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

A qualitative analysis of people who died by suicide and had gambling documented in their coronial file

BACKGROUND

Gambling related harms are vast and varied. There is evidence that gambling is associated with increased risk of suicidal ideation and attempts. Our aim was to identify and profile individuals who died by suicide and had gambling documented in their coronial file.

METHODOLOGY

The Irish Probable Suicide Death Study dataset contains all (n = 3,625) coroner and research-determined suicide deaths between 2015 and 2020. It was systematically searched to identify all deaths where gambling was recorded in coroner's files. Relevant data were extracted and included in a new database for further qualitative-driven analysis. Long-term distal (or chronic) and short-term proximal (or acute) risk factors were used as a framework for the analysis of the data.

RESULTS

Gambling was recorded in 23 coroners' files, representing 0.6% of all suicides during the six-year period. Males were overrepresented and less than half were in employment at the time of death. Distal risk factors included co-occurring mental health conditions (notably mood disorders), a history of drug and alcohol dependency, past suicide intent and/or behaviour, and exposure to suicide. Key proximal risk factors included acute mental health symptoms, financial issues, interpersonal problems, intoxication, and recent stressful life events.

CONCLUSIONS

We found that 23 people who died by suicide had gambling documented in their coronial file between 2015 and 2020. Numerous socioeconomic factors, interpersonal issues, and mental health conditions including addiction were also present at the time of death. The numbers in this study are likely an underrepresentation and support the need for improvements in data collection.

Problematic gambling in municipal social work in Tampere, Finland: Social workers' perceptions of service pathways before the casino opening and the health and social services reform

Aims: Gambling can lead to a variety of economic and social harms, many of which are of central concern to social work. However, the "invisibility" of gambling-related harms can impede professional assistance by delaying recognition in social and healthcare services. The present study illuminates how problematic aspects of gambling surface in social work encounters within municipal social services, and how municipal social workers of the City of Tampere, Finland, perceive the available service pathways for problem gambling help provision before the opening of a casino in the city in 2021 and before the health and social services reform of 2023. Methods: We conducted five focus group interviews with 15 social workers employed by the City of Tampere Social Services, utilizing the Reception Analytical Group Interview (RAGI) method. The data were analyzed thematically using ATLAS.ti. Results: Gambling-related harm is entangled with multiple other issues, often inadvertently revealed in daily social work encounters. Lack of time to adequately address clients' gambling issues and the absence of suitable services in the municipality were perceived as major structural obstacles to adequate help provision. The study participants recognized gambling-related shame, stigma and misconceptions as barriers to clients' help-seeking. However, they did not view the opening of the casino as likely to increase harms locally. Conclusions: The study highlights the importance of diverse approaches in providing appropriate services for individuals facing gambling-related harm. Furthermore, it underscores the necessity of addressing gambling issues in daily social work encounters and ensuring diverse, accessible service provision.

Association between gambling disorder and suicide mortality: a comparative cohort study using Norwegian health registry data

Background

Gambling disorder has been consistently linked to suicidal ideation and suicide attempts, but few studies have investigated the association between gambling disorder and suicide mortality. This study examined the risk of suicide mortality associated with gambling disorder compared to the general population and other patient groups.

Methods

A registry-based cohort study was conducted employing individual-level linked and aggregated data from Norwegian nationwide health registries. The study population comprised all patients with gambling disorder in Norway (n = 6899) for the period 2008 to 2021. Standardized mortality ratios were estimated to assess suicide risk among gambling disorder patients against the adult Norwegian general population. Cox regressions were used to estimate hazard ratios comparing suicide risk among patients with gambling disorder to 12 comparison groups comprising patients treated for other conditions (n = 391,897).

Findings

Suicide was the leading cause of death among patients with gambling disorder (37 of 148 deaths; 25%). Patients with gambling disorder had a higher suicide risk than the general population (standardized mortality ratio = 5.12, 95% CI [3.71; 7.06]), and 5 of 12 patient groups with other conditions. Suicide risk was not significantly different when compared to that of patients with anxiety disorders, personality disorders, or depression. However, suicide risk was lower among patients with gambling disorder than patients with substance use disorders, alcohol dependence, psychotic disorders, or mood disorders.

Interpretation

Norwegian patients with gambling disorder have an elevated risk of suicide mortality but the risk is similar to or lower than other patient groups known to be at increased suicide risk.

Funding

Norwegian Competence Center for Gambling and Gaming Research and the Faculty of Psychology at the University of Bergen (no specific grant).

