Gambling disorder is associated with suicidal behaviors, but it is not clear whether the association is due to common etiologic factors or to gambling disorder being causally related to suicidality. This question was examined from the perspective of epidemiologic, longitudinal, and discordant-twin studies. The results suggested that the causes of the association with disordered gambling differed for suicidal ideation, plan, and attempt and differed for men and women. The association of suicidal thoughts with disordered gambling was noncausally explained by common genetic influences among women but not men. Conversely, there was evidence consistent with a potentially causal influence of disordered gambling on suicide attempt among men but not women, which might have been related to gambling-related financial problems. The use of monetary data to identify individuals experiencing financial harms associated with their gambling may represent a more practicable target for screening, intervention, and prevention and may reduce gambling-related financial crises, thereby warding off a potential gambling-related suicide attempt.
AbbottM. W. (2020). The changing epidemiology of gambling disorder and gambling-related harm: Public health implications. Public Health, 184, 41–45. https://doi.org/10.1016/j.puhe.2020.04.003
2.
American Psychiatric Association. (2000). Diagnostic and statistical manual (4th ed., text rev.).
BlackD. W.CoryellW.CroweR.McCormickB.ShawM.AllenJ. (2015). Suicide ideations, suicide attempts, and completed suicide in persons with pathological gambling and their first-degree relatives. Suicide and Life-Threatening Behavior, 45(6), 700–709. https://doi.org/10.1111/sltb.12162
5.
BlaszczynskiA.FarrellE. (1998). A case series of 44 completed gambling-related suicides. Journal of Gambling Studies, 14(2), 93–109. https://doi.org/10.1023/A:1023016224147
6.
BucholzK. K.CadoretR.CloningerC. R.DinwiddieS. H.HesselbrockV. M.NurnbergerJ. I.Jr.ReichT.SchmidtI.SchuckitM. A. (1994). A new, semi-structured psychiatric interview for use in genetic linkage studies: A report on the reliability of the SSAGA. Journal of Studies on Alcohol, 55(2), 149–158. https://doi.org/10.15288/jsa.1994.55.149
7.
CarrM. M.EllisJ. D.LedgerwoodD. M. (2018). Suicidality among gambling helpline callers: A consideration of the role of financial stress and conflict. The American Journal on Addictions, 27(6), 531–537. https://doi.org/10.1111/ajad.12787
8.
ChenE. Y.ChanW. S.WongP. W.ChanS. S.ChanC. L.LawY. W.BehP. S.ChanK. K.ChengJ. W.LiuK. Y.YipP. S. (2006). Suicide in Hong Kong: A case-control psychological autopsy study. Psychological Medicine, 36(6), 815–825. https://doi.org/10.1017/S0033291706007240
9.
ErlangsenA.AppaduraiV.WangY.TureckiG.MorsO.WergeT.MortensenP. B.StarnawskaA.BørglumA. D.SchorkA.NudelR.Bækvad-HansenM.Bybjerg-GrauholmJ.HougaardD. M.ThompsonW. K.NordentoftM.AgerboE. (2020). Genetics of suicide attempts in individuals with and without mental disorders: A population-based genome-wide association study. Molecular Psychiatry, 25(10), 2410–2421. https://doi.org/10.1038/s41380-018-0218-y
10.
GainsburyS. M. (2015). Online gambling addiction: The relationship between Internet gambling and disordered gambling. Current Addiction Reports, 2(2), 185–193. https://doi.org/10.1007/s40429-015-0057-8
GirardC. (1993). Age, gender, and suicide: A cross-national analysis. American Sociological Review, 58(4), 553–574. https://doi.org/10.2307/2096076
13.
GrayH. M.LaPlanteD. A.ShafferH. J. (2012). Behavioral characteristics of Internet gamblers who trigger corporate responsible gambling interventions. Psychology of Addictive Behaviors, 26(3), 527–535. https://doi.org/10.1037/a0028545
HedekerD. (2003). A mixed-effects multinomial logistic regression model. Statistics in Medicine, 22(9), 1433–1446. https://doi.org/10.1002/sim.1522
16.
HenryB.MoffittT. E.CaspiA.LangleyJ.SilvaP. A. (1994). On the “remembrance of things past”: A longitudinal evaluation of the retrospective method. Psychological Assessment, 6(2), 92–101. https://doi.org/10.1037/1040-3590.6.2.92
17.
HodginsD. C.MansleyC.ThygesenK. (2006). Risk factors for suicide ideation and attempts among pathological gamblers. American Journal on Addictions, 15(4), 303–310. https://doi.org/10.1080/10550490600754366
18.
HoertelN.FrancoS.WallM. M.OquendoM. A.KerridgeB. T.LimosinF.BlancoC. (2015). Mental disorders and risk of suicide attempt: A national prospective study. Molecular Psychiatry, 20(6), 718–726. https://doi.org/10.1038/mp.2015.19
19.
KarlssonA.HåkanssonA. (2018). Gambling disorder, increased mortality, suicidality, and associated comorbidity: A longitudinal nationwide register study. Journal of Behavioral Addictions, 7(4), 1091–1099. https://doi.org/10.1556/2006.7.2018.112
20.
