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Veterans are exposed to challenging life circumstances after military service, and Australia’s lax gambling regulations make it too easy for veterans to gamble and fall on hard times, write Sean Cowlishaw, Olivia Metcalf and Nicole Sadler.
Suicide is a major public health issue globally and in Australia, where deaths due to intentional self-harm are a leading cause of premature mortality.
Suicide is a particularly serious concern among ex-serving members of the Australian Defence Force (ADF), with monitoring programs documenting around 1600 certified deaths by suicide among current and former ADF members between 1997 and 2020, and 83% of these occurring among ex-serving personnel (here).
When compared with the Australian population, suicide rates are 27% higher among men and 107% higher among women who are ex-serving personnel — although the crude suicide rate for men remains greater than the equivalent rate among women (here). Similar patterns of elevated suicide rates have been reported among United States veterans across similar periods. In Australia, such trends are the focus of a Royal Commission into Defence and Veteran Suicide, which commenced in 2021 and is due to hand down its final report in mid-2024.
Research about risk factors
In Australia, the main source of evidence about risk factors for suicidality among ex-serving personnel has been the Transition and Wellbeing Research Programme, which involved the largest survey conducted of Australian veterans who had recently transitioned out of military service.
Surveys were administered in 2015 and have shown that this transition is a period of increased risk for mental health problems, with just under half of all veterans who had recently left the ADF reporting common mental health conditions in the past year .This may be due to factors including mental health problems that precede separations from the ADF, and changes in identity, social networks, finances, and family roles, which all characterise the transition out of service.
Analyses of these data have also confirmed high rates of suicidality among transitioned personnel, with around 30% of these veterans reporting any suicidality in the past year, including passive (29%) or active (21%) suicidal ideation, and suicide plans (8%) and attempts (2%). Risk factors have been identified and include factors such as lower ranks and medical discharge from the ADF, as well as probable mental disorders and anger problems.
Gambling problems and harms
Our most recent research based on the Transition and Wellbeing Research Programme has also shown that problems with gambling are common among current and ex-serving ADF personnel.
For example, these analyses identified more than 13% of transitioned veterans report gambling problems across a continuum of severity, which includes just under 5% that report clinically significant gambling conditions (ie, problem gambling), and around 9% that report subclinical difficulties that may be classified in terms of at-risk gambling (as measured by the Problem Gambling Severity Index).
Gambling problems were associated with trauma exposure, as well as depression and arousal symptoms of post-traumatic stress disorder. They were also characterised by low levels of help seeking for gambling, with only 2% of veterans who reported problem gambling also identifying this as a reason for having accessed care. Instead, these veterans were far more likely to report seeking help for other presenting problems, such as anxiety or depression.
Links between gambling problems and suicidality among veterans
Our most recent article in the Australian and New Zealand Journal of Public Health also identified a strong association between gambling problems and suicidality among veterans.
This showed that instances of problem gambling were associated with near threefold increases in the risk of suicidal ideation and fourfold increases in the risk of suicide planning or attempts.
At-risk gambling was also associated with near twofold increases in suicidal ideation and planning or attempts.
Analyses of potential explanatory factors suggested that the association with gambling problems and suicidality was no longer significant when controlling for depression symptoms, and was modestly reduced when controlling for other factors, including social support and financial hardship.
While our study had several important strengths (the study population represented nearly 20% of veterans who separated from the ADF over a five-year period), the study was cross-sectional in design and does not indicate the direction of causality among the variables we researched.
The complexity of suicide
The causes of suicide are complex and there are presumably many pathways that link gambling problems and suicidality that involve both risk and protective factors, and underlying processes that unfold over time.
For example, major theories of suicidality highlight predisposing factors that are known to increase general vulnerabilities to suicide (eg, early life adversity and mental health disorders), as well as psychosocial processes that lead to the emergence of suicidal ideation; for example, appraisals of defeat, humiliation and entrapment, which may lead to suicidal ideation particularly in the context of low social connectedness (here).
It seems likely that gambling problems would have complex relationships with depression symptoms that may increase the risk of problematic gambling (eg, when individuals gamble as a way of lifting mood), while gambling losses and debts may increase levels of stress and depression (here).
Accumulating debts may also contribute to the sense of entrapment (here), and gambling harms often involve impacts on significant others and may erode levels of social support, which are protective and may reduce suicide risk (here).
Among veterans, these processes may unfold for some individuals who have already acquired higher capability for suicide (as reflected in factors such as fearlessness about death) that are also presumed to facilitate the transition from suicidal ideation to action.
The need to address gambling problems among veterans
There is much that remains unknown about gambling behaviour and links with suicidality among veterans. This includes how risks have changed over the past decade, given the massive expansion of the online gambling industry and marketing strategies that are overwhelmingly targeted at young men in Australia (here).
Notwithstanding this, the findings of our research suggest a strong need for treatment support programs for gambling problems that may be embedded in veteran-specific services, while low levels of help seeking for gambling suggest value from screening programs among veterans accessing services for other presenting problems.
Such initiatives should be prioritised and integrated with broader suicide prevention programs and policies for veterans in Australia (here).
Gambling environments and life after military service
Critically, the findings draw attention to the hazardous environments that veterans are often exposed to when they separate from the ADF, which presumably interact with trauma and mental health experiences to increase the risks of gambling harm and related suicidality (here).
For example, some ex-serving organisations provide access to electronic gambling machines (or “pokies”) and should be encouraged to follow the lead of RSL (Returned and Services League of Australia) Tasmania, which recently removed high intensity gambling products from venues on the basis of negative impacts on veterans.
Other gambling environments also need to be reconsidered, including broader online settings and professional sporting codes through which gambling advertisements are targeted at young men in particular (here).
The Australian Government is currently considering recommendations from an inquiry into online gambling and impacts on those who experience harms, which comprised a major intervention into the gambling sector by a federal governmental body. Among other things, this inquiry recommended a comprehensive ban on all forms of gambling advertising in Australia, based on successful public health strategies for reducing the harms from tobacco.
The findings of our research underscore the critical importance of such regulatory interventions for gambling.
They highlight the urgent need for public health reforms that protect all Australians from hazardous environments and may have important benefits in terms of reducing the risk of future suicides among veterans.
Sean Cowlishaw is an Associate Professor with Turner Institute for Brain and Mental Health, in the School of Psychological Science at Monash University.
Olivia Metcalf is a Senior Research Fellow at Phoenix Australia and the Centre for Digital Transformation of Health, University of Melbourne.
Nicole Sadler is an Enterprise Professor at the Phoenix Australia Centre for Posttraumatic Mental Health at the University of Melbourne’s Department of Psychiatry
If you, or someone you know, needs help:
Lifeline on 13 11 14
MensLine Australia on 1300 789 978
BeyondBlue on 1300 22 46 36
Open Arms Veterans and Families Counselling on 1800 011 046
All-hours support line for ADF members on 1800 628 036
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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