Suicidal ideation and familicidal-suicidal ideation among individuals presenting to problem gambling services: a retrospective data analysis

Gambling as a precipitating factor in deaths by suicide in the National Violent Death Reporting System

OBJECTIVES

The public health burden of gambling remains difficult to estimate, given the lack of relevant, available data. Death by suicide, represents a substantial and quantifiable public health cost. The current study reviews data from the National Violent Death Reporting System to detect cases where gambling was identified as a meaningful contextual factor to a death by suicide.

STUDY DESIGN

This study is an exploratory content analysis.

METHODS

We analysed narrative data from cases of death by suicide, collected from 2003 to 2020 recorded in the Restricted Access Data of the National Violent Death Reporting System. Gambling-related cases identified in our analysis were compared against all other cases on demographic characteristics, case characteristics, US state, and incident year. Chi-square tests of independence and the Wilcoxon ranked sum tests were used in bivariate comparisons.

RESULTS

Overall, 1306 of 296 317 cases were classified as gambling-related. This represented 0.44% of total cases. Gambling-related classification was over-represented among those identified as Asian (7.0% vs 2.2%) and under-represented among those identified as Black or African American (4.0% vs 6.4%) compared with all other deaths by suicide. Gambling-related cases were also over-represented in cases where alcohol use was suspected (28.0% vs 21.2%), where there were significant financial problems (50.3% vs 8.6%), where there were intimate partner problems (31.5% vs 25.6%), and under-represented in cases where there was a previous mental health diagnosis (35.1% vs 38.8%). The rate of gambling-related cases in Nevada was approximately nine times greater than the rate in the overall sample (4.0% vs 0.44%).

CONCLUSIONS

Administrative data can be used to study the impacts of gambling on public health in the absence of quality representative survey data. However, these sources are still likely to underestimate the public health burden of gambling with current structures and procedures. Requiring intentional collection of gambling-related information in cases of suicide would be a significant step towards better quantifying the public health burden of gambling in the United States.

Sleep Problems and Gambling Disorder: Cross-Sectional Relationships in a Young Cohort

AIMS

To investigate the potential association between gambling disorder and symptoms of sleep problems (including insomnia and excessive daytime sleepiness). It was hypothesised that, compared to controls, individuals with gambling disorder would have significantly greater disturbance of sleep, as indicated by increased scores in: (1) sleep items on the Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Rating Scale for Depression (HAM-D); (2) total score on the HAM-A and HAM-D; and (3) the Epworth Sleepiness Scale (ESS).

METHODS

Secondary analysis of previously published data from 152 young adults, aged 18-29 years. Individuals were stratified into three groups: controls, those at risk of gambling disorder, and those with gambling disorder. One-way ANOVAs with post-hoc tests were conducted to determine whether groups differed significantly in sleep item scores and total scores of the HAM-A and HAM-D, and the ESS.

RESULTS

HAM-D scale insomnia item scores were significantly higher in the disorder group, when compared to controls, this being particularly marked for middle and late insomnia. The HAM-A item score indicated significantly worse sleep quality in the disorder group, compared to at risk and control groups. Total HAM-A and HAM-D scores were significantly higher in the disorder group, but ESS scores did not differ significantly.

CONCLUSION

Measures of disruptions in sleep were significantly higher in gambling disorder than controls. Anxiety and depressive symptom severity was also significantly higher in the gambling disorder group. Further research could have implications for identification and treatment of sleep disorders and psychiatric comorbidities in gambling disorder.

Suicidal Behaviors and Associated Factors Among Individuals with Gambling Disorders: A Meta-Analysis

The risk for suicidal behaviors including suicide ideations and attempts among individuals with gambling disorder (IWGDs) is high compared to the general population. Little is known about the interplay of mood disorders, alcohol use disorders, and suicidal behaviors among IWGDs. The study aimed to determine the prevalence, sociodemographic characteristics, risky behaviors, mental health disorders, and alcohol use disorders associated with suicide behaviors among IWGDs. Studies published between January 1 1995 and September 1 2022 were obtained from following databases: PubMed, Scopus, Web of Science and Cochrane Library databases. PECOS (population, exposures, comparison, outcome, and study design) criteria were used for selecting studies. The Newcastle-Ottawa Scale (NOS) was used for assessing risk of bias and rated each study in terms of exposure, outcome, and comparability. After initial assessment of 10,243 papers, a total of 39 studies met the eligibility criteria. Among IWGDs, the findings indicated a life-time pooled prevalence rate of 31% for suicide ideations (95% CI, 23-39%), 17% for suicide plans (95% CI, 0-34%), and 16% for suicide attempts (95% CI, 12-20%). Generally, suicide ideations among IWGDs were associated with having any financial debt and having chronic physical illnesses, as well as experiencing depression, mood disorders, and alcohol use disorders. Suicide attempts among IWGDs were associated with being older and having a childhood history of sexual abuse, as well as experiencing depression, mood disorders and alcohol use disorders. Interventions can help to facilitate seeking support among IWGDs by de-stigmatizing mental health disorders as well as improving the quality of care presented to individuals with psychiatric conditions.