KesslerR. C.BorgesG.WaltersE. E. (1999). Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry, 56(7), 617–626. https://doi.org/10.1001/archpsyc.56.7.617
21.
KesslerR. C.HwangI.LaBrieR.PetukhovaM.SampsonN. A.WintersK. C.ShafferH. J. (2008). DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychological Medicine, 38(9), 1351–1360. https://doi.org/10.1017/S0033291708002900
22.
KlonskyE. D.MayA. M. (2015). The three-step theory (3ST): A new theory of suicide rooted in the “ideation-to-action” framework. International Journal of Cognitive Therapy, 8(2), 114–129. https://doi.org/10.1521/ijct.2015.8.2.114
LynskeyM. T.AgrawalA.BucholzK. K.NelsonE. C.MaddenP. A.TodorovA. A.GrantJ. D.MartinN. G.HeathA. C. (2006). Subtypes of illicit drug users: A latent class analysis of data from an Australian twin sample. Twin Research and Human Genetics, 9(4), 523–530. https://doi.org/10.1375/twin.9.4.523
25.
LynskeyM. T.AgrawalA.HendersA.NelsonE. C.MaddenP. A.MartinN. G. (2012). An Australian twin study of cannabis and other illicit drug use and misuse, and other psychopathology. Twin Research and Human Genetics, 15(5), 631–641. https://doi.org/10.1017/thg.2012.41
26.
MacmahonB.JohnsonS.PughT. F. (1963). Relation of suicide rates to social conditions: Evidence from U.S. vital statistics. Public Health Reports, 78(4), 285–293. https://doi.org/10.2307/4591780
27.
MayA. M.KlonskyE. D. (2016). What distinguishes suicide attempters from suicide ideators? A meta-analysis of potential factors. Clinical Psychology: Science and Practice, 23(1), 5–20. https://doi.org/10.1037/h0101735
28.
McGueM.OslerM.ChristensenK. (2010). Causal inference and observational research: The utility of twins. Perspectives on Psychological Science, 5(5), 546–556. https://doi.org/10.1177/1745691610383511
29.
McIntyreR. S.LeeY. (2020). Preventing suicide in the context of the COVID-19 pandemic. World Psychiatry, 19(2), 250–251. https://doi.org/10.1002/wps.20767
30.
MeltzerH.BebbingtonP.BrughaT.JenkinsR.McManusS.DennisM. (2011). Personal debt and suicidal ideation. Psychological Medicine, 41(4), 771–778. https://doi.org/10.1017/S0033291710001261
31.
MoghaddamJ. F.YoonG.DickersonD. L.KimS. W.WestermeyerJ. (2015). Suicidal ideation and suicide attempts in five groups with different severities of gambling: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions. The American Journal on Addictions, 24(4), 292–298. https://doi.org/10.1111/ajad.12197
MuggletonN.ParpartP.NewallP.LeakeD.GathergoodJ.StewartN. (2021). The association between gambling and financial, social and health outcomes in big financial data. Nature Human Behaviour, 5(3), 319–326. https://doi.org/10.1038/s41562-020-01045-w
34.
MullinsN.BigdeliT. B.BørglumA. D.ColemanJ. R.DemontisD.MehtaD.PowerR. A.RipkeS.StahlE. A.StarnawskaA.AnjorinA.CorvinA.SandersA. R.ForstnerA. J.ReifA.KollerA. C.Świa˛tkowskaB.BauneB. T.Müller-MyhsokB.. . . LewisC. M. (2019). GWAS of suicide attempt in psychiatric disorders and association with major depression polygenic risk scores. American Journal of Psychiatry, 176(8), 651–660. https://doi.org/10.1176/appi.ajp.2019.18080957
35.
MuthénL. K.MuthénB. O. (2017). Mplus user’s guide (8th ed.).
36.
NewmanS. C.ThompsonA. H. (2003). A population-based study of the association between pathological gambling and attempted suicide. Suicide and Life-Threatening Behavior, 33(1), 80–87. https://doi.org/10.1521/suli.33.1.80.22785
37.
NewmanS. C.ThompsonA. H. (2007). The association between pathological gambling and attempted suicide: Findings from a national survey in Canada. The Canadian Journal of Psychiatry, 52(9), 605–612. https://doi.org/10.1177/070674370705200909
38.
NockM. K.BorgesG.BrometE. J.AlonsoJ.AngermeyerM.BeautraisA.BruffaertsR.ChiuW. T.de GirolamoG.GluzmanS.de GraafR.GurejeO.HaroJ. M.HuangY.KaramE.KesslerR. C.LepineJ. P.LevinsonD.Medina-MoraM. E.WilliamsD. (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. The British Journal of Psychiatry, 192(2), 98–105. https://doi.org/10.1192/bjp.bp.107.040113
ParkS.ChoM. J.JeonH. J.LeeH. W.BaeJ. N.ParkJ. I.SohnJ. H.LeeY. R.LeeJ. Y.HongJ. P. (2010). Prevalence, clinical correlations, comorbidities, and suicidal tendencies in pathological Korean gamblers: Results from the Korean Epidemiologic Catchment Area Study. Social Psychiatry and Psychiatric Epidemiology, 45(6), 621–629. https://doi.org/10.1007/s00127-009-0102-9
41.
