention to long-term risk of death in GD patients and interventions against comorbid health problems.

Suicidality among gambling helpline callers: A consideration of the role of financial stress and conflict

BACKGROUND AND OBJECTIVES

High rates of suicidal ideation and attempts secondary to gambling are well established among those with gambling disorders. The present study explores potential risk factors for suicidal ideation and/attempt among a sample of help-line callers.

METHODS

Participants (N = 202) completed measures assessing demographics; gambling behavior; and financial, family/social, employment, substance use, and legal difficulties related to gambling. Bivariate analyses, logistic regression, and mediation analyses were used to explore relationship between predictors and risk of suicidal ideation and attempt.

RESULTS

Female gender, gambling severity (including engagement in illegal behaviors), a history of mental health problems, financial problems, and conflict related to gambling were associated with current suicidality in this sample. Mediation analyses revealed that financial problems were associated with increased familial conflict, which was in turn associated with increased suicidality.

CONCLUSIONS

Family and social conflict may be one important way in which financial problems confer risk for suicidality among problem gamblers. These results align with findings from the substance use disorder (SUD) literature and highlight one potential factor that may merit further assessment and/or intervention.

SCIENTIFIC SIGNIFICANCE

Researchers and clinicians may want to consider the overall level of conflict a patient is experiencing when assessing suicide risk among individuals with gambling problems. Professionals may also want to consider the suitability of interventions to address conflict within the context of gambling treatment. (Am J Addict 2018;27:531-537).

Sense of Coherence and Gambling: Exploring the Relationship Between Sense of Coherence, Gambling Behaviour and Gambling-Related Harm

Understanding why some people experience problems with gambling whilst others are able to restrict gambling to recreational levels is still largely unexplained. One potential explanation is through salutogenesis, which is a health promotion approach of understanding factors which move people towards health rather than disease. An important aspect of salutogenesis is sense of coherence. Individuals with stronger sense of coherence perceive their environment as comprehensible, manageable and meaningful. The present study examined the relationship of individuals' sense of coherence on their gambling behaviour and experience of gambling related harm. This exploratory study utilised an archival dataset (n = 1236) from an online, cross sectional survey of people who had experienced negative consequences from gambling. In general, a stronger sense of coherence was related to lower problem gambling severity. When gambling behaviour was controlled for, sense of coherence was significantly related to the experience of individual gambling harms. A strong sense of coherence can be seen as a protective factor against problematic gambling behaviour, and subsequent gambling related harms. These findings support the value of both primary and tertiary prevention strategies that strengthen sense of coherence as a harm minimisation strategy. The present study demonstrates the potential value of, and provides clear direction for, considering sense of coherence in order to understand gambling-related issues.

Current suicidal ideation in treatment-seeking individuals in the United Kingdom with gambling problems

BACKGROUND

Studies show higher lifetime prevalence of suicidality in individuals with pathological gambling. However, less is known about the relationship between pathological gambling and current suicidal ideation.

OBJECTIVES

We investigated socio-demographic, clinical and gambling-related variables associated with suicidality in treatment-seeking individuals.

METHODS

Bivariate analyses and logistic regression models were generated on data from 903 individuals to identify measures associated with aspects of suicidality.

RESULTS

Forty-six percent of patients reported current suicidal ideation. People with current suicidal thoughts were more likely to report greater problem-gambling severity (p<0.001), depression (p<0.001) and anxiety (p<0.001) compared to those without suicidality. Logistic regression models suggested that past suicidal ideation (p<0.001) and higher anxiety (p<0.05) may be predictive factors of current suicidality.

CONCLUSIONS

Our findings suggest that the severity of anxiety disorder, along with a lifetime history of suicidal ideation, may help to identify treatment-seeking individuals with pathological gambling with a higher risk of suicidality, highlighting the importance of assessing suicidal ideation in clinical settings.

Is it all about money? A qualitative analysis of problem gamblers' conceptualisations of money

Aim

Money is an essential element in gambling but gambling disorders are more often discussed from the perspective of individual and psychological experiences than in the context of financial practices. Losing money is often among the first signs of problem gambling as well as being a motive for treatment-seeking. This article asks: what kinds of practices and meanings do problem gamblers assign to money in their everyday lives?

