Investigating gambling-related suicide

Gambling has been linked to negative consequences such as poor health [1], domestic violence [2] and homelessness [3]. For some individuals, the most serious consequence of gambling is suicide or suicide attempt(s) [4]. Elevated instances of suicidality in gamblers have been reported in many international studies in the last decade [5-9].

However, there is a lack of comprehensive data and understanding related to the role of gambling in suicide. The charity Gambling With Lives applied figures from UK and international studies and estimated that that there are 250–650 gambling-related suicides in the United Kingdom each year [10]. Similarly, the Office for Health Improvement and Disparities (OHID) estimated this figure to be between 117 and 496 per annum in England [11]. Despite the lack of an official or exact estimate, both suicidality and disordered gambling are significant public health concerns, and the annual economic cost of gambling-related suicide in England is estimated to be between £241.1 million to £961.7 million (approximately £2.06 million per death) [11].

It is estimated that every suicide impacts 135 people [12]; therefore, using OHID estimates, gambling-related suicide in England could potentially impact between 15 795 and 66 960 people every year. The recent National Suicide Prevention Strategy initiated by the former UK government identified gambling as one of just six risk factors for suicide at a population level [13]. However, we need a deeper understanding of contextual factors that elevate suicide risk for gambling to develop initiatives to support suicide prevention efforts. There has been little progress on establishing data collection and procedures/processes to address gambling-related suicide by government agencies in the United Kingdom.

An established way of understanding the socio-ecological nature of suicide is via a psychological autopsy. This methodology was suggested in a recent report scoping current evidence and evidence-gaps in research into gambling-related suicide [14]. A psychological autopsy is a method of investigating a death by suicide through interviews with close contacts, and a comprehensive review of the deceased person’s medical and psychological history, social and cultural factors and environmental and contextual information leading up to the suicide. It offers the most direct technique currently available for examining the relationship between antecedents and suicide [15]. Only one study of its kind has even been performed on gambling-related suicide in Hong Kong. The study found that 17 people who died by suicide in a sample of 150 individuals (11.3%) had gambling disorder which was much higher than the rate in a reference/control group of 0.6% [16]. None of those affected had previously received psychiatric treatment.

We are carrying out the first ever psychological autopsy study in the United Kingdom to ascertain the socio-ecological antecedents of gambling-related suicide. Our research will aid clearer understanding of the mechanistic relationship between gambling and suicide, how individuals experience gambling-related suicidality and the role of contributory and mitigating factors. The direction of the mechanistic relationship will be understood from the qualitative element on the study [17]. Our work will provide insights into the warning signs, common themes and underlying causes of gambling-related suicide, which can inform the development of population-wide prevention measures and intervention strategies.

As part of the National Suicide Prevention Strategy for England, the former UK government initiated several measures to reduce the rate of suicides associated with gambling for the first time as part of a 5-year plan [13]. However, for this strategy to work, it requires ongoing new governmental support, including (and not limited to) the much-anticipated statutory levy which will transform the landscape in terms of supporting independent research, prevention and treatment. Similarly, in the future, it is essential that all gambling-related suicides are accurately recorded and investigated, as this is currently not common practice.

Amanda Roberts: Conceptualization (lead); writing—original draft (lead). Jim Rogers: Writing—original draft (equal). Elena Petrovskaya: Writing—original draft (equal). Annie Ashton: Writing—original draft (equal). Emily Beck: Writing—original draft (equal). Charles Ritchie: Writing—original draft (equal). Pauline Turnbull: Writing—original draft (equal). Gursharan Johal: Writing—original draft (equal). Richard James: Writing—original draft (equal). Tony Parente: Writing—original draft (equal). Chrissy Boyce: Writing—original draft (equal). Samuel R. Chamberlain: Writing—original draft (equal). Henrietta Bowden-Jones: Conceptualization (supporting); writing—original draft (equal). Paul Wong: Writing—original draft (equal). Steve Sharman: Conceptualization (supporting); writing—original draft (equal).

A.R. is Co-Chair of the Executive Committee of the Academic Forum for the Study Gambling (AFSG). Funding for the AFSG is derived from regulatory settlements for socially responsible purposes that are approved by the Gambling Commission and is administered by Greo. She has received funding from the SSA, Greo, NIHR, Lincolnshire County Council, Ashfield District Council, Nottingham County Council, Health and Care Research Wales, Public Health Lincoln, Santander, P3 and Framework and has no potential conflicts of interest in relation to gambling or the gambling industry. J.R. is Co-Chair of the Executive Committee of the Academic Forum for the Study Gambling (AFSG). Funding for the AFSG is derived from regulatory settlements for socially responsible purposes that are approved by the Gambling Commission, and is administered by Greo. He does not have any potential conflicts of interest in relation to gambling or the gambling industry. E.P. does not have any potential conflicts of interest in relation to gambling or the gambling industry. She has received research funding as a principal investigator on projects funded by the AFSG, for which the funds are sourced from regulatory settlements levied by the UK Gambling Commission. P.T. does not have any potential conflicts of interest in relation to gambling or the gambling industry. She reports grants from the Healthcare Quality Improvement Partnership, NHS England, the National Institute for Health and Care Research, the MPS Foundation and the Department for Education. R.J. has received research funding as a principal investigator on projects funded by the AFSG and Greo Evidence Insights, for which the funds are sourced from regulatory settlements levied by the UK Gambling Commission. He has been co-investigator on research grants funded by Greo Evidence Insights and the International Center for Responsible Gaming (ICRG). The ICRG is a charity funded by corporate responsibility donations from the gambling industry. Funding decisions are made by an independent scientific committee. S.C. does not have any potential conflicts of interest in relation to gambling or the gambling industry. He receives a stipend from Elsevier for journal editorial work. His research is currently funded by the NHS. H.B-J. is the Director of Treatment for Gambling-Related Harms at The National Problem Gambling Clinic, which was previously part -funded by GambleAware. It is no longer funded by GambleAware and is now fully funded by the National Health Service (NHS). We do not consider this to constitute a significant conflict of interest in relation to this application, as it relates to historical funding of clinically commissioned services and not to current funding. She does not have any potential conflicts of interest in relation to gambling or the gambling industry. P.W. received funds for three projects funded by the Hong Kong Jockey Club on topics about elderly and youth mental health promotion, and evaluation on the World Health Organization’s Caregiver Skills Training Programme in Hong Kong, respectively. The projects were not related to gambling and suicide, where he has no conflicts of interest. S.S. is part of the Executive Committee of the Academic Forum for the Study Gambling (AFSG). Funding for the AFSG is derived from regulatory settlements for socially responsible purposes that are approved by the Gambling Commission, and is administered by Greo. He is a trustee for the Society for the Study of Addiction, and member of the Advisory Board for Safer Gambling (ABSG), who provide advice to, and is remunerated by, the Gambling Commission. S.S has received funding from Greo, the NIHR, and is currently funded by a UKRI Future Leaders Fellowship. He does not have any potential conflicts of interest in relation to gambling or the gambling industry. A.A., E.B, C.R., T.P., C.B. and G.J. do not have any potential conflicts of interest in relation to gambling or the gambling industry.