Gambling disorder and suicidality within the UK: an analysis investigating mental health and gambling severity as risk factors to suicidality

Efficacy of Social Norm Interventions on Addictive Behaviours-A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Mental health-related behaviours including addictive behaviours contribute significantly to the global burden of disease. Social norm interventions appear to be a cost-effective means of reducing addictive behaviour. We conducted a systematic review and meta-analysis of the efficacy of social norm interventions for addictive behaviours. We searched the databases Medline and PsycInfo from inception to April 2024 as well as reference lists of eligible studies and related systematic reviews for randomised controlled trials (RCTs) comparing the efficacy of social norm interventions for addictive behaviours to control conditions. Out of the 11,515 potentially eligible RCTs, 52 trials with a total of 31,764 adult participants met inclusion criteria, with 45 trials targeting alcohol consumption, three trials targeting Marijuana use, two trials targeting other substance abuse and two trials targeting gambling. Overall, 37 trials were included in the random-effects meta-analysis. The comparison of social norm interventions to control conditions at posttreatment showed a small but statistically significant effect (g = -0.12; 95% CI = -0.22 to -0.02; p < 0.01). Risk of bias was rated low in 37 RCTs, 14 RCTs were rated as having some risk of bias concerns and one RCT was rated as having high risk of bias. Social norm interventions can be an effective intervention method for reducing substance abuse and gambling. Yet, data is largely derived from studies targeting alcohol consumption and current trials suffer from methodological and practical limitations. The small effect sizes need to be appraised in the context of cost-effectiveness of these interventions.

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.

Predictors of suicide attempts in male UK gamblers seeking residential treatment

BACKGROUND

Disordered gambling can have serious negative consequences for the individual and those around them. Previous research has indicated that disordered gamblers are at an increased risk of suicidal thoughts, ideation and attempts. The current study sought to utilise data from a clinical sample to identify factors that are associated with prior suicide attempts.

METHODS

The sample included 621 patients entering a gambling-specific residential facility in the UK. A series of Chi-Square analyses and binary logistic regressions were run to identify clinical and sociodemographic variables associated with suicide attempts.

RESULTS

Of the 20 variables analysed using Chi-square statistics, five were significantly associated with the outcome variable (lifetime attempted suicide): loss of family relationships, loss of home, prior depression, prior suicidal thoughts, and medication use. Regression analysis showed that individuals were more likely to have reported suicide attempts if they had experienced loss of family relationships (1.65 times), loss of a home (1.87 times), prior depression (3.2 times), prior suicidal thoughts (6.14 times), or were taking medication (1.95 times) compared to those not reporting such individual events.

CONCLUSIONS

Disordered gamblers are vulnerable to suicide; a number of factors have been identified in the current study that predict an increased likelihood of attempted suicide. The factors mainly revolve around loss: not financial loss, but rather disintegration of an individual's support network and deterioration in the individual's mental health. Findings indicate that isolation and negative affect associated with gambling are most influential in attempted suicide and should therefore be more strongly considered when creating and providing the legislative, educational and treatment environments for those experiencing gambling related harm.

Traumatic brain injuries and problem gambling in youth: Evidence from a population-based study of secondary students in Ontario, Canada

Traumatic brain injury (TBI) is characterized by a change in brain function after an external force or sudden movement to the head. TBI is associated with risk-taking, impulsivity, psychological distress, substance abuse, and violent crime. Previous studies have also linked problem gambling to TBI, but these studies have not controlled for possible confounding variables such as mental health problems and hazardous drinking which are also linked to TBI. This study examines the relationship between problem gambling and TBI among adolescents. Data were obtained from the 2011, 2013 and 2015 cycles of the OSDUHS, a biennial cross-sectional school-based study of children in grades 7 to 12 (N = 9,198). Logistic regression was used to estimate adjusted odds ratios (AOR) in controlled and uncontrolled analyses. Adjusting for sex and grade only, problem gambling was associated with a history of TBI (AOR = 2.8). This association remained significant after adjusting for hazardous drinking and suicidality (AOR = 2.0). In addition, problem gambling had a statistically significant relationship with being male (AOR = 4.7), hazardous drinking (AOR = 4.5), and suicidality (AOR = 3.1). This study provides further data to suggest a link between TBI and problem gambling. However, research is needed on the causal relationship between these variables and the potential implications for treatment and prevention.

Psychosocial correlates in treatment seeking gamblers: Differences in early age onset gamblers vs later age onset gamblers

BACKGROUND

Age of onset is an important factor in the development and trajectory of psychiatric disorders; however, little is known regarding the age of onset in relation to disordered gambling in treatment seeking samples in the UK. Utilising a large residential treatment seeking gambler cohort, the current study examined the relationship between age of gambling onset and a range of variables thought to be associated with disordered gambling.

METHOD

Data were collected from 768 gamblers attending residential treatment for disordered gambling. Individuals were grouped per the age they started gambling as either a child (≤12), adolescent (13-15), or young adult/adult (≤16). Data were analysed using linear, backward stepwise, and multinomial logistic regressions to identify significant relationships between age of onset and variables of theoretical significance.

RESULTS

Results indicate the younger age of gambling onset was associated with increased gambling severity. Those who began gambling at an earlier age were more likely to have abused drugs or solvents, committed an unreported crime, been verbally aggressive and experienced violent outbursts. They are less likely to report a positive childhood family environment and are more likely to have had a parent with gambling and/or alcohol problems.

DISCUSSION

Gamblers who began gambling at an earlier age experience negative life events and exhibit some antisocial behaviors more than later onset gamblers, indicating that when addressing gambling behavior, it is important to consider the developmental trajectory of the disorder, rather than merely addressing current gambling behavior. However, the direction of the relationship between gambling and significant variables is in some instance unclear, indicating a need for further research to define causality.