Design

The data consist of 17 individual interviews with problem gamblers in Finland. The participants form a heterogeneous group of people with different financial backgrounds. Their discourses on money are systematically organised into a structured qualitative content analysis.

Results

The results reveal four main conceptual traits of money as an everyday gambling-related problem: (1) a compelling need for money; (2) disposable money defining the tempo of gambling; (3) the balance between using money for gambling and spending it on other matters of everyday life; and (4) gradual spiral of increased money-related problems.

Conclusions

Problem gambling re-organises the uses and sources of money in everyday life, and changes the meanings of money. Nevertheless, gambling spending does not seem to be utterly out of control, rather, on one hand, disposable income organises spending episodically, and on the other hand, problem gamblers exercise a certain degree of control over their household expenses. This observation could promote problem gamblers' sense of control when recovering.this page for more information about identifying these."-->.

What is the harm? Applying a public health methodology to measure the impact of gambling problems and harm on quality of life

While the PGSI is indeed an established index of problem-gambling symptoms, it nevertheless does not quantify the degree of harm experienced by individuals at different points on the spectrum of gambling problems. The purpose of the present study was to establish the relationship between the PGSI category and health-related quality of life (HRQoL) decrements using a population health (PH) method. Harms reported by gamblers and affected others across the PGSI spectrums were transformed into 798 vignettes. A general population panel (N=786) and experts who work with gamblers (N=51) rated the impact of these vignette descriptions on quality of life using the Time Trade-Off task, and a Visual Analogue Scale incorporating 27 comparison conditions. Disability weights (DW) were then estimated for different levels of gambling symptoms. A DW of 0.44 was estimated for problem gamblers (PG), suggesting a reduction in the effective enjoyment of life by over 4 years for every 10 years in lifespan. Lower—but non-negligible—DWs of .14 and .29 were determined for low- and moderate-risk gamblers. Gambling is compared with a number of other conditions with respect to HRQoL impact. On average, PG harm appears to be similar to that of a manic episode of bipolar disorder and severe alcohol abuse disorder. We discuss advantages, and methodological challenges, in applying PH methods to measuring the severity of gambling problems in terms of HRQoL.Bien que l'indice du jeu excessif (PGSI) soit en effet un indice établi des symptômes liés aux problèmes de jeu, il ne quantifie pas le niveau de préjudice subi par les personnes situées à différents points sur le spectre des problèmes de jeu. Le but de l'étude a été d’établir la relation entre la catégorie PGSI et les écarts à la baisse en lien avec la qualité de vie liée à la santé (QVLS) en utilisant une méthode de santé de la population. Les torts signalés par les joueurs et les personnes touchées dans le spectre PGSI ont été transformés en 798 vignettes. Un groupe de population en général (N = 786) et des experts qui travaillent avec des joueurs compulsifs (N = 51) ont évalué l’incidence de ces descriptions de vignette sur la qualité de vie à l’aide de la tâche Time Trade-Off (marchandage de temps) et une échelle visuelle analogue intégrant 27 conditions de comparaison. Les poids d’incapacité (DW) ont ensuite été estimés pour différents niveaux de symptômes du jeu. Un DW de 0,44 a été estimé pour les joueurs compulsifs, ce qui laisse supposer une diminution de la jouissance réelle de la vie de plus de 4 ans pour chaque tranche de vie de 10 ans. Les DW inférieurs, mais non négligeables, de 0,14 et 0,29 ont été déterminés pour les joueurs à risque faible et modéré. Le jeu est comparé à un certain nombre d’autres conditions en ce qui concerne l’incidence de la qualité de vie liée à la santé (QVLS). En moyenne, le préjudice causé par un joueur compulsif s'apparente à celui d’un épisode maniaque de trouble bipolaire et d’un trouble sévère d’abus d’alcool. Nous discutons des avantages et des défis méthodologiques, en appliquant des méthodes de santé de la population pour mesurer la gravité des problèmes de jeu en termes de QVLS.