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.

Public health effects of gambling - debate on a conceptual model

BACKGROUND

Gambling for money is a popular leisure time activity in most countries, which has major social and economic impacts not only affecting the gambler, but his/her significant others, and the society. Gambling impact studies can help researchers and policymakers compare the health and social costs and benefits of different gambling policies and can be used when considering which gambling policies will reduce or increase costs or benefits the most. In a public health approach, the impacts of gambling, negative and positive, are assessed across the entire severity spectrum of the activity. Although some studies have created basic principles for conducting impact studies, a theoretical model is currently lacking. The aim of this debate is to review complementing and contrasting views on the effects of gambling to create a conceptual model, where a public health perspective is applied.

MAIN TEXT

The effects of gambling can be structuralized using a conceptual model, where impacts are divided into negative and positive; costs and benefits. Costs and benefits are categorized into three classes: financial, labor and health, and well-being. These classes manifest in personal, interpersonal, and societal levels. Individual impacts cause effects on a personal level to gamblers themselves. External impacts influence the interpersonal and society/community levels and concern other people. The temporal level refers to the development, severity and scope of the gambling impact. These include general impacts, impacts of problem gambling and long-term impacts of gambling.

CONCLUSIONS

The conceptual model offers a base on which to start building common methodology for assessing the impact of gambling on the society. While measuring monetary impacts is not always straightforward, the main issue is how to measure the social impacts, which are typically ignored in calculations, as are personal and interpersonal impacts. The reviewed empirical work largely concentrated on the costs of gambling, especially costs on the community level. The Model can be used to identify areas where research is scarce. Filling the gaps in knowledge is essential in forming a balanced evidence base on the impacts of gambling. Ideally, this evidence could be the starting point in formulating public policies on gambling.

Exploring online problem gamblers' motivation to change

Background

In order to improve interventions for problem gambling, there is a need for studies that can highlight psychological factors that support the desire to reduce gambling.

Objective

To explore online problem gamblers' motivation for change by studying participants' reactions to an online treatment referral website designed to motivate at-risk gamblers to seek help.

Design

A qualitative evaluation study, combining focus groups and in-depth interviews. Data were analyzed using the general inductive approach.

Informants

The informants included 19 male, treatment- and non-treatment seeking, online gamblers who played a variety of games, including poker, sports betting and online casino.

Results

Motivation to change emerged as two processes including (a) empathy with others, which included projection of their thoughts and feelings onto others, and (b) dissonance between gambling behavior and ideal self-image. Dissonance included two subthemes: (i) dissonance due to positive feelings towards sports and athletics, and (ii) dissonance due to gambling among family.

Conclusions

The findings have implications for interventions designed to evoke motivation early in treatment of online problem gambling. Inducing problem gamblers to reflect on the thoughts and feelings of concerned significant others, real or fictional, could be a viable strategy to motivate online problem gamblers to consider change.

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We identified three sources of motivation for changing gambling behavior:

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Empathy with concerned significant others, real or fictional

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Cognitive dissonance due to positive feelings towards sports and athletics

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Cognitive dissonance due to gambling among family members

Suicidal ideation and history of suicide attempts in treatment-seeking patients with gambling disorder: The role of emotion dysregulation and high trait impulsivity

BACKGROUND AND AIMS

Gambling disorder (GD) presents high rates of suicidality. The combined influences of emotion dysregulation and trait impulsivity are crucially important (albeit understudied) for developing strategies to treat GD and prevent suicide attempts. The aim of this study is to investigate the association between trait impulsivity, emotion dysregulation, and the dispositional use of emotion regulation (ER) strategies with suicidal ideation and psychopathological symptom severity in GD.