Gambling and Substance Use Disorders in U.S. Military Veterans: Prevalence, Clinical Characteristics, and Suicide Risk

Gambling and substance use disorders (SUDs) are prevalent among U.S. military veterans and often co-occur. However, little is known about the clinical and behavioral correlates and suicidal risk of SUDs and gambling among veterans that can help inform targeted interventions for their co-occurrence. In the current study, we analyzed data from a nationally representative sample of 4069 veterans who participated in the National Health and Resilience in Veterans Study. Self-reported measures of lifetime SUDs and past-year gambling (Brief Problem Gambling Screen) were administered. A multinomial logistic regression analysis was conducted to examine differences between four groups: non-SUD/non-gambling, 40.3%; SUD-only 27.3%; Gambling-only 16.3%; and SUD + Gambling, 16.1%. The Gambling-only, SUD-only, and SUD + Gambling groups reported more adverse childhood experiences relative to the non-SUD/non-gambling group. The SUD-only and SUD + Gambling groups had higher odds for all lifetime and current clinical and trauma variables relative to the non-SUD/non-gambling group. The SUD + Gambling group had higher odds of suicidality, non-suicidal self-injury, nicotine dependence and mental health treatment relative to the SUD-only group and all assessed clinical measures relative to the Gambling-only group. Results suggest that SUDs and gambling are associated with substantial trauma and mental health burden among U.S. veterans, with co-occurring SUDs and gambling linked particularly to suicidality/self-harm and mental health treatment. The findings underscore the importance of multicomponent assessments and interventions targeting SUDs, gambling, and related concerns, such as trauma-related mental health difficulties, in this population.

Prediction of Suicidal Thoughts and Suicide Attempts in People Who Gamble Based on Biological-Psychological-Social Variables: A Machine Learning Study

Recent research has shown that people who gamble are more likely to have suicidal thoughts and attempts compared to the general population. Despite the advancements made, no study to date has predicted suicide risk factors in people who gamble using machine learning algorithms. Therefore, current study aimed to identify the most critical predictors of suicidal ideation and suicidal attempts among people who gamble using a machine learning approach. An online survey conducted a cross-sectional analysis of 741 people who gamble (mean age: 25.9 ± 5.56). To predict the risk of suicide attempts and ideation, we employed a comprehensive set of 40 biological, psychological, social, and socio-demographic variables. The predictive models were developed using Logistic Regression, Random Forest (RF), robust eXtreme Gradient Boosting (XGBoost), and ensemble machine learning algorithms. Data analysis was performed using R-Studio software. Random Forest emerged as the top-performing algorithm for predicting suicidal ideation, with an impressive AUC of 0.934, sensitivity of 0.7514, specificity of 0.9885, PPV of 0.9473, and NPV of 0.9347. Across all models, dissociation, depression, and anxiety symptoms consistently emerged as crucial predictors of suicidal ideation. However, for suicide attempt prediction, all models exhibited weaker performance. XGBoost showed the best performance in this regard, with an AUC of 0.663, sensitivity of 0.78, specificity of 0.8990, PPV of 0.34, NPV of 0.984, and accuracy of 0.8918. Depressive symptoms and rumination severity were highlighted as the most important predictors of suicide attempts according to this model. These findings have important implications for clinical practice and public health interventions. Machine learning could help detect individuals prone to suicidal ideation and suicide attempts among people who gamble, assisting in creating tailored prevention programs to address future suicide risks more effectively.

Community sports leaders' perceptions of the risks and benefits of gambling sponsorship in community sport

Gambling sponsorship of professional sport, particularly relating to online wagering, has been a key focus of global regulatory reform efforts to address the normalization of gambling. In Australia, gambling companies and venues (including community clubs and hotels) also sponsor and develop relationships with community (non-professional) sports teams and clubs. In-depth interviews (n = 24) were conducted with senior leaders in community sporting organizations in Australia with an aim of understanding the factors that shape decisions about accepting or refusing gambling sponsorships and partnerships. A reflexive approach to thematic analysis was used to construct three themes from the data. First, participants considered the alignment of values between the sponsor and the community sporting organization. While most stated that gambling and sport should not be aligned through sponsorship, some forms of sponsorship (for example from community clubs) were perceived as less harmful than others (such as online wagering). Second, some thought that while there were ethical ways to engage with gambling sponsors such as not promoting sponsors' products, they were concerned about how gambling sponsorship might have an overall impact on the community. Third, was the impact of gambling sponsorships on the organization's reputation, and balancing this with a need for financial stability. Decisions to accept (or reject) gambling sponsorship were influenced by a range of perceived risks and benefits. Addressing the acceptance of gambling sponsorships among community sporting organizations could involve several approaches to interventions, including regulation, formal policies to guide sponsorship decisions and education about the risks of accepting these sponsorships.