Financial recovery from problem gambling: problem gamblers’ experiences of social assistance and other financial support

The objective of this article is to understand problem gamblers’ experiences of recovery from financial difficulties caused by problem gambling. Specifically, financial social assistance from public services is considered. A sample of 17 interviews with Finnish self-identified, treatment-seeking problem gamblers from various financial positions was analyzed qualitatively using thematic content analysis. The analysis revealed four themes. The first theme examines how the financial concerns of problem gamblers were left unaddressed by treatment professionals. The second theme discusses the rationalizations behind not applying for or not receiving financial social assistance from public services. The reasons behind not applying for financial social assistance were related to financial stability and perceived pride derived from surviving independently (loss of pride when not being able to survive independently). Not receiving assistance despite applying for it was mostly because of their income having been assessed as adequate by the social services. Third theme examines receiving financial social assistance during, or after, problematic gambling. Participants living on welfare often spent their benefits on gambling in the hopes of an increased income. Recovering lower-income problem gamblers also received financial social assistance for living expenses or for treatment. Fourth, non-governmental and more controlling forms of financial support were (1) financial assistance within private safety nets, (2) support for over-indebtedness from an NGO, or (3) private person/official authority taking control over problem gamblers’ financial matters. The socio-economic background factors are important to address when designing financial and other support for problem gamblers. The results of this study provide useful information for future survey studies of the topic.Dans cet article, on cherche à comprendre le vécu des joueurs pathologiques qui ont dû surmonter des problèmes d’argent en raison du jeu compulsif. Plus particulièrement, on s’est intéressé à l’aide sociale financière offerte par les services publics. Un échantillon de 17 entrevues avec des Finlandais s’étant déclarés joueurs pathologiques à la recherche d’un traitement et se trouvant dans différentes situations financières a été étudié qualitativement à partir d’une analyse du contenu thématique. De cette analyse, quatre thèmes ont été dégagés. Le premier porte sur la façon dont les fournisseurs de traitement n’ont pas tenu compte des soucis matériels des joueurs pathologiques. Le deuxième parle des arguments avancés pour ne pas avoir demandé ou reçu d’aide sociale financière des services publics. Les raisons s’opposant à la présentation d’une telle demande avaient trait à la stabilité financière et à la fierté ressentie au fait d’assurer seul sa survie. Dans la plupart des cas, les personnes qui n’avaient pas reçu d’aide même après avoir fait une demande pour en obtenir disposaient d’un revenu que les services sociaux jugeaient adéquat. Le troisième aborde l’aide sociale financière qui a été reçue durant ou après les problèmes de jeu. Les participants vivant de l’aide sociale dépensaient souvent leurs prestations au jeu dans l’espoir d’augmenter leur revenu. Les joueurs pathologiques en voie de guérison dont le revenu était plus faible ont également reçu de l’aide sociale financière pour leurs dépenses courantes ou pour leur traitement. Le quatrième traite des formes de soutien monétaire non gouvernementales et plus contrôlantes, notamment (1) l’aide financière dans le cadre de filets de sécurité privés, (2) l’aide fournie par une organisation non gouvernementale pour le surendettement ou (3) un particulier ou une autorité officielle qui prend en main les problèmes d’argent des joueurs pathologiques. Il est important d’examiner les facteurs en matière de contexte socioéconomique au moment de concevoir des mécanismes de soutien financier ou autres pour les joueurs pathologiques. Les résultats de cette étude fournissent des renseignements utiles pour de futures études par sondage sur ce sujet.

Quelle est l’influence du genre dans la recherche de soins chez les joueurs?

Cette étude vise à décrire l’influence du genre sur les différentes étapes amenant un joueur ayant des problèmes de jeu à prendre la décision de rechercher de l’aide. Le modèle de recherche d’aide de Goldsmith, Jackson et Hough (1988) a été utilisé pour conceptualiser les étapes de prise de décision menant à consulter des services d’aide pour un problème de jeu de hasard et d’argent. Au total, 83 participants, dont 45 femmes et 38 hommes adultes, y ont pris part. Les résultats indiquent que, comparativement aux hommes, les femmes sont plus nombreuses à habiter en couple, ont plus souvent de faibles revenus et subviennent moins fréquemment seules à leurs besoins, rapportent des conduites de jeu plus conséquentes, souffrent davantage de troubles anxieux au cours de leur vie et, enfin, consultent surtout des services non spécialisés. Au cours des 12 derniers mois, les femmes avaient consulté plus souvent les services médicaux de première ligne et avaient eu moins fréquemment recours aux services spécialisés que les hommes.The aim of this study was to describe the influence of gender on the various stages of the decision-making process that bring problem gamblers to seek help. The authors used the help-seeking model developed by Goldsmith, Jackson and Hough (1988) to conceptualize the different stages of the process that leads to consulting support services for a gambling problem. A total of 83 participants (45 females and 38 males) took part in the study. Results show that women are more likely to have a partner and to earn a lower income; they provide for their own needs less frequently than men; report more consistent gaming behaviours; are more prone to anxiety disorder during their lifetime; and consult primarily non-specialized services. In the previous 12 months, they had accessed front-line services more often and specialized services less frequently than men.

