The relationship between gambling and suicides or suicidality: Qualitative literature review

Background: Excessive gambling is a serious public health concern and a matter of public interest (Sulkunen et al. 2019; 2020). Gambling causes a range of harms to the health and wellbeing of individuals. Suicidality and suicides are at the most severe end of the harm spectrum. The relationship between gambling and suicides (or suicidality) has already received earlier academic research attention (e.g., Pfulmann & Schmidtke 2002). Research has shown that up to half of those in treatment for gambling disorder have had suicidal ideation, and 17 per cent of those in treatment have attempted suicide (Nevada Council on Problem Gambling). According to a longitudional nationwide study in Sweden, largest of its kind, problem gamblers are 15 times more likely to take their own life (Karlsson & Håkansson 2018). Review studies have already mapped the quantitative occurrence of suicide attempts, suicides, and self-harm among gamblers, and found a positive association (Gray et al. 2021; Andreeva et al. 2022). Related comorbidities and conditions have also been charted in previous reviews. However, there is still a gap in knowledge regarding the actual processes that connect gambling and suicidal behavior. In order to understand these processes, this presentation explains the results of a systematic review of qualitative evidence on gambling-related suicides and suicidality. We identified the role of gambling as well as other confounding factors in suicidality, and also noted what kind of support suicidal individuals have obtained (or would need, if available). Methods: We searched for relevant literature in seven scientific databases (Scopus, PubMed, Ebscohost, ProQuest, OpenAire, and Web of Science). In addition, Google Scholar was used in assistance. Grey literature, anecdotal evidence, and quantitive research was excluded. We used an adapted version of the PRISMA guidelines. We included all studies that presented empirical qualitative evidence on gambling-related suicide, suicidality and/or self-harm (N = 20). In analysing the studies, we used the following categories: (1) contribution of gambling to suicide or suicidality, (2) confounding factors that may be associated to gambling and suicidality, (3) treatment and/or recovery. Results: Our results show that two main processes connect gambling and suicidal behavior: indebtedness and shame. At the same time, suicide is a multifactorial phenomenon, and in many cases related to multiple confounding factors. These include psychiatric conditions, personality traits, and life conditions. There are, however, also certain cases in which these confounders appear to emerge as a direct consequence of gambling. Conclusions: Treatment for suicidality has been effective in some cases, but indebtedness and shame may also function as barriers to help-seeking. We conclude that effective prevention is needed by adapting a more comprehensive public health approach and population-level interventions (cf. Ukhova et al. 2023).