Institutional investment in addictive industries: an important commercial determinant of health

Background

The production of addictive commodities is subject to a range of commercial determinants. There has nevertheless been a gap in understanding how investments into addictive commodities may function as commercial determinants. Institutional investors can yield important financial power with their investment decisions. Many investors apply responsible investment (RI) policies to address environmental, social, and governance concerns. Negative screening is used to exclude certain sectors or companies from investment portfolios, mainly for ethical concerns. Negative screening also affects investment into tobacco and other addictive industries. This article investigates RI policies toward addictive industries among institutional investors that are signatories of the Tobacco-Free Finance Pledge (TFFP; N = 161). The TFFP is an initiative created in 2021 to de-normalize tobacco-related investments.

Methods

The mixed-method study uses descriptive statistics to quantify the extent and scope of exclusion policies as well as institutional and geographical profiles of investors, and a qualitative analysis of the justifications for these exclusion policies.

Results

Some TFFP signatories apply negative screening to other addictive industries (gambling: 35%; alcohol: 24%; cannabis 12% of signatories). There are important differences in the applied exclusion thresholds, with only 47% of TFFP signatories applying a zero-tolerance policy to tobacco. Thresholds are higher for other addictive industries. Signatories also differ in terms of their geographical and investor profiles. Justifications pertaining to compliance with international standards and reputational risks were the most common.

Conclusion

Addictive industries, such as tobacco, alcohol, gambling, and recreational cannabis, are increasingly excluded by investors. However, different understandings of RI influence how sector exclusions are implemented. Divesting from tobacco and other addictive industries is a crucial step toward a public health approach that prioritizes population health over financial profits. Prominent institutional investors are influential opinion leaders who can change the behavior of other investors and de-normalize controversial industries and reduce or prevent harm.

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.

Addressing key risk factors for suicide at a societal level

A public health approach to suicide prevention recognises the powerful influence of social determinants. In this paper-the fifth in a Series on a public health approach to suicide prevention-we consider four major risk factors for suicide (alcohol use, gambling, domestic violence and abuse, and suicide bereavement) and examine how their influence on suicide is socially determined. Cultural factors and societal responses have an important role in all four risk factors. In the case of alcohol use and gambling, commercial entities are culpable. This Series paper describes a range of universal, selective, and indicated interventions that might address these risk factors, and focuses particularly on key universal interventions that are likely to yield substantial population-level benefits.

Problematic Pornography Use, Mental Health, and Suicidality among Young Adults

The relationship between suicidality and problematic pornography use (PPU) is not clear, and the limited research data that exists show contradictory results. The present study aims to explore the associations between these two variables in a sample of young adults, taking into account gender differences and the role of loneliness, emotional states, and well-being. A total of 332 national and international students (60% female) at an Italian University with a mean age of 23 years (SD = 2.84) completed an anonymous online survey during the period from March 2023 to May 2023. The results show that PPU was associated with higher levels of anxiety, depression, stress, loneliness, and suicide ideation, as well as lower life satisfaction. Gender comparison analysis revealed significantly higher scores for PPU and loneliness among men, while women scored higher in stress, anxiety, and life satisfaction. Significant correlations between PPU and suicidal ideation and having a suicide plan were established for female participants despite their lower scores in PPU. Multiple regression analysis revealed that PPU and its interaction with gender were both significant predictors of suicidal ideation. Future attention should be paid to how young women may be influenced by exposure to sexually explicit materials, while always considering the role of loneliness.

Problem Gambling and Suicidal Behaviours in Young Adult men in Ghana: A Moderated Mediation Model of Psychological Distress and Social Support : Journal of Gambling Studies

Problem gambling has been recognised as an important public health issue because of its harmful consequences at the personal, interpersonal, and societal levels. There is a proliferation of gambling activities in Ghana owing to increased access to the internet, soaring smartphone penetration, and an influx of sports betting companies. Yet, very little research has addressed the harm associated with problem gambling in Ghana. This study assessed if the effect of problem gambling severity on suicidal behaviours (ideation, planning, and attempts) through psychological distress is contingent on the level of perceived social support. A total of 350 young adult men in the Greater Accra Region of Ghana provided the data for the current analysis. The data were analysed using a moderated mediation approach. The results showed that psychological distress is an important intervening mechanism through which problem gambling severity influences suicidality. In addition, the positive association between psychological distress and suicidal behaviours was found to be conditional on the levels of perceived social support. In other words, our results showed that problem gambling may first trigger episodes of psychological distress, which, in turn, can lead to suicidality among problem gamblers who report low to moderate levels of perceived social support. Our findings suggest that young adult problem gamblers require higher levels of social support from family, friends, and significant others to prevent those experiencing psychological distress from engaging in suicidal behaviours.

