The links between problem gambling, self-harm and mental health

Over the last year, a team of researchers were commissioned by the charity GambleAware to carry out a new in-depth piece of research exploring the links between problem gambling and suicide. In this guest blog, researcher and report co-author Sally McManus presents the findings, and the recommendations to help improve support for people struggling with problem gambling.

Studies of problem gamblers and studies of people who self-harm have tended to focus on people in contact with treatment or services. However, most problem gamblers do not get specialist help, and most people who feel suicidal or self-harm do not disclose to health services. The result is a lack of evidence on both gambling and suicidality in the wider population. 

Some studies have concluded that the links between gambling and suicidality are explained by prior mental health conditions. In this view, problem gamblers are more likely to be depressed or anxious, and it is their depression or anxiety that leads to their suicidality, not their gambling. Our new research aimed to examine this assertion. Such conclusions matter, as they inform the policy and treatment responses that follow. 

We analysed data from England’s mental health survey series, the 2007 Adult Psychiatric Morbidity Survey (APMS), which assessed people living in the general population for problem gambling and a range of different mental disorders. 

We found that problem gamblers were indeed more likely to experience a range of depressive symptoms, such as fatigue, sleep problems, and difficulties with concentration and forgetfulness. They were also more likely to experience anxiety, phobias, panic, and worry.  We also found a strong link with attention-deficit/hyperactivity disorder (ADHD), a developmental disorder characterised by impulsivity and reduced self-control. Alcohol and drug dependence were also more evident in problem gamblers than in the rest of the population.

The research showed that problem gamblers were much more likely than other adults to have recently thought about suicide and made a suicide attempt. They were about five times more likely than people without signs of problem gambling to have thought about suicide in the past year (19.2%, compared with 4.1%), as well as five times more likely to have made a suicide attempt in the past year (4.1%, compared with 0.6%).

But crucially, using APMS data we were able to show that problem gamblers were more likely to be suicidal even when we took account of their higher rates of depression and anxiety disorders, substance dependence, and ADHD. This indicates that the mental health status of problem gamblers is unlikely to explain the whole relationship between problem gambling and suicidality. The accumulation of a range of different factors usually plays a role in whether someone becomes suicidal, of which problem gambling may be one.

The APMS dataset covers many aspects of life and provides wider context for assessing the relationship between gambling and suicidality. Factors that can stem directly from problematic gambling behaviours are likely to play a key and direct role in this relationship. 

For example, problem gamblers were more likely to be seriously in debt or have had their utilities disconnected in the past year. They were also more likely to be living in rented accommodation – with the associated insecurity that can bring – and to experience different types of social discord, with many describing themselves as lonely and isolated from others. 

If we want to break the link between gambling and suicide, we need to understand the complex and multifaceted dynamics between gambling, suicidality and mental health. For this, we need current datasets that cover social, economic and behavioural context too. We also need datasets that reflect the wider population, not just those in treatment. 

We’re calling on the Department of Health and Social Care (DHSC) to continue to fund the APMS – England’s longstanding mental health survey – which is a vital source of data on the issues discussed above. Problem gambling was last asked on the 2007 survey, but not in 2014. It is urgent that there is another survey in the series which includes questions on gambling behaviour, and that comparable data are also collected in Wales and Scotland. Problem gambling needs to be studied alongside other mental health conditions, in a survey that covers the wider circumstances of people’s social and economic lives, and with a sample of people in the general population – not just those who manage to access treatment. Without this, we cannot understand the current nature and extent of the treatment gap for problem gamblers.

It is vital to better understand the role gambling plays, for some, in contributing to suicidality. We urgently need to speak with people who have experienced this to understand this relationship and map the different ways in which gambling and suicidality may be connected. But crucially, gambling should now be considered a risk factor for suicide and awareness of this should be raised with all those working in suicide prevention, health care services and with vulnerable populations.