Association of Pathological Gambling with Depression in Scotland

As most research concerning gambling and depression has been conducted on clinical populations, the present study examined the relationship between gambling and depression across a large sample in Scotland in higher education and the community. A questionnaire-based cluster design involved the distribution of the South Oaks Gambling Screen and the Centre for Epidemiologic Studies Depression Scale mainly to students and staff of higher educational establishments, with small community and gambling samples also included. Thirty-seven colleges and universities across Scotland participated in the research, with a sample of 2,259 people aged sixteen years of age or over ( M = 28.9 yr., SD = 13.4) being obtained. It was found that past-year probable pathological gamblers had significantly higher depression than problem gamblers, nonproblem gamblers, and nongamblers. However, when probable pathological gamblers who had sought treatment were omitted from the analysis, the nontreatment-seeking probable pathological gambling group no longer had significantly higher depression than the problem gambling group. Female problem and probable pathological gamblers had particularly high depressive symptomatology, suggesting comorbid depression may be a prominent feature of problematic female gambling.

Factors associated with suicidal risk among a French cohort of problem gamblers seeking treatment

Compared to general population, pathological gamblers are 3.4 times more likely to attempt suicide. Our objective was to identify specific profiles of problem gamblers (PGs) with suicidal risk according to sociodemographic, clinical and gambling characteristics. The PGs cohort, called "EVALJEU" , consists in the inclusion of any new PG seeking treatment in our Department. Patients underwent a semi-structured clinical interview and completed self-report questionnaires. The "suicidal risk module" of the Mini International Psychiatric interview (MINI) allowed to constitute two groups of patients that were compared, according to the presence of a suicidal risk. A logistic regression was performed to identify factors related to suicidal risk in PGs. In our sample (N=194), 40.21% presented a suicidal risk. A history of major depression and anxiety disorders were predictors of suicidal risk as well as the perceived inability to stop gambling. Suicidality is a significant clinical concern in PGs. Therefore, three specific predictors, identified by our study, must be assessed.

Suicide Ideations, Suicide Attempts, and Completed Suicide in Persons with Pathological Gambling and Their First-Degree Relatives

We examined the relationship between suicidal ideations and attempts in 95 probands with pathological gambling (PG), 91 controls, and 1075 first-degree relatives. The results were analyzed using logistic regression with generalized estimating equations. Thirty-four PG probands (35.8%) and 4 controls (4.4%) had attempted suicide (OR = 12.12, p < .001); in 13 probands, the attempt occurred before PG onset. Lifetime suicidal ideations occurred in 60 PG probands (63.2%) and 12 controls (13.2%) (OR = 11.29, p < .001). Suicidality in PG probands is a marker of PG severity and is associated with greater psychiatric comorbidity. Offspring of PG probands had significantly higher rates of suicide attempts than control offspring.

Problem gambling and internalising symptoms: a longitudinal analysis of common and specific social environmental protective factors

INTRODUCTION

Comorbidity between problem gambling and internalising disorders (anxiety and depression) has long been recognised. However, it is not clear how these relationships develop, and what factors can foster resilience to both conditions. The current study draws on longitudinal cohort data to investigate: 1) the cross-sectional and longitudinal relationships between problem gambling and internalising symptoms; 2) whether there are common and/or specific social environmental factors protective against both internalising symptoms and problem gambling in young adulthood; and 3) interactive protective factors (i.e., those that moderate the relationship between problem gambling and internalising symptoms).

