Brief report
A psychological autopsy study of pathological gamblers who died by suicide

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Abstract

Background

Pathological gambling is associated with suicidal ideation and attempt. There is no known report on pathological gambling preceding suicide. By examining a series of 17 suicide cases with evidence of pathological gambling prior to death, we sought to generate hypotheses for further study of this under-researched but rapidly-increasing worldwide public health problem.

Method

Psychological autopsy interviews using a semi-structured format were conducted with proxy respondents for suicide and control subjects aged 15–59 years in Hong Kong SAR, China.

Results

Of the 150 suicides and 150 controls examined, 17 suicides (11.3%) and one control case (0.6%) met criteria for the diagnosis of pathological gambling at the time of death or interview. All 17 suicide cases with pathological gambling had unmanageable debt at the time of death. Fourteen cases (82.4%) had other associated psychiatric disorders, most often major depressive disorders (n = 10, 58.9%) and substance-use disorders (n = 3, 17.6%). None had ever received psychiatric treatment.

Limitations

Descriptive, retrospective case series with a small sample size.

Conclusions

Along with unmanageable debt, a high proportion of the suicide cases with pathological gambling also experienced other psychiatric illnesses, most often depression, at the time of death. None sought treatment for their addictive behavior or psychiatric illness prior to death. Pathological gambling is a modifiable risk factor for suicide for which means to enhance case identification and engagement in treatment are urgently needed. Clinicians treating depression should explore the presence of pathological gambling behavior or unmanageable debts among their patients. Addressing pathological gambling should be one important component of a comprehensive suicide prevention strategy especially in countries where gambling activities are legalized and expanding.

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

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