Gambling disorder, increased mortality, suicidality, and associated comorbidity: A longitudinal nationwide register study

Anna Karlsson · Anders Håkansson

163 citations0/0 files storedJournal of Behavioral Addictions

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Gambling Behavior and Treatments Substance Abuse Treatment and Outcomes Suicide and Self-Harm Studies

Abstract

BACKGROUND AND AIMS: Gambling disorder (GD) appears to be an independent risk factor for suicide, and all-cause mortality has been sparsely studied in patients with GD. This study aims to explore mortality and suicide rates in individuals with GD compared to the general population as well as explore risk factors associated with all-cause mortality and suicide mortality. METHODS: This is a nationwide register study on 2,099 individuals with a GD diagnosis in the Swedish inpatient and/or outpatient specialist health care system between the years of 2005-2016. Comorbid diagnoses from treatment episodes included in national registers were categorized into diagnostic groups according to the 10th revision of International Classification of Diseases, and prevalence rates (any occurrence during 2005-2016) were calculated for each diagnostic group. Multivariate Cox regression analyses on risk factors for death and suicide were performed, controlling for age, gender, and major categories of comorbidity. Standardized mortality ratios (SMRs) were calculated for men and women with regard to overall mortality and suicide compared to the general Swedish population. RESULTS: The population consisted of 1,625 men and 474 women ranging from 18 to 83 years of age at first GD diagnosis (mean: 36.5 years). Sixty-seven individuals passed away, among whom 21 deaths were due to suicide. SMR calculations showed a 1.8-fold increase in mortality for individuals 20-74 years old with GD compared to the general population, and a 15-fold increase in suicide mortality. All-cause mortality was predicted by higher age and any treatment episode for cardiovascular disease, whereas suicide death was predicted by depression. DISCUSSION AND CONCLUSIONS: Mortality and suicide rates are significantly elevated among individuals with GD. Although common mental health comorbidities did not predict overall mortality, depression predicted suicide death. Findings call for attention to long-term risk of death in GD patients and interventions against comorbid health problems.

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References

2013Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010 2013Burden of Depressive Disorders by Country, Sex, Age, and Year: Findings from the Global Burden of Disease Study 2010 2009Suicide 2017The Swedish cause of death register 2005Comorbidity of DSM-IV Pathological Gambling and Other Psychiatric Disorders 2008DSM-IV pathological gambling in the National Comorbidity Survey Replication 2013Excess Mortality, Causes of Death and Life Expectancy in 270,770 Patients with Recent Onset of Mental Disorders in Denmark, Finland and Sweden 2016Problem gambling worldwide: An update and systematic review of empirical research (2000–2015)

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2022The Role of Unemployment, Financial Hardship, and Economic Recession on Suicidal Behaviors and Interventions to Mitigate Their Impact: A Review 2020Setting Limits: Gambling, Science and Public Policy—summary of results

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