The expansion of gambling across the Americas poses risks to mental health and wellbeing

The Americas are facing a significant burden of mental health conditions. The Pan American Health Organisation's regional Strategy for Improving Mental Health and Suicide Prevention is an important milestone in tackling this challenge. However, absence of any focus on gambling as a potential risk to the health and wellbeing represents a serious omission in the Strategy. In this viewpoint, we review existing scholarship demonstrating unequivocal links between gambling and a variety of mental health conditions and related harms. This is followed by an empirically-grounded discussion of how commercial gambling has recently rapidly expanded across the region and how the risks of this expansion have not been sufficiently considered at the policy level. We then present emerging regional evidence of the negative mental health impacts of gambling expansion. The review concludes by proposing possible policy actions to improve control over the gambling industry and reduce ensuing harms on mental health and wellbeing in the region, with a focus on PAHO's remit.

Problem gambling in psychotic disorders: A systematic review and meta-analysis of prevalence

INTRODUCTION

Problem gambling (PBG) is more common in people with mental health disorders, including substance use, bipolar, and personality disorders, than in the general population. Although individuals with psychotic disorders might be expected to be more vulnerable to PBG, fewer studies have focused on this comorbidity. The aim of this review was to estimate the prevalence of PBG in people with psychotic disorders.

METHODS

Medline (Ovid), EMBASE, PsycINFO (Ovid), CINAHL, CENTRAL, Web of science, and ProQuest were searched on November 1, 2023, without language restrictions. Observational and experimental studies including individuals with psychotic disorders and reporting the prevalence of PBG were included. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal for systematic reviews of prevalence data. The pooled prevalence of PBG was calculated using a fixed effects generalized linear mixed model and presented through forest plots.

RESULTS

Of 1271 records screened, 12 studies (n = 3443) were included. The overall prevalence of PBG was 8.7% (95% CI = 7.8%-9.7%, I2 = 69%). A lower prevalence was found in studies with a low risk of bias (5.6%; 95% CI = 4.4%-7.0%) compared with studies with a moderate risk of bias (10.4%; 95% CI = 9.2%-11.7%). Different methods used to assess PBG also contributed to the heterogeneity found.

CONCLUSION

This meta-analysis found substantial heterogeneity, partly due to the risk of bias of the included studies and a lack of uniformity in PBG assessment. Although more research is needed to identify those at increased risk for PBG, its relatively high prevalence warrants routine screening for gambling in clinical practice.

Gambling among indebted individuals: an analysis of bank transaction data

BACKGROUND

Gambling is connected to important financial harms, including debt. Most existing research has investigated the relationship between gambling and debt using self-reported data. Only a few studies have used objective data. The current study focuses on the gambling of indebted individuals. It investigates the amounts and types of gambling consumed by indebted individuals, and the amounts of unsecured debt among heavy gamblers.

METHODS

We use past-year banking data of Finnish individuals (N = 23 231) collected between 2018 and 2021 among applicants to a debt consolidation service. The transactions consist of deposits to, and winnings paid by gambling operators, distinguished by type of gambling (sports betting, casino, lottery) as well as active loans divided into secured and unsecured loans.

RESULTS

Gambling is widespread among indebted individuals in Finland. In terms of gambling types, casino-type gambling is the most popular among indebted individuals. Gambling spending is highly concentrated. Nearly half (49.5%) of all gambling deposits are concentrated among the highest spending 5% of indebted individuals. Individuals with unsecured loans have higher median losses than those without unsecured loans.

CONCLUSIONS

The results suggest that gambling and indebtedness are strongly linked. The connection is stronger for individuals with unsecured debt. This has implications for prevention and treatment. Easy access to unsecured credit is likely to worsen gambling harms. Debt counselling services routinely encounter gambling-related harms and need to be equipped to manage these issues.

