Gambling Disorder – Suicidality, Mortality and Comorbidity

Abstract

Background: Gambling disorder (GD) is a behavioural addiction in which a person faces negative consequences due to uncontrolled gambling, such as financial, personal, or relational difficulties. GD more often affects men but both men and women face severe consequences of GD. Psychiatric comorbidity is the rule rather than the exception and suicidality is abundant. Health issues such as obesity and cardiovascular disease are also common. Financial difficulties are common and might be both a consequence of and a risk factor for GD.Aim and methods: To examine, through registry and qualitative research, comorbidity, intentional self-harm, suicide and mortality in GD. In Study I, standardized mortality ratios for men and women with GD were compared to the general population and potential risk factors for suicidality and mortality were investigated (N=2099). In Study II, the effect of comorbid alcohol and drug use disorders on intentional self-harm in individuals with GD was examined (N=2099). In Study III, the effects of psychiatric and socioeconomic risk factors on intentional self-harm (N=848) were examined, and in Study IV, a gender- and age-matched cohort was utilized to investigate the association between GD,suicide, and general mortality in relation to known risk factors in men and women (N=10,792). Finally,a qualitative interview study (V) investigated, through qualitative content analysis (N=7), experiences of suicidality in women with GD and potential mediators of suicidality. Results: In the first study, mortality and suicide levels were greatly elevated in GD. Depression was associated with suicide death, and age and cardiovascular disease predicted general mortality. However,in the fourth study, GD did not appear to be a significant risk factor for the increase in suicide and general mortality when controlling for previously known risk factors. In the second and third studies,female gender, and psychiatric comorbidity such as substance use diagnoses, anxiety and depression were important risk factors for intentional self-harm. In the fifth study, the themes “internal shame and stigma”, “chaotic life circumstances due to gambling (such as eviction)” and “external stigmatization” appeared important in the development of suicidality.Conclusion: Individuals with GD suffer from increased suicide levels as well as high rates of intentional self-harm. Shame, stigma, and chaotic life circumstances might be mediators for suicidality in women with GD. Psychiatric comorbidity including substance use disorders appears to increase the risk of intentional self-harm and depression might increase the risk of suicide. This research could no tdetermine whether GD is an independent risk factor for suicide and further research is needed.Mortality levels are higher and might be due to cardio-vascular comorbidity.

• author: Karlsson, Anna
• supervisor: Anders C Håkansson; Helena Hansson
• opponent: Associate Professor Castrén, Sari, Finnish Institute for Health and Welfare and University of Helsinki, Finland
• organization: Psychiatry (Lund); Clinical addiction research unit (research group)
• alternative title: Spelberoende - suicidalitet, mortalitet och samsjuklighet
• publishing date: 2023
• type: Thesis
• publication status: published
• subject: Psychiatry
• keywords: Gambling Disorder, Suicidality, Mortality, Comorbidity, Suicide, Self-harm, Indebtedness, Gender, Socio-economy
• in: Lund University, Faculty of Medicine Doctoral Dissertation Series
• issue: 2023:55
• pages: 121 pages
• defense location: Agardh föreläsningssal, CRC, Jan Waldenströms gata 35, Skånes Universitetssjukhus i Malmö
• defense date: 2023-05-12 13:30:00
• ISSN: 1652-8220
• ISBN: 978-91-8021-395-0
• language: English
• LU publication?: yes
• id: 87ea86a2-6d8e-4cae-80c5-54b5e3dd1905
• date added to LUP: 2023-04-05 09:31:45
• date last changed: 2023-05-02 07:32:23