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Abstract

Objectives: Problem gamblers in treatment are known to be at high risk for suicidality, but few studies have examined if this is evident in community samples. Evidence is mixed on the extent to which an association between problem gambling and suicidality may be explained by psychiatric comorbidity. We tested whether they are associated after adjustment for co-occurring mental disorders and other factors. Study design: Secondary analysis of the Adult Psychiatric Morbidity Survey 2007, a cross-sectional na- tional probability sample survey of 7403 adults living in households in England.
Methods: Rates of suicidality in problem gamblers and the rest of the population were compared. A series of logistic regression models assessed the impact of adjustment on the relationship between problem gambling and suicidality.
Results: Past year suicidality was reported in 19.2% of problem gamblers, compared with 4.4% in the rest of the population. Their unadjusted odds ratios (OR) of suicidality were 5.3 times higher. Odds attenuated but remained significant when depression and anxiety disorders, substance dependences, attention- deficit/hyperactivity disorder, and other factors were accounted for (adjusted OR 1⁄4 2.9, 95% confi- dence interval 1⁄4 1. 1, 8.1 P 1⁄4 0.023).
Conclusions: Problem gamblers are a high-risk group for suicidality. This should be recognised in indi- vidual suicide prevention plans and local and national suicide prevention strategies. While some of this relationship is explained by other factors, a significant and substantial association between problem gambling and suicidality remains.

Publication Type:	Article
Additional Information:	©2020 The Author(s). Published by Elsevier Ltd on behalf of The Royal Society for Public Health. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).IntroductionThe scale and nature of gambling provisions in Great Britain, aselsewhere, have evolved rapidly in the last decade, with the adventand expansion of online gambling and a more permissive legisla-tive environment.1In Great Britain, online gambling is now thelargest of gambling sectors and products such as online sportsbetting have seen sustained growth.2New products, such as in-playbetting, where customers can bet on quick speed events withinsports matches, have developed, and these changes have increasedconcern about the potential for harms from gambling. These con-cerns are heightened for young people, where participation inonline sports betting, for example, has risen rapidly.3The harmsfrom gambling are wide ranging, effecting people's resources, re-lationships and health. Gambling harms can range in severity, and acritical concern is the potential relationship between gamblingbehaviours and suicidality.1Problem gamblers who seek treatment have long been recog-nised as a high-risk group for suicidal ideation and behaviours.4,5These associations have been replicated among treatment pop-ulations in various jurisdictions, including Spain, France, Britain,Sweden and America.6e11*Corresponding author.E-mail address:heather.wardle@lshtm.ac.uk(H. Wardle).Contents lists available atScienceDirectPublic Healthjournal homepage:www.elsevier.com/locate/puhehttps://doi.org/10.1016/j.puhe.2020.03.0240033-3506/©2020 The Author(s). Published by Elsevier Ltd on behalf of The Royal Society for Public Health. This is an open access article under the CC BY-NC-ND license(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Publisher Keywords:	Problem gambling, Suicide, Mental health, Comorbidity, Survey
Subjects:	B Philosophy. Psychology. Religion > BF Psychology G Geography. Anthropology. Recreation > GV Recreation Leisure
Departments:	School of Health & Psychological Sciences > Healthcare Services Research & Management
SWORD Depositor:	Symplectic Administrator

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