METHODS

A sample of 2248 young adults (55% female) completed a survey in 2010 (T1) and 2012 (T2) which assessed problem gambling (measured via two items based on established measures), internalising symptoms, and social environmental protective factors.

RESULTS

A positive cross-sectional relationship between problem gambling and internalising symptoms was found; however, there was no statistically significant longitudinal relationship between the two conditions. Protective factors for internalising symptoms were observed within the domains of the community, family and peer group; however, there were no statistically significant protective factors identified for problem gambling.

CONCLUSIONS

These findings demonstrate that the social environmental protective factors for adult internalising symptoms assessed in the present study are poor longitudinal predictors of young adult problem gambling. Given the lack of common protective factors, it may be necessary to focus on separate factors to protect against each condition, if we are to address the comorbidity between problem gambling and internalising symptoms.

Unexpected online gambling disorder in late-life: a case report

Background: The lifetime prevalence of problem or Gambling disorder (GD) in the elderly (i.e., those over 60 years old) is reported to range from 0.01 to 10.9%. Research has identified several specific risk factors and vulnerabilities in the elderly. Since the late 1990s, an increase in online GD has been observed in the youth population, whereas casinos, slot machines, and bingo seem to be the activities of choice among the elderly. Interestingly, online GD has not been described in the elderly to date.

Case Description: We report an 83-year-old man who started online casino gambling from the age of 80 years, leading to debts that exceeded €30,000. He underwent a full clinical and neuropsychological assessment, without any evidence of cognitive impairment or any associated neurodegenerative disease. However, he had risk factors for GD, including adjustment disorder, stressful life events, previous offline casino GD when 50 years old, and dysfunctional personality traits. The change to online GD may have been due to his isolation, movement difficulties, and his high level of education, which facilitated his access to the Internet. Care management focused on individual cognitive-behavioral therapy.

Conclusion: The prevalence of online GD may be underestimated among the elderly, and may increase among isolated old people with movement difficulties and ready access to the Internet. However, late-life GD should be considered a diagnosis of elimination, requiring a full medical, psychiatric (including suicide risk), and cognitive assessment. Specific therapeutic approaches need to be proposed and developed.

From problem gambling to crime? Findings from the Finnish National Police Information System

In previous studies, problem gambling was found to have many adverse consequences, including crime. However, links between crime and problem gambling have been studied relatively little. To fill this gap, we collected problem gambling-related police reports from the Finnish National Police Information System. Fifty-five problem gambling-related crime incidents reported to the police 2011 in Finland were subjected to qualitative analysis. The role of problem gambling, as self-identified by the gamblers themselves, was examined as highlighted in different crime reports: what common features did the gamblers share, and what were the possible causal mechanisms between problem gambling and crime? The data consisted of text documents produced by the police, specifically crime reports and preliminary investigation documents. Collected documents were coded using Weft QDA and SPSS. Grounded theory approach was applied. The majority of the cases were non-violent property crimes, committed at home or at the workplace. We determined that problem gambling, through financial difficulties, does indeed lead to crime.

Suicidal ideation and suicide attempts in five groups with different severities of gambling: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions

BACKGROUND AND OBJECTIVES

Problem and pathological gamblers show high rates of suicidal behavior. However, previous research of suicide among this population has been inconsistent. Discrepancies may stem from methodological issues, including variable use of suicide nomenclature and selection bias in study samples. Furthermore, earlier research has rarely examined gambling severity aside from problem or pathological categories. This study utilized subgroups derived from a nationally representative data set, examining different characteristics of suicidal behavior and several gambling levels, including subclinical groups.

METHODS

Participants included 13,578 individuals who participated in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and provided information on gambling behavior, lifetime suicidal ideation, and/or lifetime suicide attempts. Five gambling groups were derived using DSM-IV criteria for pathological gambling; non-gambling, low-risk gambling, at-risk gambling, problem gambling, and pathological gambling.

RESULTS

Problem gambling was associated with suicidal ideation [adjusted odds ratio (AOR) = 1.64, 95% confidence interval (CI) = 1.19-2.26] and suicide attempts [(AOR) = 2.42, 95% (CI) = 1.60-3.67] after adjustment for sociodemographic variables. Pathological gambling was associated with suicidal ideation [(AOR) = 2.86, 95% (CI) = 1.98-4.11] and suicide attempts [(AOR) = 2.77, 95% (CI) = 1.72-4.47) after adjustment for sociodemographic variables.

