Brief reportA psychological autopsy study of pathological gamblers who died by suicide
Introduction
Studies have found that pathological gambling is associated with marital conflict, child neglect, domestic violence, criminal involvement, and juvenile delinquency (Hodgins et al., 2006, Kausch, 2003, Maccallum and Blaszczynski, 2003, Newman and Thompson, 2003, Petry and Kiluk, 2002) and comorbid psychiatric illness (Baldo et al., 2006, Borras and Huguelet, 2007, Petry, 2007, Potenza and Chambers, 2001), and mood disorders in particular (for a review, see Kim et al., 2006). Limited studies on treatment-seeking individuals support a relationship between pathological gambling and suicidal ideation and attempt (for a review, see Hodgins et al., 2006).
Pathological gambling has been reported as the third most common psychiatric disorder among suicides in Hong Kong (Chen et al., 2006); however, no previous evidence is available on pathological gambling preceding suicide death. Further research on pathological gambling and suicide is needed to inform the development of targeted prevention initiatives. Using data from the psychological autopsy study conducted by Chen and colleagues (2006), this paper reports the characteristics of suicides of pathological gamblers which can be used to generate hypotheses for further investigation on the association between pathological gambling and suicide.
Section snippets
Methods
Data was collected from a territory-wide case-control psychological autopsy study of suicide between 15 and 59 years of age in Hong Kong. Proxy respondents for 150 suicides and 150 age-and-gender matched controls were interviewed. Death files were also reviewed to triangulate interview data. The study was approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (HKU/HA HKW IRB) and the Ethics Committee of the Department of Health, Hong
Prevalence
Table 1 shows the characteristics of the suicide cases with and with pathological gambling and the controls without pathological gambling. Seventeen (11.3%) suicide cases and one (0.6%) control case were found to have a pathological gambling diagnosis immediate before death or at the time of interview. Bivariate analysis shows that suicides were more likely than controls to experience pathological gambling (Fisher's Exact Test, P < .001).
More pathological gambling than non-gambling suicides were
Discussion
This is the first published study to provide a detailed description of pathological gambling preceding suicide using a representative case series of suicides. Using DSM-IV diagnostic criteria, we found that pathological gambling was the third most prevalent psychiatric disorder in our suicide cases (Chen et al., 2006). Reflecting the relatively low prevalence of pathological gambling within the general population in Hong Kong (Wong and So, 2003), only 1 control case was found to be suffering
Conclusion
The study is limited by its retrospective design, small sample size, and insufficient controls with gambling. Nonetheless, the results of the study offer support for the suggestion that pathological gambling is associated with serious psychosocial problems, psychiatric disorders, and even completed suicide. This is a preliminary step towards understanding the association of pathological gambling with suicide that argues for future research into the topic to generate preventive strategies for
Role of funding source
The study was supported by the Hong Kong Jockey Club Charities Trust (which underwrote this research study via the Chief Executive's Community Project List 2002). The publication of this article was partly supported by the NIMH (P20 MH 071897).
Conflicts of interest
None.
Acknowledgement
The authors gratefully acknowledge the assistance of the Coroner's Court in facilitating case recruitment and data collection. We are grateful to Prof. Eric Chen, the principle investigator of the original psychological autopsy study, for giving us the permission to utilize the data. We thank Dr. Sandra Chan, Dr. Philip S.L. Beh, Dr. K.L. Hau, Dr. Bobby Shum, all staff at the mortuaries, the Coroner's Court, the Department of Health, and the HKJC Centre for Suicide Research and Prevention HKU
References (24)
- et al.
Pathological gambling and mood disorders: clinical associations and treatment implications
J Affect Disord.
(2006) - et al.
Role of culture in gambling and problem gambling
Clin. Psychol. Rev.
(2004) Diagnostic and Statistical Manual of Mental Disorders
(2000)- et al.
Relationship between pathological gambling, alcoholism and drug addiction
Annali di Igiene
(2006) - et al.
Schizophrenia and pathological gambling
Am. J. Addict.
(2007) - et al.
Suicidality in Chinese adolescents in Hong Kong: the role of family and cultural influences
Soc. Psychiatry. Psychiatr. Epidemiol.
(2009) - et al.
Suicide in Hong Kong: a case-control psychological autopsy study
Psychol. Med.
(2006) - et al.
Tin Sin Kuk (Heavenly swindle)
(1990) Sample size requirements for case-control study designs
(2001)- et al.
Suicide and no axis I psychopathology
(2004)