Involving lived experience in regional efforts to address gambling-related harms: going beyond 'window dressing' and 'tick box exercises'

BACKGROUND

Lived Experience (LE) involvement has been shown to improve interventions across diverse sectors. Yet LE contributions to public health approaches to address gambling-related harms remain underexplored, despite notable detrimental health and social outcomes linked to gambling. This paper analyses the potential of LE involvement in public health strategy to address gambling-related harms. It focuses on the example of a UK city-region gambling harms reduction intervention that presented multiple opportunities for LE input.

METHODS

Three focus groups and 33 semi-structured interviews were conducted to hear from people with and without LE who were involved in the gambling harms reduction intervention, or who had previous experience of LE-informed efforts for addressing gambling-related harms. People without LE provided reflections on the value and contributions of others' LE to their work. Data analysis combined the Framework Method with themes developed inductively (from people's accounts) and deductively (from the literature, including grey literature).

RESULTS

Four themes were identified: (1) personal journeys to LE involvement; (2) the value added by LE to interventions for addressing gambling-related harms; (3) emotional impacts on people with LE; and (4) collective LE and diverse lived experiences. Two figures outlining LE involvement specific to gambling harms reduction in the UK, where public health efforts aimed at addressing gambling-related harms coexist with industry-funded programmes, are proposed.

CONCLUSIONS

Integrating a range of LE perspectives in a public health approach to gambling harms reduction requires local access to involvement for people with LE via diverse routes that are free from stigma and present people with LE with options in how they can engage and be heard in decision-making, and how they operate in relation to industry influence. Involving LE in gambling harms reduction requires enabling people to develop the affective and critical skills necessary to navigate complex emotional journeys and a challenging commercial and policy environment.

Disordered gambling among people with psychotic disorders: a systematic review

Disorders of gambling are more common among the mentally ill, including in people with psychotic disorders. The aim of this study was to conduct a systematic review of the literature regarding the prevalence and correlates of gambling disorders in people with psychotic disorders. We systematically reviewed English-language literature through searches of six bibliographic databases, all run on 11 November 2022: Medline ALL, Embase, Emcare, APA PsycINFO, CINAHL and the Cochrane Library. Observational studies that reported the prevalence of gambling in psychotic disorders or psychosis among gamblers were included. Studies were critically appraised using the Joanna Briggs Institute Critical Appraisal Tools. Sixteen studies, including 1,116,103 participants, from across a range of settings, were included. Most studies were done on males and recruited participants with a mean age of 40 years. Most of the studies (n = 12) were cross-sectional, and the remaining were case control in design. Most of the studies rated fair in quality. The prevalence of gambling among psychotic population ranged from 0.32 to 19.3%, with the majority of the studies reporting rates between 6.4 and 17%. The rates were 5-25 times higher than in the general population. While there were no consistent associations found with socio-demographic indices, several studies reported an association between gambling behaviours and substance use disorder among those with psychotic illnesses. Our research suggests that clinicians should assess for comorbid gambling among those with psychotic illness, particularly in those with mood symptoms, impulsivity, and substance use disorders. Gambling can negatively impact on their financial and social situations. Future research should study specific strategies or therapies among those with comorbid gambling and psychotic disorders.

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.

Personal experiences of suicidality in women with gambling disorder - A qualitative interview study

Background

Gambling disorder is associated with increased suicidality, especially in women who also are more likely to have psychiatric comorbid disorders and more often have experiences of traumatic life events. Although suicidality is increased and several risk factors have been identified, knowledge of the suicidal process is lacking, especially for women.

Aim

To explore the lived experiences of suicidality in women with gambling disorder and to investigate potential factors involved in the development of suicidality.

Method

Semi-structured interviews were held with seven women with experiences of gambling disorder and suicidality in Malmö, Sweden between November 2021 and June 2022, when saturation was reached. Interviews were audio-recorded, transcribed, and coded in NVivo. Qualitative content analysis was used to build categories and themes.

Results

Several women had experienced suicidality before developing gambling disorder and gambling-related suicidality. However, for some, suicidality had appeared seemingly only due to the gambling disorder. Suicidality ranged from ideation to severe suicide attempts. Three themes of factors modulating suicidality related to gambling were found; a) guilt shame and self-stigmatization, b) loss of control/chaotic life circumstances, and c) social consequences/fear of guilt and shame from others.

Conclusion

More research on the experience of suicidality in women with gambling disorder is needed. Attempts to address self-stigmatization, guilt, and shame in women with gambling disorder and society at large as well as aiding women to regain a sense of control over their economy and gambling may be ways to reduce suicidality.