DISCUSSION, CONCLUSIONS, AND SCIENTIFIC SIGNIFICANCE

Our results from this population sample reinforce increased rates of suicidal behavior amongst smaller, clinical samples of problem and pathological gamblers. Education for providers about gambling is recommended, including screening for gambling-related symptoms such as suicidal behavior.

Suicidal ideation and lifetime attempts in substance and gambling disorders

Suicidality is more commonly reported among individuals with addictions relative to the general population, though data from Asian countries remain scarce. The medical records of 2187 Singaporean patients with drug (n=879), alcohol (n=754) or gambling (n=554) disorders entering an outpatient treatment service were examined to explore differences in suicidal ideation and lifetime attempts between substance and gambling addictions. The relationship between suicidality, co-morbidity and addiction severity were also examined. 25.0% reported thoughts of suicide in the past month, 11.8% had a suicide plan and 12.2% reported lifetime attempts. Rates of suicidal ideation (thoughts, and plan) but not lifetime attempts were significantly higher among gambling than substance use patients. Co-morbid (DSM-IV axis-1) disorders were found among 32.5%, 38% and 40% of those reporting thoughts, plan and lifetime attempts respectively. Addiction severity was higher and quality of life lower among those reporting suicidal behaviors. Logistic regression revealed co-morbidity, debt, gender (being female) and being a gambling patient as significant predictors of suicidal behaviors. The findings highlight the importance of screening for suicidality, even in the absence of co-morbidity, particularly among gambling disorder patients with debts. Suicide risk should be assessed periodically and referral to suicidal prevention interventions routinely offered to this vulnerable population.

Decoding Problem Gamblers' Signals: A Decision Model for Casino Enterprises

The aim of the present study is to offer a validated decision model for casino enterprises. The model enables those users to perform early detection of problem gamblers and fulfill their ethical duty of social cost minimization. To this end, the interpretation of casino customers' nonverbal communication is understood as a signal-processing problem. Indicators of problem gambling recommended by Delfabbro et al. (Identifying problem gamblers in gambling venues: final report, 2007) are combined with Viterbi algorithm into an interdisciplinary model that helps decoding signals emitted by casino customers. Model output consists of a historical path of mental states and cumulated social costs associated with a particular client. Groups of problem and non-problem gamblers were simulated to investigate the model's diagnostic capability and its cost minimization ability. Each group consisted of 26 subjects and was subsequently enlarged to 100 subjects. In approximately 95% of the cases, mental states were correctly decoded for problem gamblers. Statistical analysis using planned contrasts revealed that the model is relatively robust to the suppression of signals performed by casino clientele facing gambling problems as well as to misjudgments made by staff regarding the clients' mental states. Only if the last mentioned source of error occurs in a very pronounced manner, i.e. judgment is extremely faulty, cumulated social costs might be distorted.

Correlates of depressive symptom severity in problem and pathological gamblers in couple relationships

Problem and pathological gamblers (PPG) often suffer from depressive symptoms. Gambling problems have negative consequences on multiple aspects of gamblers' lives, including family and marital relationships. The objectives of the current study were to (1) replicate the results of studies that have suggested a stronger and more significant relationship between gambling and depression in PPG than in non-problem gamblers (NPG) and (2) explore specific correlates of depressive symptom severity in PPG in couple relationships. Variables demonstrated to be significantly correlated with depressive symptoms in the general population were selected. It was hypothesized that gender, age, gambler's mean annual income, perceived poverty, employment status, clinical status (i.e., problem or pathological gambler versus non-problem gambler), trait anxiety, alcoholism, problem-solving skills, and dyadic adjustment would be significant predictors of depressive symptoms. Sixty-seven PPG were recruited, primarily from an addiction treatment center; 40 NPG were recruited, primarily through the media. Results revealed that PPG reported significantly greater depressive symptoms than did NPG. Further, elevated trait anxiety and poor dyadic adjustment were demonstrated to be significant and specific correlates of depressive symptom severity in PPG. These findings contribute to the literature on depressive symptomatology in PPG in relationships, and highlight the importance of the influence of the couple relationship on PPG.