METHODS

The sample composed of 249 patients with GD (166 with suicidal ideation) who underwent face-to-face clinical interviews and completed questionnaires to assess psychopathological symptoms, impulsive traits, and ER.

RESULTS

Patients with GD who presented suicidal ideation were older and had a later age of GD onset and higher GD severity. Analyses of variance showed higher comorbid symptoms, emotion dysregulation, and trait impulsivity in patients with suicidal ideation. Still, no significant differences were found in the use of ER strategies. SEM analysis revealed that a worse psychopathological state directly predicted suicidal ideation and that both emotion dysregulation and GD severity indirectly increased the risk of suicidal ideation through this state. High trait impulsivity predicted GD severity. Finally, a history of suicide attempts was directly predicted by suicidal ideation.

CONCLUSIONS

Patients with GD are at risk of presenting suicidal behaviors. The results of this study revealed the importance of comorbid psychopathology in the occurrence of suicidal ideation and the indirect effect of trait impulsivity and emotion dysregulation on suicidality. Thus, suicidal rates in GD could possibly be reduced by specifically targeting these domains during treatment.

Gambling and Subsequent Road Traffic Injuries: A Longitudinal Cohort Analysis

BACKGROUND

To compare the risks of a road traffic injury (RTI) crash among adults who were involved in high-risk gambling and those who did not gamble.

METHODS

We conducted a linked longitudinal cohort analysis of adult persons in large population survey conducted during 2007 and 2008 in Ontario, Canada. We used responses to Problem Gambling Severity Index to distinguish persons as nongamblers, no-risk, low-risk, or high-risk gamblers. All persons were subsequently monitored for a subsequent RTI crash as a driver, pedestrian, or bicyclist up to March 31, 2014, through health insurance databases. We estimated relative risks as rate ratios (RRs) with 95% confidence intervals (95% CIs).

RESULTS

In all, 30,652 adults were included, of whom 52% self-identified as gamblers, including 49% as no-risk gamblers, 2% as low-risk gamblers, and 1% as high-risk gamblers. During a median follow-up period of 6.8 years, 708 participants (2%) were involved in 821 RTI crashes. The absolute risks of an RTI were 6.4 per 1000 person-years (95% CI 3.7-10.4) in high-risk gamblers and 3.6 per 1000 person-years (95% CI 3.2-4.0) in nongamblers. The relative risks for RTI crashes were significantly higher in high-risk gamblers than in nongamblers (adjusted RR 1.68, 95% CI 1.03-2.76). The risks for RTI crashes as a driver were augmented in high-risk gamblers than in nongamblers (RR 1.97, 95% CI 1.13-3.43).

CONCLUSIONS

We found an increased risk of an RTI crash among drivers who self-identified as high-risk gamblers. Further research exploring the underlying mechanisms of these associations might interest health professionals to monitor RTI risks in adults involved in high-risk gambling.

An exploratory study of illegal gamblers in Hong Kong

This study investigates the nature and behaviour of illegal gamblers in Hong Kong. A face-to-face street survey of 512 gamblers was conducted in Hong Kong between September and December 2015 with supplementary convenience sampling allowing for analysis of a total sample of 103 illegal gamblers. 56% of illegal gamblers recorded results consistent with this study’s definition of ‘excessive gambling’ [i.e. moderate risk and problem gamblers under the Problem Gambling Severity Index (PGSI)]. 81% of surveyed illegal gamblers were male, 77% were aged between 30 and 49 and 67% were in blue collar occupations. Illegal gamblers bet more frequently on both legal and illegal games than their legal counterparts and spent more when they did bet. While this research did not indicate the direction of causality between illegal and excessive gambling, international work (de Bruin et al. in verslingerd aan meer dan een spel: Een onderzoek naar de aard en omvang van kansspelproblematiek in Nederland, WODC/CVO, Utrecht, http://www.lexandgaming.eu/nl/wp-content/uploads/2015/01/Verslingerd-aan-meer-dan-een-spel.pdf, 2005; Binde in What are the most harmful forms of gambling? Analysing problem gambling prevalence surveys, http://www.utbildning.gu.se/digitalAssets/1327/1327132_cefos-wp12.pdf, 2011) suggests that excessive gamblers are drawn to illegal gambling. Reform could allow excessive gambling by illegal gamblers to be better addressed and initial work suggests some financial benefits to Hong Kong.

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.