Chronically homeless veterans with gambling disorder: Epidemiology, clinical correlates, and traumatic experiences

BACKGROUND

Gambling disorder (GD) is often a concern for people living in poverty. Although GD has been correlated with homelessness, there has been no study of factors related to chronic homelessness among veterans with GD.

METHOD

This study used data from specialized homeless programs from the U.S. Department of Veterans Affairs Homeless Operations Management System to explore prevalence and correlates of chronic homelessness among veterans with GD in this program and to describe initial descriptive epidemiology. Chi-square tests, analyses of variance, and logistic regressions were conducted to examine differences in sociodemographic, military, clinical, and behavioral characteristics between veterans with versus without chronic homelessness.

RESULT

Of 6053 veterans with GD, 1733 (28.6%) had chronic homelessness. Veterans with versus without chronic homelessness were more likely to be older, male, unemployed, and of low educational attainment and report having spent fewer years in the military. Chronic homelessness was associated with elevated odds of mental health and medical diagnoses, traumatic experiences, incarceration, and suicidal thoughts. Veterans with versus without chronic homelessness more frequently reported needing substance use, medical and psychiatric treatments but expressed low interest in participation in psychiatric treatment.

CONCLUSION

Veterans with GD and chronic homelessness have more clinical and behavioral concerns and needs for treatment, but participate in treatment at lower rates. It may be important to address both chronic homelessness and GD concurrently in order to effectively support veterans facing these challenges.

Conceptualising the commercial determinants of suicide: broadening the lens on suicide and self-harm prevention

Suicide is preventable, yet, in many settings, robust suicide prevention strategies have not been implemented. Although a commercial determinants of health lens is increasingly being applied to industries important to the field of suicide prevention, the interplay between the vested interests of commercial actors and suicide has received little attention. There is a need to shift attention to the causes of the causes, directing more focus to the ways that commercial determinants influence suicide and shape suicide prevention strategies. Such a shift in perspective, with an evidence base and precedents to draw upon, has transformative potential for research and policy agendas dedicated to understanding and addressing upstream modifiable determinants of suicide and self-harm. We propose a framework intended to help guide efforts to conceptualise, research, and address the commercial determinants of suicide and their inequitable distribution. We hope these ideas and lines of inquiry help to catalyse connections between disciplines and open further debate and discussion as to how to take such an agenda forward.

Changes in severity of problem gambling and subsequent suicide attempts: a longitudinal survey of young adults in Great Britain, 2018-20

BACKGROUND

Cross-sectional studies identify problem gambling as a risk factor for suicidality. Using an online longitudinal survey, we aimed to examine the association between changes in severity of gambling behaviour and attempted suicide.

METHODS

The Emerging Adults Gambling Survey is a longitudinal survey of people in England, Scotland, and Wales, aged 16-24 years interviewed online between June 25 and Aug 16, 2019 (wave 1) and 1 year later between July 13 and Oct 8, 2020 (wave 2). The Problem Gambling Severity Index (PGSI) was administered at both waves. Multivariable logistic regression models examined wave 1 PGSI score and between-wave change in PGSI score as risk factors for suicide attempts at wave 2, unadjusted and with adjustment for wellbeing, anxiousness, impulsivity, perceived loneliness, and suicide attempts at wave 1.

FINDINGS

3549 participants were interviewed in wave 1 and 2094 were interviewed in wave 2, of whom 1941 were included in this analysis (749 [39%] men; 1192 women [61%]). Prevalence of attempted suicide did not change between waves (wave 1: 3·7% [95% CI 2·9-4·8], n=75; wave 2: 3·3% [2·5-4·3], n=65). 78·9% (95% CI 76·7-80·9, n=1575) of participants had stable PGSI scores between the two waves, 13·7% (11·9-15·6, n=233) of participants had a decrease in PGSI score by 1 or more, and 7·5% (6·2-8·9, n=133) had an increase in PGSI score by 1 or more. An increase in PGSI scores over time was associated with suicide attempt at wave 2, even with adjustment for baseline PGSI score and other factors (adjusted odds ratio 2·74 [95% CI 1·20-6·27]). Wave 1 PGSI score alone was not associated with suicide attempt at wave 2 in fully adjusted models.

INTERPRETATION

Repeated routine screening for changes in gambling harm could be embedded in health, social care, and public service settings to allow effective identification and suicide prevention activities among young adults.

FUNDING

Wellcome Trust.