Self-reported differences on measures of executive function in a patient sample of pathological gamblers

Patients seeking help for pathological gambling often exhibit features of impulsivity, cognitive rigidity, poor judgment, deficits in emotion regulation, and excessive preoccupation with gambling. Some of these characteristics are also common among patients presenting with neurological pathology associated with executive deficits. Evidence of executive deficits have been confirmed in pathological gamblers using objective neurocognitive tests, however, it remains to be seen if such findings will emerge in self-report measures of executive control. These observations led to the current investigation of differences between a group of pathological gamblers (n = 62) and a comparison group (n = 64) using the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A). Significant differences between the groups emerged over all nine subscales of executive functioning with the most dramatic differences on BRIEF-A subscales Inhibit, Plan/Organize, Shift, Emotion Control, Self-Monitor, and Initiate among the pathological gamblers. These results provide evidence that support findings among pathological gamblers using objective neuropsychological measures and suggest that the BRIEF-A may be an appropriate instrument to assess possible problems with executive control in this population.

Behavioral addictions: where to draw the lines?

Behavioral addictions can present in a variety of subtle and deceptive patterns. Because of the intense shame, guilt, and embarrassment felt by patients, it may fall to providers to utilize screening tools and deeper interviewing techniques to uncover the extent of these behaviors. Identifying when the line is crossed from recreation/habit to psychopathology relies on understanding current diagnostic criteria and consideration of cultural, ethnic, and local community standards. Individuals are also likely to cross back and forth between this line of pathology and habit, further clouding provider’s opinions of diagnosis; therefore, tracking and monitoring these symptoms over time is critical to establishing patterns of use and documenting ongoing consequences. Treatment for these conditions is emerging slowly, and treatment outcomes for these conditions appear to be similar to those with other addictive disorders.

Gambling and completed suicide in Hong Kong: a review of coroner court files

BACKGROUND

Previous studies have established a positive relationship between gambling and suicidal ideation and suicide attempts. Limited studies have investigated the role of gambling in completed suicide. This study aimed to determine the prevalence of gambling behavior among suicides and to compare the correlates of nongambling and gambling with and without related debt suicides.

METHOD

The death records from the coroner's court files of suicides (N = 1,201) in Hong Kong in 2003 were reviewed. Logistic regression models were used to investigate relevant correlates in suicides with gambling behavior and debt due to gambling compared to suicides with gambling behavior but no debt and nongamblers.

RESULTS

Of the suicide victims, 233 (19.4%) showed evidence of gambling behavior prior to death; 110 of the 233 gambling suicides (47.2%) involved individuals who were indebted due to gambling. In comparison with the other 2 groups, the gambling with debt suicide victims were more likely to be male, aged 30-49 years old, married, and employed and to have died by charcoal burning (carbon monoxide poisoning). These individuals also had fewer recorded medical and psychiatric problems in the past year and lifetime. When comparing suicides with gambling behavior with and without gambling-related debt, the indebted victims were more likely to also have had debt problems not attributed to gambling (OR = 149.66, P < .001) and to have been disturbed by loan sharks prior to death (OR = 28.14, P < .001) but were less likely to have recorded psychiatric disorders during their lifetime (OR = 0.41, P < .05) and at the time of death (OR = 0.26, P < .05).

CONCLUSIONS

Gambling and indebted suicides have a distinct profile and may be difficult to predict using standard risk factors as references. This finding suggests the need for improved detection and suicide prevention efforts related to gambling in individuals with gambling-related debt.

Beyond drugs and alcohol: Including gambling in a high-risk behavioural framework

Studies throughout North America have suggested that more adolescents are gambling today than in the past. Over the past decade, gambling has become a popular form of entertainment and part of mainstream society. With the increase in gambling availability has come a rise in not only the number of youth who participate in gambling, but also the number who exhibit serious gambling problems. There is growing concern that adolescents and young adults are the highest risk group for problem gambling. The National Research Council, in its critical review of pathological gambling, indicated that the prevalence of problem gambling among adolescents is consistently higher than among adults, despite differences in measurement. Yet, efforts to prevent and treat problems among this population have only recently emerged as an important adolescent health issue. The present article reviews the risk factors, mental health correlates and warning signs of adolescent gambling problems, with the aim of raising awareness among health professionals working with youth of the need to address this issue within their practices.