PetryN. M.StinsonF. S.GrantB. F. (2005). Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 66(5), 564–574. https://doi.org/10.4088/JCP.v66n0504
PrusoffB. A.MerikangasK. R.WeissmanM. M. (1988). Lifetime prevalence and age of onset of psychiatric disorders: Recall 4 years later. Journal of Psychiatric Research, 22(2), 107–117. https://doi.org/10.1016/0022-3956(88)90075-1
44.
ReevesA.McKeeM.StucklerD. (2014). Economic suicides in the great recession in Europe and North America. The British Journal of Psychiatry, 205(3), 246–247. https://doi.org/10.1192/bjp.bp.114.144766
45.
Richmond-RakerdL. S.SlutskeW. S.LynskeyM. T.AgrawalA.MaddenP. A.BucholzK. K.HeathA. C.StathamD. J.MartinN. G. (2016). Age at first use and later substance use disorder: Shared genetic and environmental pathways for nicotine, alcohol, and cannabis. Journal of Abnormal Psychology, 125(7), 946–959. https://doi.org/10.1037/abn0000191
46.
RobertsA.SharmanS.CoidJ.MurphyR.Bowden-JonesH.CowlishawS.LandonJ. (2017). Gambling and negative life events in a nationally representative sample of UK men. Addictive Behaviors, 75, 95–102. https://doi.org/10.1016/j.addbeh.2017.07.002
47.
SlutskeW. S. (2006). Natural recovery and treatment-seeking in pathological gambling: Results of two US national surveys. American Journal of Psychiatry, 163(2), 297–302. https://doi.org/10.1176/appi.ajp.163.2.297
48.
SlutskeW. S.DeutschA. R.StathamD. J.MartinN. G. (2015). Local area disadvantage and gambling involvement and disorder: Evidence for gene-environment correlation and interaction. Journal of Abnormal Psychology, 124(3), 606–622. https://doi.org/10.1037/abn0000071
49.
SlutskeW. S.MeierM. H.ZhuG.StathamD. J.BlaszczynskiA.MartinN. G. (2009). The Australian Twin Study of Gambling (OZ-GAM): Rationale, sample description, predictors of participation, and a first look at sources of individual differences in gambling involvement. Twin Research and Human Genetics, 12(1), 63–78. https://doi.org/10.1375/twin.12.1.63
50.
SlutskeW. S.PiaseckiT. M.DeutschA. R.StathamD. B.MartinN. G. (2019). Potential causal influence of neighborhood disadvantage on disordered gambling: Evidence from a multi-level discordant twin design. Clinical Psychological Science, 7, 582–596. https://doi.org/10.1177/2167702618812700
51.
StackS. (2000). Suicide: A 15-year review of the sociological literature part I: Cultural and economic factors. Suicide and Life-Threatening Behavior, 30(2), 145–162. https://doi.org/10.1111/j.1943-278X.2000.tb01073.x
52.
SundqvistK.RosendahlI. (2019). Problem gambling and psychiatric comorbidity-risk and temporal sequencing among women and men: Results from the Swelogs Case-control Study. Journal of Gambling Studies, 35(3), 757–771. https://doi.org/10.1007/s10899-019-09851-2
53.
SwantonT. B.GainsburyS. M. (2020). Gambling-related consumer credit use and debt problems: A brief review. Current Opinion in Behavioral Sciences, 31, 21–31. https://doi.org/10.1016/j.cobeha.2019.09.002
54.
Tapia GranadosJ. A.Diez RouxA. V. (2009). Life and death during the Great Depression. Proceedings of the National Academy of Science, USA, 106(41), 17290–17295. https://doi.org/10.1073/pnas.0904491106
55.
TurkheimerE.HardenK. P. (2014). Behavior genetic research methods: Testing quasi-causal hypotheses using multivariate twin data. In ReisH. T.JuddC. M. (Eds.), Handbook of research methods in social and personality psychology (pp. 159–187). Cambridge University Press.
56.
Van OrdenK. A.WitteT. K.CukrowiczK. C.BraithwaiteS. R.SelbyE. A.JoinerT. E.Jr. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575–600. https://doi.org/10.1037/a0018697
WohlM. J.DavisC. G.HollingsheadS. J. (2017). How much have you won or lost? Personalized behavioral feedback about gambling expenditures regulates play. Computers in Human Behavior, 70, 437–445. https://doi.org/10.1016/j.chb.2017.01.025
59.
WongP. W.ChanW. S.ConwellY.ConnerK. R.YipP. S. (2010). A psychological autopsy study of pathological gamblers who died by suicide. Journal of Affective Disorders, 120(1–3), 213–216. https://doi.org/10.1016/j.jad.2009.04.001
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