Predictors of gambling behaviors in Filipino Americans living in Honolulu or San Francisco

This study compared the prevalence and predictors of gambling behaviors between Filipino Americans who live in San Francisco (S.F.) or Honolulu. Data from the 1998-1999 Filipino American Community Epidemiological Survey were used to answer two research questions: (1) What are the prevalence and types of gambling behaviors among Filipino Americans and (2) What are the protective/risk factors of heavy gambling for Filipino Americans in S.F. and Honolulu? Overall, S.F. Filipino Americans had a higher level of participation in gambling, and the odds of gambling increased among older age groups, males, those who were US-born, and those with more health problems. Multinomial logistic regression analyses revealed that factors associated with infrequent and regular gambling participation were different between the S.F. group (older, male, higher education) and Honolulu group (male, US-born, more health concerns). Differential gambling environments, i.e., wide open gambling in S.F. and the restrictive gambling in Honolulu, may contribute to gambling participation and predictors of risk gambling Filipino Americans living in Honolulu and S.F. Policy makers and health professionals need to be aware of these differences to serve this population more effectively.

Predictive factors of excessive online poker playing

Despite the widespread rise of online poker playing, there is a paucity of research examining potential predictors for excessive poker playing. The aim of this study was to build on recent research examining motives for Texas Hold'em play in students by determining whether predictors of other kinds of excessive gambling apply to Texas Hold'em. Impulsivity, negative mood states, dissociation, and boredom proneness have been linked to general problem gambling and may play a role in online poker. Participants of this study were self-selected online poker players (N = 179) who completed an online survey. Results revealed that participants played an average of 20 hours of online poker a week and approximately 9% of the sample was classified as a problem gambler according to the Canadian Problem Gambling Index. Problem gambling, in this sample, was uniquely predicted by time played, dissociation, boredom proneness, impulsivity, and negative affective states, namely depression, anxiety, and stress.

Severity of gambling is associated with severity of depressive symptoms in pathological gamblers

The objective of this study was to investigate the relationship between gambling severity and depressive symptoms in pathological gamblers addicted to slot machines, with the hypothesis that comorbid depressive symptoms are associated with exacerbated gambling symptoms and behavior. Twenty controls and 20 pathological gamblers with different levels of depressive symptoms were studied during slot machine gambling. We found exacerbated gambling behavior in gamblers with high compared to low levels of depressive symptoms in terms of self-reported gambling urge (P < 0.01) and excitement from gambling (P < 0.05), number of games played (P < 0.01), and duration of gambling (P < 0.05). A correlation between depressive and gambling symptoms was found (r = 0.602, P < 0.01), thereby questioning which symptoms contribute to the exacerbated gambling behavior. Regression analyses showed that the symptoms influenced gambling behavior albeit in different ways. Although gambling symptoms predicted the rate of games played (P < 0.001), depressive symptoms predicted gambling urge (P < 0.01) and duration of gambling (P < 0.05). We discuss whether gambling symptoms only co-occur with other disorders; the need to look beyond the classification of pathological gambling as an impulse control disorder; and the potential role of anhedonia in depressed gamblers.

Adapted Couple Therapy (ACT) for pathological gamblers: a promising avenue

The study of the effectiveness of treatment for pathological gambling constitutes a field that is still largely unexplored. To date, the models assessed primarily target the individual and include little or no involvement of the family circle. Yet, the deleterious effects of gambling on loved ones and especially spouses are well recognized. Further, the addition of a couple modality to individual treatment has been shown to be effective on many levels in the treatment of substances use disorders. This article therefore proposes a critical review of (1) the literature providing a better understanding of the complex interactions between the couple relationship and pathological gambling, (2) studies on the effects of couple therapies on gamblers and their partners. We then present the therapeutic model developed by our team of clinician-researchers in collaboration with actors from Québec clinical settings: Adapted Couple Therapy (ACT) for pathological gamblers. In the Québec context, this model will serve as a complement to an individual cognitive-behavioral treatment model that has been proven effective and is employed throughout the Canadian province. The assessment of couple therapies could reveal avenues of solutions to better assist pathological gamblers who tend to drop-out of treatment and relapse.